Associations Between Postdischarge Care and Cognitive Impairment-Related Hospital Readmissions for Ketoacidosis and Severe Hypoglycemia in Adults With Diabetes.

Autor:	Wang Y; Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL.; Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, FL., Jiao T; Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL.; Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, FL., Muschett MR; Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL.; Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, FL., Brown JD; Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL.; Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, FL., Guo SJ; Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL.; Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, FL., Kulshreshtha A; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA., Zhang Y; Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY., Winterstein AG; Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL.; Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, FL., Shao H; Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL.; Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, FL.; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA.; Hubert Department of Global Health, Rollin School of Public Health, Emory University, Atlanta, GA.
Jazyk:	angličtina
Zdroj:	Diabetes care [Diabetes Care] 2024 Feb 01; Vol. 47 (2), pp. 225-232.
DOI:	10.2337/dca23-0013
Abstrakt:	Objective: Patients with severe hypoglycemia (SH) or diabetic ketoacidosis (DKA) experience high hospital readmission after being discharged. Cognitive impairment (CI) may further increase the risk, especially in those experiencing an interruption of medical care after discharge. This study examined the effect modification role of postdischarge care (PDC) on CI-associated readmission risk among U.S. adults with diabetes initially admitted for DKA or SH. Research Design and Methods: We used the Nationwide Readmissions Database (NRD) (2016-2018) to identify individuals hospitalized with a diagnosis of DKA or SH. Multivariate Cox regression was used to compare the all-cause readmission risk at 30 days between those with and without CI identified during the initial hospitalization. We assessed the CI-associated readmission risk in the patients with and without PDC, an effect modifier with the CI status. Results: We identified 23,775 SH patients (53.3% women, mean age 65.9 ± 15.3 years) and 140,490 DKA patients (45.8% women, mean age 40.3 ± 15.4 years), and 2,675 (11.2%) and 1,261 (0.9%), respectively, had a CI diagnosis during their index hospitalization. For SH and DKA patients discharged without PDC, CI was associated with a higher readmission risk of 23% (adjusted hazard ratio [aHR] 1.23, 95% confidence interval 1.08-1.40) and 35% (aHR 1.35, 95% confidence interval 1.08-1.70), respectively. However, when patients were discharged with PDC, we found PDC was an effect modifier to mitigate CI-associated readmission risk for both SH and DKA patients (P < 0.05 for all). Conclusions: Our results suggest that PDC can potentially mitigate the excessive readmission risk associated with CI, emphasizing the importance of postdischarge continuity of care for medically complex patients with comorbid diabetes and CI. (© 2024 by the American Diabetes Association.)
Databáze:	MEDLINE
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