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The Impact of Diabetes on Hospital Readmissions

The Impact of Diabetes on Hospital Readmissions. New York State Regional Family Medicine Conference. James Desemone , MD Director of Medical Staff Quality Ellis Medicine October 15, 2011. Dr. Desemone has no financial disclosures nor conflicts of interest to declare.

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The Impact of Diabetes on Hospital Readmissions

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  1. The Impact of Diabetes on Hospital Readmissions New York State Regional Family Medicine Conference James Desemone, MD Director of Medical Staff Quality Ellis Medicine October 15, 2011

  2. Dr. Desemone has no financial disclosures nor conflicts of interest to declare

  3. The Impact of Diabetes on Hospital ReadmissionsWith Special Thanks to: Nancy Landor Senior Director, Strategic Quality Initiatives, HANYS Amy Jones Manager, Quality Initiatives, HANYS Karen Pirigyi Assistant to the Director, Quality Services, Ellis Medicine

  4. Impact of Diabetes on Hospital Readmissions By attending this conference, the participant should be able to: • Name 3 of the measures in the National Committee for Quality Assurance (NCQA) Diabetes Recognition Program • Explain how diabetes education reduces the cost of care • Name the percentage of patients with diabetes that physicians refer to diabetes education

  5. Hospital Readmissions CHF COPD Pneumonia AMI

  6. Hospital Readmissions What about Diabetes? • Keeps a low profile • Frequently a secondary diagnosis

  7. Estimated Adult Diabetes Prevalence in NYS, 2002-2008

  8. Past and projected prevalence of overweight (BMI >25 kg/m²) Wang YC, et al. Lancet 378: 815–25 (2011)

  9. New York StateEmergency Department UtilizationDiabetes Patients Admitted as Inpatient as a % of Total ED Visits 726,553 7,146,817 Healthcare Association of New York State, July 2010

  10. Percentage of NYS Admissions with Diabetes as 1o or 2oDx Healthcare Association of New York State, July 2010

  11. NYS Readmission Rates, 2008 Healthcare Association of New York State, July 2010

  12. Survey : NYS Systems/Hospitalsn=70 Do you have discharge planning criteria for referring any type of diabetes patient to a Certified Diabetes Educator (CDE) or ADA/AADE Certified Education Program post-discharge? No Criteria in Place Criteria in Place

  13. HANYS’ Study—NYS DataIdentifying Routine Diabetes CareRoom for Improvement There are 33,327 diabetes patients on the 5% SAF Carrier File or Medicare patients. Of those, 3,327 (10%) did not receive any preventive care. Only 12,969 (38.9%) received all of the recommended procedures in the year. Source: 2007 Medicare Limited Data Set Standard Analytic Files 5% version

  14. National Committee for Quality Assurance Diabetes Recognition Program

  15. National Committee for Quality AssuranceDiabetes Recognition Program Healthcare Association of New York State, July 2010

  16. Reducing Readmissions • Improved Diabetes Treatment by the Provider? • Referral to a Diabetes Self-Management Training and Education (DSMT/E) Program?

  17. Philadelphia • January 1994 to December 2001 • 80,218 unique patients with diabetes • 224,818 hospital discharges to self-care

  18. Odds ratio for Hospital Readmission within 30 days Robbins JM, et al. J Health Care for the Poor and Underserved 19:562-573 (2008)

  19. Maybe… ….for patients who are discharged without a recorded diagnosis of diabetes • Caveats: • Administrative data are prone to error • Did not examine transition of care from inpatient to outpatient

  20. What We Want Safe, Positive Clinical Quality Cost Savings

  21. Hospital Costs Account for Majority of Total Costs of Diabetes Per Capita Health Care Expenditures (2002) Diabetes Without Diabetes Hogan P, et al. Diabetes Care. 2003;26:917–932.

  22. Assessing the Value ofDiabetes Education • 2005, 2006, 2007 • Insurance • Commercial or Medicare • Purpose: • Evaluate the impact of Diabetes Self-Management Training and Education (DSMT/E) on the cost of care Duncan et al, The Diabetes Educator. 35:752-761 (2009)

  23. Number of Patients with Diabetes Who Received Education Commercial 482,571 Medicare 152,074 7.3% 3.8% Duncan et al, The Diabetes Educator. 35:752-761 (2009)

  24. Preliminary Conclusion The care with DSMT/E is better. Duncan et al, The Diabetes Educator. 35:752-761 (2009)

  25. Duncan et al, The Diabetes Educator. 35:752-761 (2009)

  26. Duncan et al, The Diabetes Educator. 35:752-761 (2009)

  27. Assessing the Value ofDiabetes Education, 2008 Tucker ME. Hospitalist News Digital Network, 2010-08-31 Duncan et al, The Diabetes Educator. 35:752-761 (2009)

  28. Assessing the Value ofDiabetes Education, 2008 Tucker ME. Hospitalist News Digital Network, 2010-08-31 Duncan et al, The Diabetes Educator. 35:752-761 (2009)

  29. Assessing the Value ofDiabetes Education, 2008 Tucker ME. Hospitalist News Digital Network, 2010-08-31 Duncan et al, The Diabetes Educator. 35:752-761 (2009)

  30. Assessing the Value ofDiabetes Education, 2008 Tucker ME. Hospitalist News Digital Network, 2010-08-31 Duncan et al, The Diabetes Educator. 35:752-761 (2009)

  31. Assessing the Value ofDiabetes Education, 2008 Tucker ME. Hospitalist News Digital Network, 2010-08-31 Duncan et al, The Diabetes Educator. 35:752-761 (2009)

  32. Assessing the Value ofDiabetes Education, 2008 Tucker ME. Hospitalist News Digital Network, 2010-08-31 Duncan et al, The Diabetes Educator. 35:752-761 (2009)

  33. The Impact of Diabetes EducationConclusions • Reduction in cost of care was driven by reducing admissions • Two or more DSMT/E sessions per year is better than 0 or 1 sessions per year • DSMT/E • Physicians refer to DSMT/E infrequently • Patients of physicians who refer to DSMT/E receive better care Duncan et al, The Diabetes Educator. 35:752-761 (2009)

  34. TREATMENT MODALITIES

  35. Assessing the Value ofDiabetes Education …in patients with significant diabetes complications

  36. Diabetes Education During Dialysis • Hemodialysis Patients • Educators met with patient during each dialysis visit • M-W-F: study group • T-R-S: control group (no education) • Peritoneal Dialysis Patients • Met with educator once a month McMurray SD, et al. Am J Kid Dis. 40:566-575 (2002)

  37. Diabetes Education During Dialysis McMurray SD, et al. Am J Kid Dis. 40:566-575 (2002)

  38. Diabetes Education During Dialysis McMurray SD, et al. Am J Kid Dis. 40:566-575 (2002)

  39. Diabetes Education During Dialysis McMurray SD, et al. Am J Kid Dis. 40:566-575 (2002)

  40. Diabetes Education During Dialysis McMurray SD, et al. Am J Kid Dis. 40:566-575 (2002)

  41. Diabetes Education During DialysisConclusions • Fewer Amputations • Fewer Hospitalizations • Better A1c McMurray SD, et al. Am J Kid Dis. 40:566-575 (2002)

  42. Medicare ReimbursementDiabetes Self Management TrainingMedical Nutrition Therapy Diabetes Education Services, Reimbursement Tips for Primary Care Practice Am Assoc Diab Educators, Revised February 2009

  43. Conclusions DSMT/E • is an underutilized treatment modality • improves Quality of Care • reduces the Cost of Care by reducing admissions

  44. Impact of Diabetes on Hospital Readmissions By attending this conference, the participant should be able to: • Name 3 of the measures in the National Committee for Quality Assurance (NCQA) Diabetes Recognition Program • Explain how diabetes education reduces the cost of care • Name the percentage of patients with diabetes that physicians refer to diabetes education

  45. Thank you James Desemone, MD Director, Medical Staff Quality Ellis Medicine

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