Comprehension of Discharge Instructions for Diabetes Therapy and Hospital Readmission
Condition: Diabetes Mellitus
MeSH terms: Diabetes Mellitus
Study type: Observational [Patient Registry]

Summary: 
      The purpose of this study is to identify and explore the existing components of discharge
      planning provided to patients with insulin treated diabetes in the inpatient setting and to
      examine the contribution of glycemic excursions as well as comprehension of discharge
      instructions among patients with diabetes, in predicting hospital readmissions.
    

Detailed description: 
      Background: Diabetes is a major contributor to hospital readmissions and health care
      expenditures. Previous studies have attempted to identify risk factors for readmission among
      patients with diabetes. However, no studies have looked at some potentially important factors
      including duration of diabetes, HbA1c, glycemic excursions preceding hospital discharge, and
      patient comprehension of discharge instructions provided for home diabetes management. In
      this study, we propose to examine patient understanding of instructions for insulin therapy
      provided at the time of hospital discharge as a potential risk factor for readmission during
      the following 30- and 90-day time periods. In addition, we will examine the contribution of
      glycemic excursions obtained in the 48-hour period prior to discharge on patient
      understanding of insulin therapy and risk for readmission.

      Purpose: The purpose of this study is to identify and explore the existing components of
      discharge planning provided to patients with insulin treated diabetes in the inpatient
      setting and to examine the contribution of glycemic excursions as well as comprehension of
      discharge instructions among patients with diabetes, in predicting hospital readmissions.

      Methods: This will be a prospective non-blinded observational study enrolling non-critically
      ill, non-pregnant, hospitalized patients aged 18-90 years of age with insulin treated
      diabetes and no evidence of baseline cognitive. The participants will be recruited from
      August 2017 to December 2018 from the Inpatient Endocrine and Diabetes Consult Services and
      from daily reports of patients experiencing BG< 70 mg/dL and >300 mg/dL. Eligible
      participants will be called within 24-48 hours following hospital discharge at which time
      they will be asked to complete a Diabetes Management Questionnaire to determine their
      comprehension of the recommendations provided for home-insulin and other diabetes therapies.
      This questionnaire will include questions about the types of insulin being used, the doses
      administered, and times given. Patient interviews will be conducted again via a telephone
      follow up at approximately 30- and 90-days following discharge with specific questions on
      home blood glucose control and ER or hospital visits and/or readmissions. The Clinical and
      Translational Science Institute at the University of Pittsburgh will be consulted for
      statistical analysis.

      Study significance:

      This study has the potential to identify modifiable factors that can potentially contribute
      to the observed frequency of hospital readmissions among patients with insulin treated
      diabetes. This study could also advocate for discharge protocols and close follow up of
      patients with insulin-treated diabetes following discharge to ensure appropriate
      understanding of discharge instructions for insulin therapy and home diabetes management.
    

Intervention name(s): Diabetes Management Questionnaire
Intervention type(s): Other
Intervention description(s): Patients will be asked questions regarding their understanding of instructions for home diabetes management within 48 hours of hospital discharge. At 1 and 3 months, participants will be contacted to obtain information regarding ER visits or hospital readmissions.
Observational model: Other
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Non-critically ill adult patients with diabetes will be recruited during a period of
        hospitalization for non-critical illness.
      
Keywords: inpatient; hypoglycemia; hyperglycemia; hospital readmission; discharge planning