Lee Melissa H, Liprino Lillianne, Brooks Jeffrey, Cayzer Brenda, Weedon Fiona, Bermingham Kate, Jenkins Alicia J, Rowley Kevin, O'Neal David N
Werribee Mercy Hospital, 300-310 Princes Highway, Werribee, Vic. 3030, Australia.
The University of Melbourne, Department of Medicine, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Vic. 3065, Australia.
Aust J Prim Health. 2017 Apr;23(1):23-30. doi: 10.1071/PY16036.
The aim was to examine predictors of duration of inpatient hospital stay in people with diabetes mellitus to assist implementation of strategies to reduce hospital stay. This audit prospectively studied patients with diabetes mellitus admitted to a medical unit of an Australian community public hospital. Other outcome measures included glucose treatment optimisation and access to GP and diabetes-specific healthcare professionals. Comparison was made to patients without diabetes mellitus who were admitted concomitantly. Diabetes patients represented 26% of admissions over a 2-month period. In total, 73% had seen a GP within the prior 6 months. Patients with diabetes mellitus (n=79) had a median age of 69 years; 53% were male and median HbA was 65mmolmol (8.1%). Diabetes mellitus was associated with a longer inpatient stay (P=0.03), particularly among patients admitted with vascular disease. Age >65 years and seeing <3 members of the community-based diabetes mellitus multidisciplinary team (MDT) in the 2-years pre-admission were independently associated with a longer stay (P=0.02). In total, 10% were referred to an endocrinologist on discharge. Involvement of more of the diabetes-specific MDT, with a skilled GP, in primary care is recommended as it may shorten inpatient hospital stay, improve glycaemia and reduce demand for limited specialist endocrinologists.
目的是研究糖尿病患者住院时间的预测因素,以协助实施缩短住院时间的策略。本次审计前瞻性地研究了澳大利亚社区公立医院内科病房收治的糖尿病患者。其他结果指标包括血糖治疗优化以及与全科医生(GP)和糖尿病专科医护人员的接触情况。并与同期收治的非糖尿病患者进行了比较。在两个月的时间里,糖尿病患者占入院人数的26%。总体而言,73%的患者在过去6个月内看过全科医生。糖尿病患者(n=79)的中位年龄为69岁;53%为男性,HbA的中位数为65mmol/mol(8.1%)。糖尿病与住院时间延长相关(P=0.03),尤其是患有血管疾病的患者。年龄>65岁以及入院前两年内接触社区糖尿病多学科团队(MDT)成员少于3人,与住院时间延长独立相关(P=0.02)。出院时,共有10%的患者被转诊至内分泌科医生处。建议在初级保健中让更多糖尿病专科MDT成员与经验丰富的全科医生参与进来,因为这可能会缩短住院时间、改善血糖水平并减少对有限的专科内分泌科医生的需求。