Abstract
Objective: To determine whether the Diabetes Inpatient Care and Education (DICE) programme, a whole systems approach to managing inpatient diabetes, reduces length of stay, in-hospital mortality and readmissions.
Research Design and Methods: DICE initiatives included identification of all diabetes admissions, a novel DICE carepathway, an online system for prioritising referrals, use of web-linked glucose meters, an enhanced diabetes team, and novel diabetes training for doctors. Patient Administration System data was extracted for patients admitted to Ipswich Hospital from January 2008 to June 2016. Logistic regression was used to compare binary outcomes (mortality, 30-day readmissions) 6 months before and after the intervention; generalized estimating equations were used to compare length of stay. Interrupted time series (ITS) analysis was performed over the full 7.5-year period to account for secular trends.
Results: Before and after analysis revealed a significant reduction in length of stay for patients with and without diabetes, relative ratio 0.89 (95%CI 0.83, 0.97) and 0.93 (0.90, 0.96), respectively. However, in ITS analysis the change in long-term trend for length of stay following the intervention was significant only for diabetes (p=0.017 vs p=0.48). Odds ratios for mortality were 0.63 (0.48, 0.82) and 0.81 (0.70, 0.93) in patients with and without diabetes, respectively; however, the change in trend was not significant in patients with diabetes while there was an apparent increase in patients without diabetes. There was no significant change in 30-day readmissions, but ITS analysis revealed a rising trend in both groups.
Conclusion: The DICE programme was associated with reduced length of stay in inpatients with diabetes beyond that observed in people without diabetes.
Research Design and Methods: DICE initiatives included identification of all diabetes admissions, a novel DICE carepathway, an online system for prioritising referrals, use of web-linked glucose meters, an enhanced diabetes team, and novel diabetes training for doctors. Patient Administration System data was extracted for patients admitted to Ipswich Hospital from January 2008 to June 2016. Logistic regression was used to compare binary outcomes (mortality, 30-day readmissions) 6 months before and after the intervention; generalized estimating equations were used to compare length of stay. Interrupted time series (ITS) analysis was performed over the full 7.5-year period to account for secular trends.
Results: Before and after analysis revealed a significant reduction in length of stay for patients with and without diabetes, relative ratio 0.89 (95%CI 0.83, 0.97) and 0.93 (0.90, 0.96), respectively. However, in ITS analysis the change in long-term trend for length of stay following the intervention was significant only for diabetes (p=0.017 vs p=0.48). Odds ratios for mortality were 0.63 (0.48, 0.82) and 0.81 (0.70, 0.93) in patients with and without diabetes, respectively; however, the change in trend was not significant in patients with diabetes while there was an apparent increase in patients without diabetes. There was no significant change in 30-day readmissions, but ITS analysis revealed a rising trend in both groups.
Conclusion: The DICE programme was associated with reduced length of stay in inpatients with diabetes beyond that observed in people without diabetes.
| Original language | English |
|---|---|
| Journal | Diabetic Medicine |
| Early online date | 2 Jul 2019 |
| DOIs | |
| Publication status | E-pub ahead of print - 2 Jul 2019 |
Access to Document
- Funke_Akiboye_The_impact_of_the_Diabetes_Inpatient_Care_and_Education_(DICE)_project_on_length_of_stay_and_mortality_Diabetic_Medicine_2019
Checked for eligibility: 21/06/2019 This is the accepted manuscript for a forthcoming publication in Diabetic Medicine.
- Funke_Akiboye_The_impact_of_the_Diabetes_Inpatient_Care_and_Education_(DICE)_project_on_length_of_stay_and_mortality_Diabetic_Medicine_2019_supplement
This is the peer reviewed version of the following article: Akiboye, F, Adderley, N, Martin, J, Gokhale, K, Rudge, G, Marshall, T, Rajendran, R, Nirantharakumar, K & Rayman, G 2019, 'The impact of the Diabetes Inpatient Care and Education (DICE) project on length of stay and mortality', Diabetic Medicine. https://doi.org/10.1111/dme.14062 which has been published in final form at https://onlinelibrary.wiley.com/doi/full/10.1111/dme.14062. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.