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How Outpatient Diabetes Education Programs Can Support Local Hospitals to Reduce Emergency Department Visits for Adults With Diabetes

      Abstract

      Objectives

      Our aim in this study was to assess the level of collaboration between a hospital-based outpatient diabetes education program (DEP) and emergency departments (EDs) for reducing number of ED revisits and hospital admissions by implementing intervention strategies to promote education services and streamlining referral and appointment intake processes.

      Methods

      Patients (≥18 years of age) with an ED visit for hyper- or hypoglycemia were analyzed in 2 cohorts based on their intervention exposure. We conducted a single-cohort analysis of the exposed cohort (exposure to the intervention strategies) and compared 2-year outcomes with those of the unexposed cohort. Primary outcomes were hyper- or hypoglycemia-related ED revisit and hospitalization rates. Process outcomes included DEP referrals and DEP attendance.

      Results

      There were no significant differences in ED revisits and hospital admissions between the exposed and unexposed cohorts. However, patients were more likely to be referred to a DEP by ED physicians (odds ratio [OR], 1.76; p=0.02) and to attend a DEP appointment (OR, 1.96; p<0.01) after intervention exposure. DEP attendees from both cohorts became less likely to revisit an ED (exposed: OR, 0.41; 95% confidence interval [CI], 0.23 to 0.71; unexposed: OR, 0.4; 95% CI, 0.15 to 1.15) at 12-month follow up; however, this reduction was sustained only among the exposed cohort (OR, 0.5; 95% CI, 0.31 to 0.81) and not the unexposed cohort (OR, 1.32; 95% CI, 0.60 to 2.91) at 24 months (p=0.04 when comparing the 2 cohorts).

      Conclusions

      Collaboration between outpatient DEPs with local EDs could effectively reduce diabetes-related ED revisits by increasing diabetes program utilization.

      Résumé

      Objectifs

      L’objectif de notre étude était d’évaluer le degré de collaboration entre un programme d’éducation sur le diabète (PÉD) en consultation externe et les services des urgences (SU) afin de réduire le nombre de consultations ultérieures au SU et d’admissions à l’hôpital par la mise en place de stratégies d’intervention qui promeuvent les services d’éducation et la simplification des processus d’aiguillage et d’attribution de rendez-vous.

      Méthodes

      Les patients (≥ 18 ans) qui avaient une consultation au SU en raison d’hyperglycémie ou d’hypoglycémie ont fait l’objet d’une analyse en 2 cohortes en fonction de leur exposition à l’intervention. Nous avons réalisé l’analyse d’une seule cohorte, à savoir la cohorte exposée (exposition aux stratégies d’intervention), et comparé les résultats après 2 ans avec ceux de la cohorte non exposée. Les critères d’évaluation principaux étaient la récurrence des consultations au SU et les taux d’hospitalisation liés à l’hyperglycémie ou à l’hypoglycémie. Les résultats des processus étaient notamment l’aiguillage vers le PÉD et la participation au PÉD.

      Résultats

      Il n’y avait aucune différence significative dans le nombre de consultations ultérieures au SU et les admissions à l’hôpital entre les cohortes exposée et non exposée. Toutefois, il était plus probable que les patients soient orientés vers un PÉD par les médecins des SU (rapport de cotes [RC], 1,76; p = 0,02) et qu’ils assistent à un rendez-vous au PÉD (RC, 1,96; p < 0,01) après l’exposition à l’intervention. Il était moins probable que les participants du PÉD des 2 cohortes consultent à nouveau au SU (exposée : RC, 0,41; intervalle de confiance [IC] à 95 %, de 0,23 à 0,71; non exposée : RC, 0,4; IC à 95 %, de 0,15 à 1,15) au suivi après 12 mois. Toutefois, cette réduction était maintenue par la cohorte exposée (RC, 0,5; IC à 95 %, de 0,31 à 0,81), mais non par la cohorte non exposée (RC, 1,32; IC à 95 %, de 0,60 à 2,91) après 24 mois (p = 0,04 lors de la comparaison des 2 cohortes).

      Conclusions

      La collaboration entre les PÉD en consultation externe et les SU locaux pourraient effectivement réduire les consultations ultérieures liées au diabète au SU si l’utilisation du programme de diabète est accrue.

      Keywords

      Mots clés

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