IDID: Intensive Discharge Intervention in Diabetes
Study Details
Study Description
Brief Summary
The goal of this study is to design and implement an intensive discharge intervention for inpatients with type 2 diabetes and cardiovascular disease, and determine the effects of the intervention on post-discharge insulin adherence, glycemic control, cardiac medication adherence, hypoglycemic events, and emergency department visits and hospital readmissions.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Intensive discharge intervention The intervention is a multi-modal program consisting of the following: Inpatient protocol for adjusting the discharge diabetes regimen; Nurse practitioner "discharge advocate" to schedule follow-up appointments, prepare an after-hospital care plan, and patient education and counseling; Inpatient pharmacist counseling (identifying and addressing previous barriers to medication adherence, performing enhanced medication reconciliation, and patient education); Visiting nurse intervention after discharge; Follow-up in a post-discharge clinic with the NP discharge advocate and pharmacist /certified diabetes educator within 3 days of discharge; Telemonitoring of POC glucose levels to the study CDE, patient's PCP, or endocrinologist as appropriate; and Follow-up with PCP or endocrinologist within 1 week of discharge. |
Other: Intensive discharge intervention
The intervention is a multi-modal program consisting of the following:
Inpatient protocol for adjusting the discharge diabetes regimen;
Nurse practitioner "discharge advocate" to schedule follow-up appointments, prepare an after-hospital care plan, and patient education and counseling;
Inpatient pharmacist counseling (identifying and addressing previous barriers to medication adherence, performing enhanced medication reconciliation, and patient education);
Visiting nurse intervention after discharge;
Follow-up in a post-discharge clinic with the NP discharge advocate and pharmacist /certified diabetes educator within 3 days of discharge;
Telemonitoring of POC glucose levels to the study CDE, patient's PCP, or endocrinologist as appropriate; and
Follow-up with PCP or endocrinologist within 1 week of discharge.
|
| No Intervention: Usual Care Patients in the control arm of this study receive usual care. |
Outcome Measures
Primary Outcome Measures
- Cardiac medication adherence [30 days after discharge]
Cardiac medication adherence as determined by patient self report 30 days after discharge
Secondary Outcome Measures
- Glycemic control [90 days after discharge]
Glycemic control as determined by change in A1c 90 days after discharge.
- Emergency department visits [Within 30 days after discharge]
Emergency department visits within 30 days of discharge.
- Number of self-reported hypoglycemic events [Within 30 days of discharge]
Number of self-reported hypoglycemic events within 30 days of discharge.
- Number of patient-days with hypoglycemia [Within 30 days of discharge]
Number of patient-days with hypoglycemia (point-of-care glucose less than 70 mg/dL) or with severe hypoglycemia (less than 40 mg/dL) within 30 days of discharge
- Cardiac medication adherence [90 days after discharge]
Cardiac medication adherence as determined by pharmacy refill rates for 90 days after discharge.
- Hospital Readmissions [Within 30 days of discharge]
Hospital readmissions within 30 days of discharge.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Adult inpatients at BWH on the medicine or cardiology services with a primary care physician who belongs to a participating practice or has not explicitly opted out of the study
-
Type 2 diabetes
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Active cardiovascular disease
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Likely to be discharged home, and one of the following:
-
prescribed insulin prior to admission
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prescribed two oral agents and with an A1c > 8.0 within 30 days of admission. - Practices that have already agreed to participate in this study for all their eligible patients.
Exclusion Criteria:
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Discharge to a location other than home or rehabilitation (or to a caregiver's home)
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Patient does not administer own medications and absence of a caregiver who lives with patient and administers all medications
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Police custody, no telephone or homeless
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Previous enrolment in the study within 90 days of discharge
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Patient unable to communicate in either English or Spanish
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Participation in the Integrated Care Management Program (iCMP)
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Brigham and Women's Hospital | Boston | Massachusetts | United States | 02115 |
Sponsors and Collaborators
- Brigham and Women's Hospital
- Sanofi
Investigators
- Principal Investigator: Jeffrey L Schnipper, MD, MPH, FHM, Brigham and Women's Hospital
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 2010A056508
- 2011-P-000217