Rubin Daniel J, Gogineni Preethi, Deak Andrew, Vaz Cherie, Watts Samantha, Recco Dominic, Dillard Felicia, Wu Jingwei, Karunakaran Abhijana, Kondamuri Neil, Zhao Huaqing, Naylor Mary D, Golden Sherita H, Allen Shaneisha
Section of Endocrinology, Diabetes, and Metabolism, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA.
Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA.
J Clin Med. 2022 Mar 8;11(6):1471. doi: 10.3390/jcm11061471.
Hospital readmission within 30 days of discharge (30-day readmission) is a high-priority quality measure and cost target. The purpose of this study was to explore the feasibility and efficacy of the Diabetes Transition of Hospital Care (DiaTOHC) Program on readmission risk in high-risk adults with diabetes. This was a non-blinded pilot randomized controlled trial (RCT) that compared usual care (UC) to DiaTOHC at a safety-net hospital. The primary outcome was all-cause 30-day readmission. Between 16 October 2017 and 30 May 2019, 93 patients were randomized. In the intention-to-treat (ITT) population, 14 (31.1%) of 45 DiaTOHC subjects and 15 (32.6%) of 46 UC subjects had a 30-day readmission, while 35.6% DiaTOHC and 39.1% UC subjects had a 30-day readmission or ED visit. The Intervention−UC cost ratio was 0.33 (0.13−0.79) 95%CI. At least 93% of subjects were satisfied with key intervention components. Among the 69 subjects with baseline HbA1c >7.0% (53 mmol/mol), 30-day readmission rates were 23.5% (DiaTOHC) and 31.4% (UC) and composite 30-day readmission/ED visit rates were 26.5% (DiaTOHC) and 40.0% (UC). In this subgroup, the Intervention−UC cost ratio was 0.21 (0.08−0.58) 95%CI. The DiaTOHC Program may be feasible and may decrease combined 30-day readmission/ED visit risk as well as healthcare costs among patients with HbA1c levels >7.0% (53 mmol/mol).
出院后30天内再次入院（30天再入院）是一项高度优先的质量指标和成本目标。本研究的目的是探讨糖尿病医院护理过渡（DiaTOHC）计划对高危糖尿病成年人再入院风险的可行性和有效性。这是一项非盲法试点随机对照试验（RCT），在一家安全网医院将常规护理（UC）与DiaTOHC进行比较。主要结局是全因30天再入院。在2017年10月16日至2019年5月30日期间，93例患者被随机分组。在意向性治疗（ITT）人群中，45例DiaTOHC受试者中有14例（31.1%）、46例UC受试者中有15例（32.6%）发生30天再入院，而DiaTOHC受试者中有35.6%、UC受试者中有39.1%发生30天再入院或急诊就诊。干预与UC的成本比为0.33（0.13 - 0.79），95%CI。至少93%的受试者对关键干预组成部分感到满意。在69例基线糖化血红蛋白>7.0%（53 mmol/mol）的受试者中，30天再入院率分别为23.5%（DiaTOHC）和31.4%（UC），30天再入院/急诊就诊复合率分别为26.5%（DiaTOHC）和40.0%（UC）。在该亚组中，干预与UC的成本比为0.21（0.08 - 0.58），95%CI。DiaTOHC计划可能是可行的，并且可能降低糖化血红蛋白水平>7.0%（53 mmol/mol）患者的30天再入院/急诊就诊综合风险以及医疗成本。
