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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Article Info
Publication History
Published online: May 26, 2022
Accepted:
May 18,
2022
Received in revised form:
May 13,
2022
Received:
November 29,
2021
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Canadian Diabetes Association.
