Intensive Discharge Intervention in Diabetes

Brigham and Women's Hospital180 enrolled

Overview

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.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

DOUBLE

Enrollment

180

Conditions

Type II Diabetes Cardiovascular Disease

Interventions

Intensive discharge interventionOTHER

The intervention is a multi-modal program consisting of the following: 1. Inpatient protocol for adjusting the discharge diabetes regimen; 2. Nurse practitioner "discharge advocate" to schedule follow-up appointments, prepare an after-hospital care plan, and patient education and counseling; 3. Inpatient pharmacist counseling (identifying and addressing previous barriers to medication adherence, performing enhanced medication reconciliation, and patient education); 4. Visiting nurse intervention after discharge; 5. Follow-up in a post-discharge clinic with the NP discharge advocate and pharmacist /certified diabetes educator within 3 days of discharge; 6. Telemonitoring of POC glucose levels to the study CDE, patient's PCP, or endocrinologist as appropriate; and 7. Follow-up with PCP or endocrinologist within 1 week of discharge.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

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 * Active cardiovascular disease * Likely to be discharged home, and one of the following: 1. prescribed insulin prior to admission 2. 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: 1. Discharge to a location other than home or rehabilitation (or to a caregiver's home) 2. Patient does not administer own medications and absence of a caregiver who lives with patient and administers all medications 3. Police custody, no telephone or homeless 4. Previous enrolment in the study within 90 days of discharge 5. Patient unable to communicate in either English or Spanish 6. Participation in the Integrated Care Management Program (iCMP)

Locations (1)

Brigham and Women's Hospital

Boston, Massachusetts, United States

Outcomes

Primary Outcomes

Cardiac medication adherence

Cardiac medication adherence as determined by patient self report 30 days after discharge

Time frame: 30 days after discharge

Secondary Outcomes

Glycemic control

Glycemic control as determined by change in A1c 90 days after discharge.

Time frame: 90 days after discharge

Emergency department visits

Emergency department visits within 30 days of discharge.

Time frame: Within 30 days after discharge

Number of self-reported hypoglycemic events

Number of self-reported hypoglycemic events within 30 days of discharge.

Time frame: Within 30 days of discharge

Number of patient-days with hypoglycemia

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

Time frame: Within 30 days of discharge

Cardiac medication adherence

Cardiac medication adherence as determined by pharmacy refill rates for 90 days after discharge.

Time frame: 90 days after discharge

Hospital Readmissions

Hospital readmissions within 30 days of discharge.

Time frame: Within 30 days of discharge

Data from ClinicalTrials.gov

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