Hospital readmission of diabetic patients a follow up of twelve months
Main Article Content
Keywords
Diabetes, Patient Readmission
Abstract
Objective: to determine the risk factors associated with hospital readmissions in diabetes mellitus (DM).
Methods: adult patients with DM hospitalized were evaluated with a follow up during one year. Odd ratios (OR) and 95 % confidence intervals (95 % CI) were calculated to identify predictors of hospital readmissions.
Results: There were 153 patients, with a mean age 58 ± 13) years, 97% had type 2 DM with a mean disease evolution of 166 ± 132) months; 131 patients were evaluated every 4 months with follow-up of 11 ± 1.2) months and 35% had hospital readmission. The causes were: infections (36 %), chronic renal failure (27 %), acute complications of DM (8 %) and cardiovascular disease (11 %). They were associated with ≤ 6 years of education (RR 2.9, 1.22-7.03 CI 95 %), duration of DM > 132 months (RR 1.2, 1.00-1.6 CI 95), nephropathy (RR 2.3, 1.5-7.0 CI 95 %), and abnormal glycemia upon being discharged from initial hospitalization (RR 2.5, 1.13-5.6 CI 95 %). Two or more readmissions where associated significantly with nephropathy (p = 0.05) and the use of alternative treatment (p = 0.01).
Conclusions: multiple hospitalizations could be preventible with the identification of risk factors.
References
King H, Aubert RE, Herman WH. Global burden for diabetes 1995-2025: prevalence numerical estimates and projections. Diabetes Care. 1998; 21:1414-1431.
Rull JA, Aguilar-Salinas CA, Rojas R, Ríos-Torres JM, Gómez-Pérez FJ, Olaiz G. Epidemiology of type 2 diabetes in Mexico. Arch Med Res. 2005; 36:188-196.
Membreño A, Zonana A. Hospitalización de pacientes con diabetes mellitus. Causas, complicaciones y mortalidad. Rev Med IMSS. 2004; 43:97-101.
Moss ES, Klein R, Klein B. Risk factors for hospitalization in people with diabetes. Arch Intern Med. 1999; 159:2053-2057.
Tomlin AM, Tilyard MW, Dovey SM, Dawson AG. Hospital admissions in diabetic and non-diabetic patients: a case-control study. Diabetes Res Clin Pract. 2006; 73:260-267.
Russel LB, Valiyeva E, Roman SH, Pogach LM, Suh DC, Safford MM. Hospitalizations, nursing home admissions and deaths attributable to diabetes. Diabetes Care. 2005; 28:1611-1617.
Jiang HJ, Friedman B, Andrews R. Multiple hospitalizations for patients with diabetes. Diabetes Care. 2003; 26:1421-1426.
Robbins JM, Webb DA. Diagnosing diabetes and preventing rehospitalizations: the urban diabetes study. Med Care. 2006; 44:292-296.
Olveira-Fuster G, Olvera-Márquez P, Carral-San-laureano F, González-Romero S, Aguilar-Diosdado M, Soriguer-Escofet F. Excess hospitalizations, hospital days, and inpatient cost among people with diabetes in Andalusia, Spain. Diabetes Care. 2004; 27:1904-1909.
Gagliardino JJ, Martella A, Etchegoyen GS, Caporale JE, Guidi ML, Olivera EM, et al. Hospitalization and rehospitalization of people with and without diabetes in La Plata, Argentina: comparison of their clinical characteristics and costs. Diabetes Res Clin Pract. 2004; 65:51-59.
Jiang HJ, Andrews R, Stryer D, Friedman B. Racial/ethnic disparities in potentially preventable readmissions: the case of diabetes. Am J Public Health. 2005; 95:1561-1567.
García A, Villagómez E, Brown S, Kouzenani F, Hanis C. The Starr County Diabetes Education Study. Development of the Spanish-language diabetes knowledge questionnaire. Diabetes Care. 2001; 24:16-21.
Benbassat J, Taragin M. Hospital readmissions as a measure of quality of health care: adventajes and limitations. Arch Intern Med. 2000; 160:1074-1081.
Duncan JM, Short A, Lewis JS, Barrett PT. Re-admissions to the state hospital at carstairs, 1992-1997. Health Bull. 2002; 60:70-82.
Harri MI. Racial and ethnic differences in health care access and health outcomes for adults with type 2 diabetes. Diabetes Care. 2001; 24:454-459.
Lau DT, Nau DP. Oral antihyperglycemic medication nonadherence and subsequent hospitalization among individuals with type 2 diabetes. Diabetes Care. 2004; 27:2149-2153.