The Role of Hemoglobin A1c on Readmission Rates for Patients with Diabetes

Presentation Number: MON 629
Date of Presentation: April 3rd, 2017

Hirva Bakeri*1, Dorothy Wakefield2 and Latha Dulipsingh3
1University of Connecticut, CT, 2University of Connecticut, 3Saint Francis Hospital and Medical Center, Hartford, CT, CT

Abstract

Hospital readmission is an indicator of quality of care and plays a significant role in total medical cost. Diabetes Mellitus (DM) is associated with an increased risk of hospital complications and readmission. Hemoglobin A1c (HbA1c) is a measure of the mean glucose level over the previous 2–3 months, and is a reflection of the efficacy of therapies that the patient is undergoing. Glycemic control in the outpatient as well inpatient setting may facilitate sustained glycemic control post-discharge and reduce hospitalizations. We hypothesize that HbA1c values can predict hospital readmission rates. We retrospectively collected data on patients admitted to Saint Francis Hospital Medical Center (SFHMC) with either primary or secondary diagnosis of diabetes from Oct. 1st, 2014-Sept. 30th 2015. We gathered data from 5128 patients. Information was extracted from the database for encounters that satisfied the following criteria: Patients admitted to SFHMC with the diagnosis of DM with a hospital length of stay of at least 1 day and had a HbA1C value in the electronic medical record (EMR). There were 7,573 discharges with a primary (6%) or secondary diagnosis (94%) of DM from SFHMC for 5,128 unique patients. Of these, there were 970 unique patients with 30-day readmissions. The number of 30-day readmissions per patients ranged from 1 to 4. Approximately 5.5% of the readmissions had a primary diagnosis of DM. Of the 970 patients with 30-day readmissions, 394 (40.6%) had HbA1c testing during the hospitalization or within 60 days prior to the initial admission. Of the 4158 patients without readmissions, 1616 (39%) of them had a HbA1c done. There was no difference in the average HbA1c values between the group that was readmitted and those that were not ((7.7% vs 7.6%), p = 0.33). The testing rate was no different among those with a primary diagnosis of DM compared to those with a secondary diagnosis of DM (47.8% vs 40.1%, p=0.22). Of the 394 readmitted patients with HbA1c testing at the initial admission, 23 (5.8%) were readmitted with a primary diagnosis of DM. The patients who were readmitted with a primary diagnosis of DM had a higher HbA1c value than those with a secondary diagnosis of diabetes (mean=9.3% (SD=2.6) vs mean=7.5% (SD=2.0), p=0.004). The primary finding in our study is that the HbA1c was an accurate predictor of readmission rates in patients readmitted with a primary diagnosis of DM than those admitted with secondary diagnosis of DM. In conclusion, measurement of HbA1c for patients with either a primary or secondary diagnosis of diabetes mellitus is useful in the hospital setting, not only to help with coordination of care but also as a predictor of readmission rates and may be associated with potentially preventable costs and improvement in patient safety.

 

Nothing to Disclose: HB, DW, LD