Diagnosing diabetes and preventing rehospitalizations - The urban diabetes study

Background: Patients with diabetes frequently are hospitalized, and quality of inpatient care for diabetes is of great concern. Rehospitalization after hospital discharge is a frequent adverse outcome experienced by patients with diabetes. Objectives: We assessed the frequency of and risk factors for rehospitalization among all Philadelphia residents with diabetes. Methods: Individual histories of hospitalization were ascertained from hospital discharge summaries for Philadelphia residents ages 25-84 who had at least 1 diabetes hospitalization from 1994 through 2001. Logistic regression was used to assess predictors of nonelective rehospitalization within 30 days of discharge, including recording of diabetes diagnosis. Results: Nonelective rehospitalizations within 30 days of hospital discharge were ascertained for 58,308 (20.0%) of 291,752 discharges. The proportion rehospitalized was 9.4% after a patient's first diabetes diagnosis hospitalization; after later discharges for which a diabetes diagnosis was not recorded, rehospitalizations occurred in 30.6% of all cases. The absence of a diabetes diagnosis was a highly significant predictor of rehospitalization after adjustment for age, year, gender, race/ethnicity, insurance status, admission type, severity code, length of stay, discharge status, and number of previous hospitalizations. Conclusion: Failure to record a diabetes diagnoses in administrative hospital discharge data may reflect lack of attention to the critical needs of patients with diabetes who are being treated for other conditions, whereas the attention to patient education and follow-up planning for patients with incident diabetes diagnoses may reduce the risk of rehospitalization.