ABSTRACT
OBJECTIVE: The objective of this study was to identify risk factors for 30-day readmission events for American Indian patients with diabetes in the southwest. RESEARCH DESIGN AND METHODS: Data from patients with diabetes admitted to Gallup Indian Medical Center between 2009 and 2016 were analyzed using logistic regression analyses. RESULTS: Of 2,660 patients, 394 (14.8%) patients had at least one readmission within 30 days of discharge. Older age (OR (95% CI) = 1.26, (1.17, 1.36)), longer length of stay (OR (95% CI) = 1.01, (1.0001, 1.0342)), and a history of substance use disorder (OR (95% CI) = 1.80, (1.25, 2.60)) were risk factors for 30-day readmission. An American Indian language preference was protective against readmission. CONCLUSIONS: Readmission events are complex and may reflect broad and interwoven disparities in community systems. Future research should work to support community-defined interventions to address both in hospital and external factors that impact risk factors for readmission.
Subject(s)
Diabetes Mellitus/ethnology , Indians, North American/statistics & numerical data , Patient Readmission/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Diabetes Mellitus/epidemiology , Female , Geography , Humans , Infant , Infant, Newborn , Length of Stay/statistics & numerical data , Male , Middle Aged , Patient Discharge/statistics & numerical data , Residence Characteristics/statistics & numerical data , Retrospective Studies , Risk Factors , Time Factors , Young AdultABSTRACT
OBJECTIVES: To evaluate the role of primary care healthcare delivery on survival for American Indian patients with diabetes in the southwest United States. METHODS: Data from patients with diabetes admitted to Gallup Indian Medical Center between 2009 and 2016 were analyzed using a log-rank test and Cox Proportional Hazards analyses. RESULTS: Of the 2661 patients included in analysis, 286 patients died during the study period. Having visited a primary care provider in the year prior to first admission of the study period was protective against all-cause mortality in unadjusted analysis (HR (95% CI)=0.47 (0.31, 0.73)), and after adjustment. The log-rank test indicated there is a significant difference in overall survival by primary care engagement history prior to admission (p<0.001). The median survival time for patients who had seen a primary care provider was 2322days versus 2158days for those who had not seen a primary care provider. CONCLUSIONS: Compared with those who did not see a primary care provider in the year prior to admission, having seen a primary care provider was associated with improved survival after admission.
Subject(s)
Cause of Death , Diabetes Mellitus/ethnology , Diabetes Mellitus/mortality , Indians, North American/statistics & numerical data , Primary Health Care/methods , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Child , Cohort Studies , Databases, Factual , Diabetes Mellitus/diagnosis , Diabetes Mellitus/therapy , Female , Hospitalization/statistics & numerical data , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Proportional Hazards Models , Retrospective Studies , Risk Assessment , Sex Factors , Southwestern United States , Statistics, Nonparametric , Survival Analysis , Young AdultABSTRACT
BACKGROUND: Alcohol dependence results in multiple hospital readmissions, but no discharge planning protocol has been studied to improve outcomes. The inpatient setting is a frequently missed opportunity to discuss treatment of alcohol dependence and initiate medication-assisted treatment, which is effective yet rarely utilized. AIM: Our aim was to implement and evaluate a discharge planning protocol for patients admitted with alcohol dependence. SETTING: The study took place at the San Francisco General Hospital (SFGH), a university-affiliated, large urban county hospital. PARTICIPANTS: Learner participants included Internal Medicine residents at the University of California, San Francisco (UCSF) who staff the teaching service at SFGH. Patient participants included inpatients with alcohol dependence admitted to the Internal Medicine teaching service. PROGRAM DESCRIPTION: We developed and implemented a discharge planning protocol for patients admitted with alcohol dependence that included eligibility assessment and initiation of medication-assisted treatment. PROGRAM EVALUATION: Rates of medication-assisted treatment increased from 0% to 64% (p value < 0.001). All-cause 30-day readmission rates to SFGH decreased from 23.4% to 8.2% (p value = 0.042). All-cause emergency department visits to SFGH within 30 days of discharge decreased from 18.8% to 6.1% (p value = 0.056). DISCUSSION: Through implementation of a discharge planning protocol by Internal Medicine residents for patients admitted with alcohol dependence, there was a statistically significant increase in medication-assisted treatment and a statistically significant decrease in both 30-day readmission rates and emergency department visits.
