Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
J Diabetes Investig. 2021 Sep;12(9):1697-1707. doi: 10.1111/jdi.13500. Epub 2021 Feb 20.
AIMS/INTRODUCTION: Currently, the impact of hospital-wide glycemic control interventions on length of hospital stay (LOS) and readmission rates are largely unknown. We investigated the impact of a 4-year hospital-wide remote glycemic management program on LOS and 30-day readmission rates among hospitalized adults who received glucose monitoring.
In this retrospective study, hospitalized patients who received glucose monitoring were classified into groups 1 (high glucose variability), 2 (hypoglycemia), 3 (hyperglycemia) and 4 (relatively stable). The monthly percentage changes, and average monthly percentage changes of hyperglycemia, hypoglycemia and treat to target were determined using joinpoint regression analysis.
A total of 106,528 hospitalized patients (mean age 60.9 ± 18.5 years, 57% men) were enrolled. We observed a significant reduction in the percentage of inpatients in poor glycemic control groups (groups 1, 2 and 3, all P < 0.001), and a reciprocal increase in the relatively stable group (group 4) from 2016 to 2019. We found a significant reduction in LOS by 11.4% (10.5-9.3 days, P = 0.002, after adjustment for age, sex, and admission department). The 30-day readmission rate decreased from 29.9% to 29.3%, mainly among those in group 4 in 2019 (P < 0.001 after adjustment of sex, age, admission department and LOS).
Improved glycemic control through a hospital-wide electronic remote glycemic management system reduced LOS and 30-day readmission rates. Findings observed in this study might be associated with the reduction in cost of avoidable hospitalizations.
目的/引言:目前,尚不清楚全院血糖控制干预对住院时间(LOS)和再入院率的影响。我们调查了一项为期 4 年的全院远程血糖管理计划对接受血糖监测的住院成人 LOS 和 30 天再入院率的影响。
在这项回顾性研究中,将接受血糖监测的住院患者分为高血糖波动组 1(high glucose variability)、低血糖组 2(hypoglycemia)、高血糖组 3(hyperglycemia)和血糖相对稳定组 4(relatively stable)。使用 joinpoint 回归分析确定高血糖、低血糖和达标治疗的每月百分比变化和平均每月百分比变化。
共纳入 106528 例住院患者(平均年龄 60.9±18.5 岁,57%为男性)。我们观察到,血糖控制较差的患者比例(组 1、2 和 3,均 P<0.001)显著降低,而血糖相对稳定组(组 4)从 2016 年到 2019 年则呈上升趋势。我们发现 LOS 显著缩短 11.4%(10.5-9.3 天,P=0.002,校正年龄、性别和入院科室后)。30 天再入院率从 29.9%降至 29.3%,主要是由于 2019 年组 4 患者(校正性别、年龄、入院科室和 LOS 后 P<0.001)。
通过全院电子远程血糖管理系统改善血糖控制可降低 LOS 和 30 天再入院率。本研究观察到的结果可能与避免住院的费用降低有关。