ORLANDO – Formal inpatient diabetes education can reduce hospital readmissions, a review of the literature suggested.
The education is most effective when it comes to helping patients understand discharge instructions and transition care, and when it involves an effort to improve health care literacy, Aiqun Liu, a registered nurse and certified diabetes educator at Barnes-Jewish Hospital at Washington University, St. Louis, reported at the annual meeting of the American Association of Diabetes Educators.
In 2008, about one in five hospitalizations was diabetes related, 20% of patients were readmitted within 30 days of discharge, and 26% were readmitted within 90 days, Ms. Liu found.
Most readmissions (87% in this review) are unplanned, and about 20% of the unplanned readmissions are potentially avoidable, she said.
Furthermore, these hospitalizations are a significant contributor to total health expenditures, accounting for nearly half of diabetes-related medical costs.
Health literacy is essential for successful self-care, but 15%-40% of patients with diabetes were found to have low health literacy, which is associated with less knowledge and skill with respect to self-management, more emergency department visits and hospital admissions, and poorer health outcomes, she said in an interview.
Based on 10 articles published between 2007 and 2013 that met prespecified search criteria, a number of educational strategies appear useful for improving health literacy and reducing readmissions, she said.
Focusing on discharge-related topics is particularly important. Such topics include blood glucose monitoring, medications, diet/nutrition, physical activity, warning signs that should prompt a call to the patient’s doctor, and lifestyle change related to illness.
Pharmacist-based interventions also were shown to be helpful and empowering. These included medication reconciliation, inpatient counseling, provision of simple adherence aids, and telephone follow-up after discharge, Ms. Liu noted.
Effective strategies for improving health literacy, self-care, and self-efficacy included pictograph-based discharge instructions, provision of health literacy– and numeracy-sensitive materials, clear communication between patients and providers, and use of the teach-back method to improve understanding and information retention.
The review also underscored the importance of transition care, providing patients with discharge instructions, appropriate prescriptions for diabetes medications and supplies, and making follow-up appointments proved most useful.
Individualized telephone follow-up after discharge is also important, Ms. Liu said.
In one study, formal inpatient diabetes education was associated with significantly reduced 30-day and 180-day readmission rates (P = .001 and .04, respectively).
The findings support the implementation of clinical protocols and interventions to support and improve health literacy; the use of literacy-sensitive materials and approaches to improve understanding of instructions and to enhance diabetes self-management; and training of health professionals regarding health literacy, numeracy, and clear communication techniques, she said, noting that additional research is needed to identify practical tools for improving health literacy in the inpatient setting.
Ms. Liu reported having no disclosures.