Qualitative Assessment of a Novel Intervention to Reduce Hospital Readmission Risk Among People with Diabetes
Main Article Content
Abstract
Purpose: To qualitatively assess a novel intervention, the Diabetes Transition of Hospital Care (DiaTOHC) Program, designed to reduce hospital readmissions within 30 days of discharge among people with diabetes.
Methods: In a separately reported randomized controlled trial of the DiaTOHC intervention, hospitalized people with diabetes were identified as high risk for 30-day hospital readmission using the Diabetes Early Readmission Risk Indicator (DERRI®). Of these, 58 participants were randomized to the intervention. After the 30-day intervention, participants and study staff completed semi-structured interviews until saturation was achieved, yielding 21 participant and 4 staff interviews. Each one underwent thematic analysis.
Results: Four themes were identified: (1) Participants were motivated to make lifestyle changes, (2) Weekly Navigator phone calls were an effective method to support participants, (3) The intervention improved some diabetes knowledge domains but not others, and (4) Perceived lack of control was associated with readmission. Participants with baseline hemoglobin A1C (A1C) ≥8% made more changes to their diabetes management due to the intervention but were less likely to review the educational materials and had more extreme blood glucose levels. Participants who completed fewer post-discharge phone calls were more likely to find the educational booklet helpful than those who completed more calls.
Conclusions: Education, care coordination, and follow up are key components of the DiaTOHC Program that may improve diabetes self-management after a hospitalization and reduce readmission risk.
Keywords:
Diabetes mellitus, readmissions, qualitative methodology, thematic analysis, hospital discharge
Article Details
How to Cite
TANNER, Samuel et al.
Qualitative Assessment of a Novel Intervention to Reduce Hospital Readmission Risk Among People with Diabetes.
Medical Research Archives, [S.l.], v. 12, n. 12, dec. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5882>. Date accessed: 06 jan. 2025.
doi: https://doi.org/10.18103/mra.v12i12.5882.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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doi:10.1016/j.jdiacomp.2014.06.013
28. Krumholz H. Post-hospital syndrome--an acquired, transient condition of generalized risk. N Engl J Med. 01/10/2013 2013;368(2) doi:10.1056/NEJMp1212324
29. Magee M, Khan N, Desale S, Nassar C. Diabetes to go: knowledge-and competency-based hospital survival skills diabetes education program improves postdischarge medication adherence. Diabetes Educ. 2014 May 2014;40(3) doi:10.1177/0145721714523684
30. Glasgow RE, Christiansen SM, Kurz D, et al. Engagement in a Diabetes Self-management Website: Usage Patterns and Generalizability of Program Use. Journal of Medical Internet Research. 2011;13(1):e9. doi:10.2196/jmir.1391
31. Vaz CL, Carnes N, Pousti B, Zhao H, Williams KJ. A randomized controlled trial of an innovative, user‐friendly, interactive smartphone app‐based lifestyle intervention for weight loss. Obesity Science & Practice. 2021;7(5):555-568. doi:10.1002/osp4.503
32. Magny-Normilus C, Nolido NV, Borges JC, et al. Effects of an Intensive Discharge Intervention on Medication Adherence, Glycemic Control, and Readmission Rates in Patients With Type 2 Diabetes. J Patient Saf. Mar 1 2021;17(2):73-80. doi:10.1097/pts.0000000000000601
33. Schnipper JL, Samal L, Nolido N, et al. The Effects of a Multifaceted Intervention to Improve Care Transitions Within an Accountable Care Organization: Results of a Stepped-Wedge Cluster-Randomized Trial. J Hosp Med. Jan 2021;16(1):15-22. doi:10.12788/jhm.3513
34. Jayakody A, Bryant J, Carey M, Hobden B, Dodd N, Sanson-Fisher R. Effectiveness of interventions utilising telephone follow up in reducing hospital readmission within 30 days for individuals with chronic disease: a systematic review. BMC Health Serv Res. Aug 18 2016;16(1):403. doi:10.1186/s12913-016-1650-9
2. Kocher RP, Adashi EY. Hospital readmissions and the Affordable Care Act: paying for coordinated quality care. JAMA. Oct 26 2011;306(16):1794-5. doi:10.1001/jama.2011.1561
3. Sun H, Saeedi P, Karuranga S, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Research and Clinical Practice. 2022;183:109119. doi:10.1016/j.diabres.2021.109119
4. 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. Jan 2017;31(1):122-127.
doi:10.1016/j.jdiacomp.2016.10.021
5. 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. Oct 2016;22(10):1204-1215. doi:10.4158/e161391.or
6. Koproski J, Pretto Z, Poretsky L. Effects of an intervention by a diabetes team in hospitalized patients with diabetes. Diabetes care. 1997 Oct 1997;20(10)doi:10.2337/diacare.20.10.1553
7. 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. Oct 2013;36(10):2960-7. doi:10.2337/dc13-0108
8. Davies M, Dixon S, Currie C, Davis R, Peters J. Evaluation of a hospital diabetes specialist nursing service: a randomized controlled trial. Diabet Med. 2001 Apr 2001;18(4) doi:10.1046/j.1464-5491.2001.00470.x
9. Wexler D, Beauharnais C, Regan S, Nathan D, Cagliero E, Larkin M. Impact of inpatient diabetes management, education, and improved discharge transition on glycemic control 12 months after discharge. Diabetes Res Clin Pract. 2012 Nov 2012; 98(2)doi:10.1016/j.diabres.2012.09.016
10. Dungan K, Lyons S, Manu K, et al. An individualized inpatient diabetes education and hospital transition program for poorly controlled hospitalized patients with diabetes. Endocr Pract. 2014 Dec 2014;20(12)doi:10.4158/EP14061.OR
11. Rubin DJ, Shah AA. Predicting and Preventing Acute Care Re-Utilization by Patients with Diabetes. Current Diabetes Reports. 2021;21(9) doi:10.1007/s11892-021-01402-7
12. Rubin DJ, Gogineni P, Deak A, et al. The Diabetes Transition of Hospital Care (DiaTOHC) Pilot Study: A Randomized Controlled Trial of an Intervention Designed to Reduce Readmission Risk of Adults with Diabetes. Journal of Clinical Medicine. 2022;11(6):1471. doi:10.3390/jcm11061471
13. Rubin DJ, Donnell-Jackson K, Jhingan R, Golden SH, Paranjape A. Early readmission among patients with diabetes: a qualitative assessment of contributing factors. Research Support, Non-U.S. Gov't. Journal of Diabetes and Its Complications. Nov-Dec 2014;28(6):869-873. doi:10.1016/j.jdiacomp.2014.06.013
14. Strunin L, Stone M, Jack B. Understanding rehospitalization risk: can hospital discharge be modified to reduce recurrent hospitalization? J Hosp Med. Sep 2007;2(5):297-304.
15. Long T, Genao I, Horwitz LI. Reasons for readmission in an underserved high-risk population: a qualitative analysis of a series of inpatient interviews. BMJ Open. 2013;3(9):e003212. doi:10.1136/bmjopen-2013-003212
16. ADA. Standards of Medical Care in Diabetes —2016. Diabetes Care. 2016;39 (Supplement 1):S52-S58. doi:10.2337/dc16-S003
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(11):2934-2939. doi:10.2337/dc14-0479
18. American Diabetes Association. Approaches to glycemic treatment. Diabetes care. 2016 Jan 2016;39 Suppl 1:S52-9doi:10.2337/dc16-S010
19. Lauster CD, Gibson JM, DiNella JV, DiNardo M, Korytkowski MT, Donihi AC. Implementation of standardized instructions for insulin at hospital discharge. J Hosp Med. Oct 2009;4(8):E41-2. doi:10.1002/jhm.489
20. Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No. 131. Medical teacher. 2020;42(8):846-854.
21. Braun V, Clarke V. Using thematic analysis in psychology. research-article. Qual Res Psychol. 21 Jul 2008 2006;3(2):77–101. doi:Qualitative Research in Psychology, Vol. 3, No. 2, 2006: pp. 77–101
22. Draznin B, Gilden J, Golden SH, et al. Pathways to quality inpatient management of hyperglycemia and diabetes: a call to action. Diabetes Care. Jul 2013;36(7):1807-1814. doi:10.2337/dc12-2508
23. Donihi AC. Practical Recommendations for Transitioning Patients with Type 2 Diabetes from Hospital to Home. Curr Diab Rep. Jul 2017;17(7):52. doi:10.1007/s11892-017-0876-1
24. Balaban RB, Galbraith AA, Burns ME, Vialle-Valentin CE, Larochelle MR, Ross-Degnan D. A Patient Navigator Intervention to Reduce Hospital Readmissions among High-Risk Safety-Net Patients: A Randomized Controlled Trial. Journal of General Internal Medicine. 2015;30(7):907-915. doi:10.1007/s11606-015-3185-x
25. Pang RK, Srikanth V, Snowdon DA, et al. Targeted care navigation to reduce hospital readmissions in ‘at-risk’ patients. Internal Medicine Journal. 2021; doi:https://doi.org/10.1111/imj.15634
26. Jack BW, Chetty VK, Anthony D, et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. Feb 3 2009;150(3):178-187.
27. Rubin DJ, Donnell-Jackson K, Jhingan R, Golden SH, Paranjape A. Early readmission among patients with diabetes: a qualitative assessment of contributing factors. J Diabetes Complications. Nov-Dec 2014;28(6):869-73.
doi:10.1016/j.jdiacomp.2014.06.013
28. Krumholz H. Post-hospital syndrome--an acquired, transient condition of generalized risk. N Engl J Med. 01/10/2013 2013;368(2) doi:10.1056/NEJMp1212324
29. Magee M, Khan N, Desale S, Nassar C. Diabetes to go: knowledge-and competency-based hospital survival skills diabetes education program improves postdischarge medication adherence. Diabetes Educ. 2014 May 2014;40(3) doi:10.1177/0145721714523684
30. Glasgow RE, Christiansen SM, Kurz D, et al. Engagement in a Diabetes Self-management Website: Usage Patterns and Generalizability of Program Use. Journal of Medical Internet Research. 2011;13(1):e9. doi:10.2196/jmir.1391
31. Vaz CL, Carnes N, Pousti B, Zhao H, Williams KJ. A randomized controlled trial of an innovative, user‐friendly, interactive smartphone app‐based lifestyle intervention for weight loss. Obesity Science & Practice. 2021;7(5):555-568. doi:10.1002/osp4.503
32. Magny-Normilus C, Nolido NV, Borges JC, et al. Effects of an Intensive Discharge Intervention on Medication Adherence, Glycemic Control, and Readmission Rates in Patients With Type 2 Diabetes. J Patient Saf. Mar 1 2021;17(2):73-80. doi:10.1097/pts.0000000000000601
33. Schnipper JL, Samal L, Nolido N, et al. The Effects of a Multifaceted Intervention to Improve Care Transitions Within an Accountable Care Organization: Results of a Stepped-Wedge Cluster-Randomized Trial. J Hosp Med. Jan 2021;16(1):15-22. doi:10.12788/jhm.3513
34. Jayakody A, Bryant J, Carey M, Hobden B, Dodd N, Sanson-Fisher R. Effectiveness of interventions utilising telephone follow up in reducing hospital readmission within 30 days for individuals with chronic disease: a systematic review. BMC Health Serv Res. Aug 18 2016;16(1):403. doi:10.1186/s12913-016-1650-9