This article is more than 5 years old. Information may no longer be current.
Recurrent DKA tied to fragmented care
Among patients with diabetes, increased number of episodes of diabetic ketoacidosis is correlated with increased fragmentation of care and mortality, according to recent findings.
Amisha Wallia, MD, assistant professor in the division of endocrinology, metabolism and molecular medicine at Northwestern University Feinberg School of Medicine, and colleagues evaluated 3,615 patients with diabetic ketoacidosis (DKA) enrolled in the Chicago HealthLNK Data Repository (CHDR) between 2006 and 2012. The CDHR is an electronic health record linkage tool encompassing records from five large academic health centers within the Chicago area.
The researchers stratified patients with DKA hospitalizations into groups of one, two, three or four or more DKA inpatient encounters during the study interval. Patients with more than one hospitalization for DKA during the study period were classified as recurrent. Care fragmentation was defined as DKA hospitalization at more than one hospital during the study interval.
The researchers found that of the participants with DKA, most had only one DKA hospitalization (78.4%), followed by two to three hospitalizations (15.7%) and four or more DKA hospitalizations (5.8%).
Although participants with four or more hospitalizations accounted for only 5.8% of the participant population, these participants encompassed 26.3% of inpatients encounters. Black race, Medicare or Medicaid insurance or uninsured states were more common in participants with recurrent DKA.
Recurrent DKA was documented in 780 of all participants and fragmented care was noted in 16% of all participants. Fragmented care participants were more likely to have had four or more DKA hospitalizations (28%) compared with two to three hospitalizations (11.6%; P = .0001), and participants in the four or more hospitalizations group had greater odds of having fragmented care (OR = 2.96; 95% CI, 1.99-4.3). Thirty-five percent of fragmented encounters were determined to occur outside of the participants’ “primary site” of health care. Ninety-nine percent of participants with recurrent DKA had inpatient encounters at two hospitals, and 11 were hospitalized at more than two hospitals.
Fragmented care was associated with a 1.88-fold increase in DKA visit count after adjustment for age, sex, race and insurance status (P < .0001). Fourteen percent of participants died during the study. In the fully adjusted model, which included fragmentation, DKA visit count, age, sex, race and insurance status, the number of DKA encounters (OR = 1.28; 95% CI, 1.04-1.58) and age (OR = 1.06; 95% CI, 1.05-1.07) were associated with death.
“Patients with fragmented care may utilize health care differently from patients who limit their care to one center,” the researchers wrote. “Therefore, unique approaches requiring collaboration between institutions may also be necessary to improve the health of this particular group of patients. This study, in addition to identifying the scope and toll of recurrent DKA on patients in Chicago, identifies just such a population of patients for whom efforts at prevention and follow-up may require a more tailored approach.” – by Jennifer Byrne
Disclosure: Wallia reports receiving grant support from Bayer, Johnson & Johnson and Merck. Please see the full study for a list of all other authors’ relevant financial disclosures.
Read more about