Hospital Readmissions among Commercially Insured and Medicare Advantage Beneficiaries with Diabetes and the Impact of Severe Hypoglycemic and Hyperglycemic Events

  • Rozalina G. McCoy
  • Kasia J. Lipska
  • Jeph Herrin
  • Molly M. Jeffery
  • Harlan M. Krumholz
  • Nilay D. Shah
Original Research

Abstract

Background

Hospital readmission is common among patients with diabetes. Some readmissions, particularly for hypoglycemia and hyperglycemia, may be avoidable with better care transitions and post-discharge management.

Objective

To ascertain the most common reasons and risk factors for readmission among adults with diabetes, with specific consideration of severe dysglycemia.

Design

Retrospective analysis of data from the OptumLabs Data Warehouse, an administrative data set of commercially insured and Medicare Advantage beneficiaries across the U.S.

Participants

Adults ≥18 years of age with diabetes, discharged from a hospital between January 1, 2009, and December 31, 2014 (N = 342,186).

Main Measures

Principal diagnoses and risk factors for 30-day unplanned readmissions, subset as being for severe dysglycemia vs. all other causes.

Key Results

We analyzed 594,146 index hospitalizations among adults with diabetes: mean age 68.2 years (SD, 13.0), 52.9% female, and 67.8% white. The all-cause 30-day readmission rate was 10.8%. Heart failure was the most common cause for index hospitalization (5.5%) and readmission (8.9%). Severe dysglycemia accounted for 2.6% of index hospitalizations (48.1% hyperglycemia, 50.4% hypoglycemia, 1.5% unspecified) and 2.5% of readmissions (38.3% hyperglycemia, 61.0% hypoglycemia, 0.7% unspecified). Younger patient age, severe dysglycemia at index or prior hospitalization, and the Diabetes Complications Severity Index (DCSI) were the strongest risk factors predisposing patients to severe dysglycemia vs. other readmissions. Prior episodes of severe dysglycemia and the DCSI were also independent risk factors for other-cause readmissions, irrespective of the cause of the index hospitalization.

Conclusions

Adults with diabetes are hospitalized and readmitted for a wide range of health conditions, and hospitalizations for severe hypoglycemia and hyperglycemia remain common, with high rates of recurrence. Severe dysglycemia is most likely to occur among younger patients with multiple diabetes complications and prior history of such events.

KEY WORDS

diabetes epidemiology readmissions hospital medicine hypoglycemia hyperglycemia health services research risk assessment 

Supplementary material

11606_2017_4095_MOESM1_ESM.docx (64 kb)
ESM 1(DOCX 63 kb)

Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • Rozalina G. McCoy
    • 1
    • 2
    • 3
  • Kasia J. Lipska
    • 4
  • Jeph Herrin
    • 5
    • 6
  • Molly M. Jeffery
    • 2
    • 3
  • Harlan M. Krumholz
    • 5
    • 7
    • 8
    • 9
  • Nilay D. Shah
    • 2
    • 3
    • 10
  1. 1.Division of Primary Care Internal Medicine, Department of MedicineMayo ClinicRochesterUSA
  2. 2.Division of Health Care Policy & Research, Department of Health Sciences ResearchMayo ClinicRochesterUSA
  3. 3.Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryRochesterUSA
  4. 4.Section of Endocrinology, Department of Internal MedicineYale School of MedicineNew HavenUSA
  5. 5.Section of Cardiovascular Medicine, Department of Internal MedicineYale School of MedicineNew HavenUSA
  6. 6.Health Research and Educational TrustChicagoUSA
  7. 7.Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal MedicineYale School of MedicineNew HavenUSA
  8. 8.Center for Outcomes Research and EvaluationYale New Haven HealthNew HavenUSA
  9. 9.Department of Health Policy and ManagementYale School of Public HealthNew HavenUSA
  10. 10.OptumLabsCambridgeUSA

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