Diabetes Research Unit, Ipswich Hospital NHS Trust, Ipswich, UK.
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Diabet Med. 2020 Feb;37(2):277-285. doi: 10.1111/dme.14062. Epub 2019 Aug 2.
To determine whether the Diabetes Inpatient Care and Education (DICE) programme, a whole-systems approach to managing inpatient diabetes, reduces length of stay, in-hospital mortality and readmissions.
Diabetes Inpatient Care and Education initiatives included identification of all diabetes admissions, a novel DICE care-pathway, an online system for prioritizing referrals, use of web-linked glucose meters, an enhanced diabetes team, and novel diabetes training for doctors. Patient administration system data were extracted for people admitted to Ipswich Hospital from January 2008 to June 2016. Logistic regression was used to compare binary outcomes (mortality, 30-day readmissions) 6 months before and after the intervention; generalized estimating equations were used to compare lengths of stay. Interrupted time series analysis was performed over the full 7.5-year period to account for secular trends.
Before-and-after analysis revealed a significant reduction in lengths of stay for people with and without diabetes: relative ratios 0.89 (95% CI 0.83, 0.97) and 0.93 (95% CI 0.90, 0.96), respectively; however, in interrupted time series analysis the change in long-term trend for length of stay following the intervention was significant only for people with diabetes (P=0.017 vs P=0.48). Odds ratios for mortality were 0.63 (0.48, 0.82) and 0.81 (0.70, 0.93) in people with and without diabetes, respectively; however, the change in trend was not significant in people with diabetes, while there was an apparent increase in those without diabetes. There was no significant change in 30-day readmissions, but interrupted time series analysis showed a rising trend in both groups.
The DICE programme was associated with a shorter length of stay in inpatients with diabetes beyond that observed in people without diabetes.
确定糖尿病住院患者护理和教育（DICE）计划——一种管理住院糖尿病的整体系统方法——是否能缩短住院时间、降低院内死亡率和再入院率。
糖尿病住院患者护理和教育计划包括确定所有糖尿病住院患者，制定新颖的 DICE 护理路径，建立在线转诊优先级系统，使用网络链接血糖仪，强化糖尿病团队，并对医生进行新的糖尿病培训。从 2008 年 1 月至 2016 年 6 月，从伊普斯维奇医院提取患者管理系统数据。采用逻辑回归比较干预前后 6 个月的二项结局（死亡率、30 天再入院率）；采用广义估计方程比较住院时间。采用中断时间序列分析方法对整个 7.5 年期间进行分析，以考虑长期趋势。
在有和没有糖尿病的患者中，干预前后分析均显示住院时间显著缩短：相对比值分别为 0.89（95%CI 0.83，0.97）和 0.93（95%CI 0.90，0.96）；然而，在中断时间序列分析中，干预后长期住院时间趋势的变化仅在糖尿病患者中具有统计学意义（P=0.017 与 P=0.48）。有和没有糖尿病的患者的死亡率比值比分别为 0.63（0.48，0.82）和 0.81（0.70，0.93）；然而，在糖尿病患者中，趋势变化不具有统计学意义，而在没有糖尿病的患者中，似乎有上升趋势。30 天再入院率没有显著变化，但中断时间序列分析显示两组均有上升趋势。
DICE 计划与糖尿病住院患者的住院时间缩短有关，这一效果超出了无糖尿病患者的观察结果。
