56 A Novel Transitional Care Strategy Improving Health Care Utilization in Diabetes Patients

Abstract

Diabetes is a common chronic disease requiring regular primary care physician (PCP) clinic visits to prevent diabetes-associated complications. Noncompliance of PCP follow-up occurs frequently among chronic diabetic patients. A novel transitional care plan was established in a hospital urgent care center (UCC) adjacent to an emergency department (ED) with the goal of increasing PCP compliance. We aim to investigate the quality improvement role of implementing this novel transitional care strategy. All patients with new-onset diabetes or history of diabetes were enrolled from April 6, 2015 through October 1, 2017. Enrolled patients followed the transitional care protocol; upon disposition, a follow-up PCP clinic appointment was scheduled and given to the patient before discharge. Each patient was also advised to return to diabetic transitional care (within the UCC), if they were unable to keep their PCP appointment. The number of PCP clinic visits, diabetic transitional care visits and ED visits were compared before and after the intervention. The association between PCP clinic/ED visits and such intervention were investigated in a linear multivariate regression model. The number of PCP clinic visits before and after the intervention was compared using paired student t-test. A total of 12,226 patient encounters were included. The average number of PCP clinic visits per patient within 12 months before the intervention was 1.75, in comparison to 2.58 post-intervention PCP clinic visits, after adjusting for the same follow-up duration (p<0.001). The number of PCP visits increased (point estimate=0.015, 95% CI0.006-0.024) and the number of ED visits decreased (point estimate= -0.012, 95% CI -0.018 to -0.007), with the increased number of transitional care visits in a multivariate regression analysis. Additionally, 68% of patients kept their PCP appointment after the transitional care visit. However, this percentage decreased with increased intervals between the initial transitional care and subsequent PCP clinic appointments. A novel diabetic transitional care strategy increased patient compliance for PCP follow-up visits and decreased the number of ED visits. However, patient PCP follow-up compliance decreased with an increased interval between transitional care and subsequent PCP clinic appointments.