The Business of Hospital Care of Diabetic Patients: 2. A New Model for Inpatient Support Services

Abstract

What is the ideal model for inpatient diabetes support services in the present environment? How should organizations and financial systems be structured for the educational, counseling, and other support services relevant to the self-care of diabetes? At present, the only model that has official endorsement is the model for diabetes support services and education of the American Diabetes Association (ADA).1 As noted in the first article in this series,2 this model was designed for application in both the outpatient and inpatient environments. The changes that have occurred in the hospital care environment since the ADA Education Recognition Program (ERP) guidelines were originally designed in the early 1980s make this model inapplicable to today’s inpatient environment. At present, no other model is available to serve as a reference. One problem is a lack of definition regarding the characteristics and needs of diabetic inpatients. Available studies demonstrate that diabetic inpatients are usually hospitalized for complications of diabetes or for problems unrelated to their diabetes.3 Only a minority of diabetic admissions are caused by problems with glycemic control. Nevertheless, all or most hospitalized diabetic patients may require or benefit from diabetes support services regardless of the cause of admission.4 If the admission is related to issues with diabetes self-care or to problems in maintaining self-care for other related medical problems, such as hypertension, the need for diabetes support services is more clearly defined. Studies do suggest that patients who are admitted for issues involving glycemic control do represent a subpopulation that often requires the vigorous application of a variety of diabetes support services. The majority of these admissions are attributable to a minority of patients, who have repeated and multiple admissions for problems with diabetic crisis.5–7 Psychosocial, financial, and case management issues arise with these patients, …