Date of Award

2017

Degree Name

PhD Nursing

Dissertation Committee

Linda D. Urden, DNSc, RN, CNS, NE-BC, FAAN, Chairperson; Kathleen Stacy, PhD, APRN, CNS; Kathy Marsh, PhD, RN, CNS

Keywords

Diabetes, diabetes education, DSME, Hemoglobin A1c, Readmisison

Abstract

Background: Hospital readmissions within 30 days of initial discharge occur frequently, but relatively limited research has focused on patients with diabetes. The problem of diabetes among hospitalized patients is significant, costly, and some are considered preventable. Unfortunately, there is relatively limited research focused on patients with diabetes to identify which aspect of disease management and patient care factors contribute to the costly and preventable readmissions.

Objective: The purpose of this study was to identify factors associated with 30-day hospital readmissions in patients with type II diabetes.

Methods: This retrospective descriptive correlational study involved abstracting 400 cases from the 2014-2015 electronic health records (EHRs) located in a Southern California urban hospital. The cases were hospitalized patients who were at least 65 years of age and older and were discharged from the acute inpatient setting with a type II diabetes regardless of their admitting diagnosis. Data abstracted from the EHR included demographic characteristics (age, gender, and race), hospital discharge disposition (home, skilled nursing facility, or rehabilitation center), clinical biomarker (Hemoglobin A1C), diabetes medications (oral, insulin, or both), disease management (whether the patient received Diabetes Self-Management Education [DSME] or was seen by an Endocrinologist), length of stay, and comorbidities. The modified Quality Health Outcomes Model was utilized and tested using logistic regression.

Results: Race, medications, Diabetes Self-Management Education (DSME), and comorbidities were found to be readmission predictors significantly associated with 30-day readmission in patients with type II diabetes who are at least 65 years of age.

Implications to Nursing: Findings from this study have important implications for policy development and nursing practice. Identification of the factors associated with 30-day readmission will enable the healthcare team to make better assessments and provide the best possible care to prevent preventable readmissions. It is recommended the study results be confirmed either prospectively or by another retrospective study in a different setting and with a larger sample size. Future prospective studies could also include other socioeconomic factors such as income, education, marital status, social support, and employment status, which are thought to be independent factors that could influence readmission.

Document Type

Dissertation: Campus Access Only

Department

Nursing

Available for download on Wednesday, July 17, 2019

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