Improving Diabetes Care Through the Discharge ProcessImproving Diabetes Care Through the Discharge ProcessPresidential Scholars 2009-2010Presidential Scholars 2009-2010

Medical University of South CarolinaMedical University of South Carolina

Our goal is to decrease the amount of Our goal is to decrease the amount of hospital readmissions by reforming discharge hospital readmissions by reforming discharge planning. We aim to decrease the incidence of planning. We aim to decrease the incidence of hospital readmissions within a 30-day period hospital readmissions within a 30-day period by re-engineering discharge planning through by re-engineering discharge planning through patient education and follow up appointments patient education and follow up appointments to increase compliance with medications and to increase compliance with medications and

clinical pathwaysclinical pathways..

• Partnered with our community liaison, Dr. Carolyn Partnered with our community liaison, Dr. Carolyn Jenkins, the chair of the Outreach Council of the Jenkins, the chair of the Outreach Council of the

state legislated Diabetes Initiative of South state legislated Diabetes Initiative of South Carolina, and principal investigator for a REACH Carolina, and principal investigator for a REACH

grant to improve care for diabetics.grant to improve care for diabetics. • Created a standardized packet for diabetic Created a standardized packet for diabetic patients, so that they will easily be able to make patients, so that they will easily be able to make

better diet and exercise decisions. If diabetics are better diet and exercise decisions. If diabetics are given concise information, they will be able to stay given concise information, they will be able to stay

healthier and avoid the hospital, therefore healthier and avoid the hospital, therefore reducing the risk of further complications of the reducing the risk of further complications of the

disease.   disease.   • Attended the Attended the Diabetes Discharge Planning Diabetes Discharge Planning Meetings Meetings with team members from around the with team members from around the state to create a thorough yet simple discharge state to create a thorough yet simple discharge

plan for newly diagnosed diabetics. plan for newly diagnosed diabetics.

• We were given the assignment of presenting an We were given the assignment of presenting an exercise plan and a healthy diet for diabetics to exercise plan and a healthy diet for diabetics to

include in the pamphlets (see figure 1).include in the pamphlets (see figure 1).

In an effort to promote healthy development and In an effort to promote healthy development and healthy behaviors at every stage of life, our group healthy behaviors at every stage of life, our group

identified our at risk population as diabetic patients identified our at risk population as diabetic patients recently discharged from an inpatient or outpatient recently discharged from an inpatient or outpatient

facility.facility.

As the seventh leading cause of death in South As the seventh leading cause of death in South Carolina, a diagnosis of diabetes not only Carolina, a diagnosis of diabetes not only

dramatically changes the lifestyle of an individual dramatically changes the lifestyle of an individual patient, but it also accounts for 3 to 4 deaths per day patient, but it also accounts for 3 to 4 deaths per day

in the state of South Carolina alone. The CDC in the state of South Carolina alone. The CDC estimates that the economic burden of diabetes in estimates that the economic burden of diabetes in the United States reaches $174 billon according to the United States reaches $174 billon according to

2007 data. 2007 data.

Our research study is set to commence in late 2010. Our research study is set to commence in late 2010. By comparing our intervention with the similar By comparing our intervention with the similar

intervention used by Project RED at Boston intervention used by Project RED at Boston University, we expect to reduce hospital readmissions University, we expect to reduce hospital readmissions

of diabetic patients.of diabetic patients.

By redesigning the method of discharge education, By redesigning the method of discharge education, we expect to reduce not only the cost of life but also we expect to reduce not only the cost of life but also

the cost of healthcare related to the diagnosis of the cost of healthcare related to the diagnosis of diabetes in our experimental group.diabetes in our experimental group.

1. Clancy, Carolyn. Agency for Healthcare Research and Quality. May 20092. Health Care Costs: http://www.cdc.gov/diabetes/pubs/costs/index.htm 3. Hawthorne K, Robles Y., Cannings-John, R., & Edwards, AGK. (2008). Culturally appropriate health education for type 2 diabetes Mellitus in ethnic minority groups.Cochrane Database of Systematic Reviews.4. Jack, B. W., Chetty, V. K., Anthony, D. et al. (2009, February 3) A reengineered hospital discharge program to decreasd rehospitalization: A randomized trial. Annals ofInternal Medicine, 150(3), 178-187. 5. Jha AK, Orav EJ, Epstein AM. Public reporting of discharge planning and rates. New Engl J Med. 2009 Dec 31;361(27):2637-45. 6. Joint Commission. (2008). 2008 Hospital National Patient Safety Goals. Accessed March 4, 2009. 7. Moore, C., McGinn, T., Halm, E. (2007, June 25). Tying up loose ends: Discharging patients with unresolved medical issues. Archives of Internal Medicine, 167(12), 1305 1311.8. National Center for Health Statistics. (2007). Health, United States, 2007. Hyattsville, MD. Accessed March 4, 2009.9. Project RED, Boston Medical Center. (2009). Components of Re-Engineered Discharge (RED). Accessed March 4, 2009.10. Roy CL, Kachalia A., Woolf S, Burdick E, Karson A, Gandhi TK. Hospital readmissions: physician awareness and communication practices. J Gen Intern Med. 2009Mar;24(3):374-80. 2008 Nov 4.11. Rudd RE. (2005). How to create and assess print materials.  Harvard School of Public Health: Health Literacy Website. 12. South Carolina Statistics: http://www.scdhec.gov/health/chcdp/diabetes/statistics.htm13. Strunin L, Stone M, Jack B. Understanding Rehospitalization Risk: Can Hospital Discharge be Modified to Reduce Recurrent Hospitalization? J Hop Med. 2007.Sept;2(5):297-304.  

Diabetes is the seventh leading cause of death Diabetes is the seventh leading cause of death in South Carolina. In 2006, three to four people in South Carolina. In 2006, three to four people died each day from diabetes, equating to one died each day from diabetes, equating to one

death from diabetes every seven hours and thirty death from diabetes every seven hours and thirty three minutes. With statistics that are so striking three minutes. With statistics that are so striking within our own state, our group has teamed up within our own state, our group has teamed up

with Dr. Carolyn Jenkins, principal investigator for with Dr. Carolyn Jenkins, principal investigator for a REACH grant to improve care for diabetics upon a REACH grant to improve care for diabetics upon

discharge. The project design is modeled after discharge. The project design is modeled after ProjectRED, a study conducted at Boston ProjectRED, a study conducted at Boston

University in which hospital readmission rates University in which hospital readmission rates were reduced by 30% by redesigning the were reduced by 30% by redesigning the

discharge process for cardiovascular patients in discharge process for cardiovascular patients in their institution. their institution.

 

BACKGROUNDBACKGROUND: Diabetes is the seventh leading cause of death in South Carolina. In 2006, : Diabetes is the seventh leading cause of death in South Carolina. In 2006, three to four people died each day from diabetes, equating to one death from diabetes every seven hours three to four people died each day from diabetes, equating to one death from diabetes every seven hours and thirty three minutes. and thirty three minutes.

METHODS:METHODS: We partnered with our community liaison, Dr. Carolyn Jenkins, the chair of the We partnered with our community liaison, Dr. Carolyn Jenkins, the chair of the Outreach Council of the state legislated Diabetes Initiative of South Carolina, and principal investigator Outreach Council of the state legislated Diabetes Initiative of South Carolina, and principal investigator for a REACH grant to improve care for diabetics. Our goal is to decrease the incidence of hospital for a REACH grant to improve care for diabetics. Our goal is to decrease the incidence of hospital readmissions within a 30-day period by re-engineering discharge planning through patient education readmissions within a 30-day period by re-engineering discharge planning through patient education and follow up appointments to increase compliance with medications and clinical pathways. We and follow up appointments to increase compliance with medications and clinical pathways. We created a standardized packet for diabetic patients so that they will easily be able to make better diet created a standardized packet for diabetic patients so that they will easily be able to make better diet and exercise decisions. If diabetics are given concise information, they will be able to stay healthier and and exercise decisions. If diabetics are given concise information, they will be able to stay healthier and avoid the hospital, therefore reducing the risk of further complications of the diseaseavoid the hospital, therefore reducing the risk of further complications of the disease

INTERVENTION:INTERVENTION: Our group members attended the Our group members attended the Diabetes Discharge Planning Meetings Diabetes Discharge Planning Meetings with team members from around the state to create a thorough yet simple discharge plan for newly with team members from around the state to create a thorough yet simple discharge plan for newly diagnosed diabetics. During the meetings, which occurred throughout the year, topics such as the need diagnosed diabetics. During the meetings, which occurred throughout the year, topics such as the need for standardized plan of care, methods to decrease readmissions and emergency department visits for standardized plan of care, methods to decrease readmissions and emergency department visits related to diabetes, and improving the discharge pamphlet for patients and providers were discussed at related to diabetes, and improving the discharge pamphlet for patients and providers were discussed at length. We designed an exercise plan and a healthy diet for diabetics to include in the pamphlets. length. We designed an exercise plan and a healthy diet for diabetics to include in the pamphlets.

DISCUSSION:DISCUSSION: Our intervention is yet to be applied in the official research study, set to Our intervention is yet to be applied in the official research study, set to commence later in 2010. However, by comparing our intervention with the similar intervention used by commence later in 2010. However, by comparing our intervention with the similar intervention used by Project RED at Boston Medical Center, we expect to reduce preventable hospital readmissions of Project RED at Boston Medical Center, we expect to reduce preventable hospital readmissions of patients with diabetes by 30% within a 30-day period and lower inpatient and outpatient costs by an patients with diabetes by 30% within a 30-day period and lower inpatient and outpatient costs by an average of $412 in the experimental group.average of $412 in the experimental group.

FIGURE 1FIGURE 1ABSTRACTABSTRACT

BACKGROUNDBACKGROUND

RESULTSRESULTS

DISCUSSIONDISCUSSION

REFERENCESREFERENCESOBJECTIVEOBJECTIVE

METHODSMETHODS

Bear EM, Brennan CR, Brzezinski WA, Fiume LB, Glace MJ, Glymph BL, Harms D, Hite SR, Korman J, Pardue EL, Terawaki H, Thompson ML and Ward JD Bear EM, Brennan CR, Brzezinski WA, Fiume LB, Glace MJ, Glymph BL, Harms D, Hite SR, Korman J, Pardue EL, Terawaki H, Thompson ML and Ward JD

• Since our project is still in research and design Since our project is still in research and design stages, no statistical results yet exist to quantify stages, no statistical results yet exist to quantify

diabetic patientdiabetic patient readmission rates. We anticipate similar statistical readmission rates. We anticipate similar statistical

results to that which was obtained by Project REDresults to that which was obtained by Project RED

• 30% less hospital readmissions and ED visits 30% less hospital readmissions and ED visits

• Reduced total costs by an average of $412 Reduced total costs by an average of $412 

• 2/3 of the patients were followed-up with a clinical 2/3 of the patients were followed-up with a clinical pharmacist and 54% of these cases presented one or pharmacist and 54% of these cases presented one or

more medication related problems, which was more medication related problems, which was identified and resolved with the help of a clinician identified and resolved with the help of a clinician 

Fats, Oils, Fats, Oils, & Sweets& Sweets

Milk Milk 2-3 servings2-3 servings

Vegetables 3-Vegetables 3-5 servings5 servings

Fruits Fruits 2-4 servings2-4 servings

Ways to classify food: the plate method for diabetic patients and USDA Food PyramidWays to classify food: the plate method for diabetic patients and USDA Food Pyramid

Presented at : Presidential Scholars Day, Medical University of South Presented at : Presidential Scholars Day, Medical University of South Carolina Carolina

Charleston, SC April 13, 2010Charleston, SC April 13, 2010