Supporting Transitions in Care for Older Adults With Type 2 Diabetes Mellitus and Obesity.
Christina R Whitehouse, Nancy C Sharts-Hopko, Suzanne C Smeltzer and 1 others
PMID 29498747WHAT IT FOUND
At 30 days, rehospitalization did not differ among older adults with diabetes and obesity in the three groups.
At 90 days, education plus homecare had fewer rehospitalizations than usual care. A1C decreased with homecare. Groups were not randomized.
Key findings
01At 30 days after discharge, rehospitalization did not differ significantly among the three groups.
02At 90 days, rehospitalization differed by group: 10% of the education plus homecare group, 20% of the education only group, and 26.7% of the usual care group were rehospitalized.
03In the education plus homecare group, mean A1C was 9.8% at baseline, 7.5% at 90 days, and 7.7% at 12 months, with significant decreases from baseline to 90 days and baseline to 12 months.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Patients were not randomized. They were enrolled by convenience and chose whether to accept homecare. The homecare group was older and had higher baseline A1C than the education-only group, so the groups were not equivalent at baseline. Rehospitalizations outside the health system may not have been captured. A1C results were missing for some patients, reducing the sample used for A1C analysis. The number and duration of homecare visits varied and were not analyzed. Usual care patients may have received informal bedside diabetes education from nurses. Findings are limited to English-speaking patients in one urban health system and may not apply elsewhere.
The easy way to misread this
Do not read the 90-day difference or A1C decline as proof that homecare caused them. Patients chose whether to accept homecare, and the homecare group was older and had higher baseline A1C. The homecare group also received bedside education, continued home education, safety assessment, medication reconciliation, follow-up calls, contact information, and handouts, so the effect of any one part cannot be separated.