INPATIENT DIABETES MANAGEMENT SERVICE, LENGTH OF STAY AND 30-DAY READMISSION RATE OF PATIENTS WITH DIABETES AT A COMMUNITY HOSPITAL.

Background: Diabetes mellitus is common among hospitalized patients. An inpatient diabetes management service (IDMS) was implemented at a community hospital in suburban Maryland to provide better glycemic control for inpatients.

Purpose: To analyze the length of stay (LOS) and 30-day readmission rate (30DR) of patients co-managed by an IDMS team.

Description: We retrospectively analyzed LOS and 30DR of patients with known diabetes admitted to a 240-bed community hospital between January 2016 and May 2017. To determine the significance of the data for LOS and 30DR, the relationship between study groups and outcome variables was assessed using Generalized Estimating Equation models.
4,654 patients with diabetes (70.8 ± 0.2 years old, 48.3% females) were admitted. The IDMS team was consulted on 18.3% of patients. Patients co-managed by the IDMS team were younger (median 67 vs. 73 years, p < 0.001), more likely to have type 1 diabetes (9.3% vs. 1.5%, p < 0.0001), and had higher severity of illness scores (51% vs. 39.9% had major illness score, p < 0.0001). Mean LOS in patients co-managed by the IDMS team decreased from 7.8 days to 5.7 days over time (27% reduction). Mean 30DR in patients co-managed by the IDMS team decreased over time from 25% to 14.29% (10.71% reduction). The median LOS was higher in patients co-managed by the IDMS team than the comparison group (5 days (interquartile range [IQR]=5) versus 3 days (IQR=3); p < 0.0001), however LOS decreased over time in the IDMS group (p = 0.046), while no significant LOS decrease was seen in the comparison group. Mean 30DR in patients co-managed by the IDMS team decreased over time from 25% to 14.29% (10.71% reduction). While 30DR were higher in patients co-managed by the IDMS team compared to the comparison group (14.8% versus 11.2%; p = 0.005), the 30DR also decreased among patients served by the IDMS team (p = 0.048).

Conclusions: While patients co-managed by the IDMS team had longer LOS and higher 30DR, over time, LOS and 30DR significantly decreased in patients co-managed by specialized diabetes team. We speculate that decreasing LOS and 30DR in patients with diabetes may have saved the study hospital more than $100,000 per month.