1251-P: The Diabetes Transition of Hospital Care (DiaTOHC) Pilot Study: A Randomized Controlled Trial of an Intervention Designed to Reduce Readmission Risk of Patients with Diabetes

Abstract

Hospital readmission within 30 days of discharge (30dRe) is a high-priority quality measure and target for cost reduction. Patients with diabetes are at higher risk of 30dRe than patients without diabetes. There have been no published studies of interventions designed to reduce 30dRe risk specifically among diabetes patients. We conducted a pilot randomized controlled trial (RCT) of the DiaTOHC intervention in adult patients with diabetes admitted to any medical-surgical unit at Temple University Hospital between 10/2017 and 12/2018. Patients predicted to be high risk (>=27%) for 30dRe based on a validated tool (DERRITM) were randomized 1:1 to the intervention (INT) or usual care (UC). The intervention consisted of novel, brief inpatient diabetes education, coordination of care, and post-discharge support by a nurse practitioner and an A1C-based algorithm to adjust diabetes therapy. Patients received weekly calls for 30 days after discharge. The primary outcome was unplanned 30dRe. Follow-up data was available for 26 INT and 30 UC patients. Mean age was 57.5 years, duration of diabetes 17 years, and median admission A1C 7.9%. The cohort was 75% black, 20% white, 13% Hispanic, 55% female, mostly low-income, and mostly insured by Medicare and/or Medicaid. Most patients (95%) had type 2 diabetes. There were few baseline differences between groups, including years of school (13.5 INT, 11.9 UC, p=0.03) and preadmission insulin use (59.6% INT, 40.4% UC, p<0.01). Six INT and 10 UC patients had a 30dRe (23.1%, 33.3%, P=0.40), yielding a non-significant relative risk reduction of 30.6%, absolute risk reduction of 10.2% and number needed to treat of 10. Median A1C at 3 months among the 18 patients with data was 6.7% INT and 8.4% UC, p=0.19. This small pilot trial shows the DiaTOHC intervention is feasible. The non-significant but measurable reductions in readmission risk and A1C merit further investigation in a larger RCT. Disclosure D.J. Rubin: Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc. S. Golden: Research Support; Self; Merck & Co., Inc. G. Foster: Employee; Self; Weight Watchers International, Inc. S. Fisher: None. C. Vaz: None. H. Zhao: None. S. Tanner: None. D. Recco: None. M. Tivon: None. F.R. Dillard: None. S. Watts: None. K.E. Joyce: None. A. Karunakaran: None. T. Reznick: None. A. Iwamaye: None. E. Miller: None. C. Mathai: None. B.S. Albury: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K23DK102963 to D.J.R.)