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Diabetes-focused ambulatory care after ED visit improves outcomes
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Open-access booking in the ED to a diabetes-focused ambulatory clinic for patients with diabetes is feasible and can improve outcomes in the subsequent year, according to study findings published in Endocrine Practice.
“We have demonstrated that providing direct, open-access booking from the ED to a diabetes clinic within 24 hours of ED discharge results in long-term reduction in acute care resource utilization among patients with poorly controlled diabetes,” the researchers wrote.
Marie E. McDonnell, MD, of the division of endocrinology, diabetes and hypertension, Brigham and Women’s Hospital, Harvard Medical School, and colleagues evaluated adults seen in the ED at Boston Medical Center with uncontrolled diabetes, between Oct. 1, 2011, and Nov. 1, 2013, as part of the ED rapid-referral program (n = 420) and between Sept. 1, 2009, and Sept. 30, 2011 (historically unexposed controls; n = 791). The primary outcomes measure was hospitalization rate during 1 year, and secondary outcomes included ED recidivism rate, HbA1c and health care expenditures.
Among participants in the rapid-referral program, 100% were booked with a diabetes visit, and 89% of those were booked within 24 hours of discharge from the ED. Compared with controls, the participants in the rapid-referral program group were less likely to be uninsured (3.1% vs. 4.6%), more likely to have government-assisted insurance (88.1% vs. 81.4%) and less likely to have commercial/private insurance (8.8% vs. 14%).
During 1 year, the hospitalization rate was lower among the rapid-referral group compared with controls (P < .001). At the end of 1 year, fewer participants in the rapid-referral group had been admitted at least once (27.1%) compared with controls (41.5%; P < .001). Rate of return to the ED in the year after the first visit also was lower among the rapid-referral group compared with controls (P = .001).
Compared with controls, the rapid-referral group had a greater reduction in HbA1c during 1 year after adjustment for baseline HbA1c (P < .001). The rapid-referral group had lower mean total costs per patient during 1 year compared with controls ($21,440 vs. $26,901; P < .001), most likely due to reductions in inpatient costs (P < .001), according to researchers.
“Most research in the area of direct online access to scheduling has been focused on the individual patent and ability to self-direct care,” the researchers wrote. “There has been less attention paid to improving access to specialty services targeting an acute problem that places a patient at risk of seeking acute care in the near future. Until this prevalent problem is solved on a large scale for diabetes and similar chronic conditions, providing direct access to booking in the ED for select cases is a feasible method of delivering high-quality services. Cost-effectiveness of such an approach is likely, but this requires further detailed study.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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