Generic placeholder image

Current Diabetes Reviews

Editor-in-Chief

ISSN (Print): 1573-3998
ISSN (Online): 1875-6417

Review Article

Diabetes Discharge Planning and Transitions of Care: A Focused Review

Author(s): Robin L. Black* and Courtney Duval

Volume 15, Issue 2, 2019

Page: [111 - 117] Pages: 7

DOI: 10.2174/1573399814666180711120830

Price: $65

Abstract

Background: Diabetes is a growing problem in the United States. Increasing hospital admissions for diabetes patients demonstrate the need for evidence-based care of diabetes patients by inpatient providers, as well as the importance of continuity of care when transitioning patients from inpatient to outpatient providers.

Methods: A focused literature review of discharge planning and transitions of care in diabetes, conducted in PubMed is presented. Studies were selected for inclusion based on content focusing on transitions of care in diabetes, risk factors for readmission, the impact of inpatient diabetes education on patient outcomes, and optimal medication management of diabetes during care transitions. American Diabetes Association (ADA) guidelines for care of patients during the discharge process are presented, as well as considerations for designing treatment regimens for a hospitalized patient transitioning to various care settings.

Results: Multiple factors may make transitions of care difficult, including poor communication, poor patient education, inappropriate follow-up, and clinically complex patients. ADA recommendations provide guidance, but an individualized approach for medication management is needed. Use of scoring systems may help identify patients at higher risk for readmission. Good communication with patients and outpatient providers is needed to prevent patient harm. A team-based approach is needed, utilizing the skills of inpatient and outpatient providers, diabetes educators, nurses, and pharmacists.

Conclusion: Structured discharge planning per guideline recommendations can help improve transitions in care for patients with diabetes. A team based, patient-centered approach can help improve patient outcomes by reducing medication errors, delay of care, and hospital readmissions.

Keywords: Diabetes, transitions of care, long-term care facility, skilled nursing facility, hospital discharge, follow-up care.

[1]
Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. (Accessed on: October 30, 2017).
[2]
Montejano L, Vo L, McMorrow D. Transitions of care for people with type 2 diabetes: Utilization of antihyperglycemic agents pre- and post-hospitalization. Diabetes Ther 2016; 7: 91-103.
[3]
Moore C, Wisnivesky J, Williams S, McGinn T. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med 2003; 18: 646-51.
[4]
Kripalani S, Jackson AT, Schnipper JL, Coleman EA. Promoting effective transitions of care at hospital discharge: A review of key issues for hospitalists. J Hosp Med 2007; 2: 314-23.
[5]
Donihi AC. Practical recommendations for transitioning patients with type 2 diabetes from hospital to home. Curr Diab Rep 2017; 17: 52.
[6]
Garnica P. Transition of care for patients with diabetes. Curr Diabetes Rev 2017; 13: 263-79.
[7]
Rubin EJ, Donnell-Jackson K, Jhingan R, Golden SH, Paranjape A. Early readmission among patients with diabetes: A qualitative assessment of contributing factors. J Diabetes Complications 2014; 28: 869-73.
[8]
Enomoto LM, Shrestha DP, Rosenthal MB, Hollenbeak CS, Gabbay RA. Risk factors associated with 30-day readmission and length of stay in patients with type 2 diabetes. J Diabetes Complications 2017; 31: 122-7.
[9]
LaManna JB, Bushy A, Norris AE, Chase SK. Early and intermediate hospital-to-home transition outcomes of older adults diagnosed with diabetes. Diabetes Educ 2016; 42: 72-86.
[10]
Rubin DJ, Handorf EA, Golden SH, Nelson DB, McDonnell ME, Zhao H. Development and validation of a novel tool to predict hospital readmission risk among patients with diabetes. Endocr Pract 2016; 22: 1204-15.
[11]
Rubin DJ, Golden SH, McDonnell ME, Zhao H. Predicting readmission risk of patients with diabetes hospitalized for cardiovascular disease: A retrospective cohort study. J Diabetes Complications 2017; 31: 1332-9.
[12]
Wheeler K, Crawford R, McAdams D, et al. Inpatient to outpatient transfer of care in urban patients with diabetes. Arch Intern Med 2004; 164: 447-53.
[13]
Healy SJ, Black D, Harris C, Lorenz A, Dungan KM. Inpatient diabetes education is associated with less frequent hospital readmission among patients with poor glycemic control. Diabetes Care 2013; 36: 2960-7.
[14]
Wexler DJ, Beauharnais CC, Regan S, Nathan DM, Cagliero E, Larkin ME. Impact of inpatient diabetes management, education, and improved discharge transition on glycemic control 12 months after discharge. Diabetes Res Clin Pract 2012; 98: 249-56.
[15]
Drincic A, Pfeffer E, Luo J, Goldner WS. The effect of diabetes case management and diabetes resource nurse program on readmissions of patients with diabetes mellitus. J Clin Transl Endocrinol 2017; 8: 29-34.
[16]
Griffith ML, Boord JB, Eden SK, Matheny ME. Clinical inertia of discharge planning among patients with poorly controlled diabetes mellitus. J Clin Endocrinol Metab 2012; 97: 2019-26.
[17]
Umpierrez GE, Reyes D, Smiley D, et al. Hospital discharge algorithm based on admission HbA1c for the management of patients with type 2 diabetes. Diabetes Care 2014; 37: 2934-9.
[18]
American Diabetes Association. Standards of medical care in diabetes - 20187. Diabetes care in the hospital: standards of medical care in diabetes - 2018. Diabetes Care 20187; 410(Suppl1): S144- S15135.
[19]
Shepperd S, Lannin NA, Clemson LM, et al. Discharge planning from hospital to home. Cochrane Database Syst Rev 2016; 1: CD0003.
[20]
Pevnick JM, Shane R, Schnipper JL. The problem with medication reconcilliation. BMJ Qual Saf 2016; 25: 726-30.
[21]
Munshi MN, Florez H, Huang ES, et al. Management of diabetes in long-term care and skilled nursing facilities: A position statement of the American Diabetes Association. Diabetes Care 2016; 39: 308-18.
[22]
Haas LB. Special considerations for older adults with diabetes residing in skilled nursing facilities. Diabetes Spectr 2014; 27: 37-43.

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy