Diabetes Patient Readmission: Qualitative Study Analysis

Introduction: The Scope of Diabetic Patient Readmission

Readmission of patients with diabetes is a problem that warrants careful consideration of its contributing factors. Readmission within 30 days of discharge is considered an indicator of healthcare quality — along with other circumstances, such as patient lifestyle — that must be addressed from both a patient care perspective and a cost-of-care perspective (Dungan, 2012). A striking statistic represents the scale of the problem: roughly 8% of the U.S. population consists of patients with diabetes, yet this group accounts for 23% of all hospitalizations in the nation (Dungan, 2012). Compounding this disparity, between 14.4% and 21% of diabetic patients are readmitted, compared to 8.5%–13.5% of U.S. hospital patients overall (Dungan, 2012).

The problem is further exacerbated by rising national rates of diabetes, which means that more patients will present from the general population and, accordingly, more patients with diabetes will experience readmission — unless the cycle of admission and readmission is prevented and absolute numbers are reduced.

Research Design and Qualitative Methodology

Rubin et al. (2014) explored the causes of readmission that occurred within 30 days of discharge among diabetic patients, a phenomenon the researchers refer to as early readmission. The purpose of the qualitative research was to understand the conditions that led to readmission from the perspective of patients with diabetes, with an emphasis on "aspects of the inpatient to outpatient transition of care" (Rubin et al., 2014, p. 1). The research question is broadly stated and lends itself well to qualitative inquiry, as the study is grounded in the qualitative tradition of personal accounts (interviews) and the philosophical orientation of epistemology: the study of knowledge.

The study was designed to circumvent the constraints of previous research that depended upon retrospective data, lacked clinical evidence, and was restricted to a "primary discharge diagnosis of diabetes," confirmed through a review of hospital records (Rubin et al., 2014, p. 2). Subjects were included if they met the following criteria: English-speaking patients with diabetes who had been readmitted within 30 days of discharge and were at least 18 years of age. Participants were selected from a large urban academic medical center in Philadelphia, Pennsylvania. A diagnosis of diabetes was established through an ICD-9-CM code of 250.xx, self-report, or outpatient use of a diabetes-specific medication. The list of potential participants — excluding obstetrics patients — was generated through an electronic medical record system. Of the original sampling frame, six patients declined to participate and one record was lost, resulting in a final sample of 20 participants interviewed between September 2012 and February 2013. These procedures are consistent with qualitative research methodology.

References

Donnell-Jackson, K., Jhingan, R. M., & Rubin, D. J. (2013). Early readmissions among hospitalized patients with diabetes: A qualitative assessment of contributing factors. Paper presented at Diabetes: Diagnosis, Complications & Outcomes, The Endocrine Society's 95th Annual Meeting and Expo, June 15–18, 2013, San Francisco, California.

Dungan, K. M. (2012, September). The effect of diabetes on hospital readmissions. Journal of Diabetes Science and Technology, 6(5), 1045–1052. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3570838/

Dye, J. G., Schatz, I. M., Rosenberg, B. A., & Coleman, S. T. (2000, January). Constant comparison method: A kaleidoscope of data. The Qualitative Report, 4(1/2).

Hellman, R. (2014, October). An individualized inpatient diabetes education and hospital transition program for poorly controlled hospitalized patients with diabetes. Endocrine Practice, 20(10), 1097–1099.

Polit, D. F., & Beck, C. T. (2012). Ethics in nursing research. In Nursing research: Generating and assessing evidence for nursing practice (9th ed., Chapter 7). Lippincott Williams & Wilkins.

Rubin, D., Donnell-Jackson, K., Jhingan, R., Golden, S. H., & Paranjape, A. (2014, November). Early readmission among patients with diabetes: A qualitative assessment of contributing factors. Journal of Diabetes and Its Complications, 28(6), 869–873.