Relationship Of Diabetes Education With Readmission Rates Discussion
Relationship Of Diabetes Education With Readmission Rates Discussion
Diabetes is a metabolic condition or illness that is characterized by high blood sugar. The disease is emerging as of critical public health importance across the world. For instance, the International Diabetes Federation (IDF) statistics for 2021 an estimated 537 million people are suffering from diabetes (Kozioł et al., 2021). The numbers are projected to increase to about 643 million in 2030 and over 780 million by 2045 (Kozioł et al., 2021). Further, it is estimated that about 9.3% of the people in the United States suffer from diabetes mellitus whereas 28% remain undiagnosed (Faridani et al., 2021)Relationship Of Diabetes Education With Readmission Rates Discussion. In the UK the prevalence of diabetes between 2012 and 2018 increased by over 20% (Hussain, 2020). Chronic high blood sugar or hyperglycemia among patients that have poorly controlled diabetes end up suffering from damaged systems and organs. When the systems and organs are affected the illness further affects the quality of life through chronic diabetes complications. Such patients present with higher readmission rates compared to those without a history of diabetes. In addition, these readmissions cause longer hospital stays and also increased in-hospital readmission rates. The increasing readmission greatly increases related rehospitalization that ends up increasing indirect and direct costs of healthcare. The rising rates of diabetes are at an alarming rate, however, there is a need to establish the relationship between diabetes education and the readmission rates.
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Title
The title is well-framed and uses simple terms that are easy to understand. It directly guides and directs the reader about the study and the contents to be discussed. The title is specific to the target population which is the inpatients with diabetes. Through the title is also evident that the dependent variables or the clinical outcomes are directly brought out which include readmission rates, mortality rates, and length of stay (LOS). The relationship was not critically felt through the title but is effectively discussed in the subsequent sections. Overall, I feel the title is appropriate as it captures the reader’s attention concerning the area of study. Relationship Of Diabetes Education With Readmission Rates Discussion
Abstract
The abstract is well structured and begins by giving the background of the study regarding the experiences of diabetic patients with regard to readmission, inpatient stay, and mortality rates. The objective of the study is clearly stated which is determining the effectiveness of inpatient diabetes education (IDE) to the patients and its impacts on readmissions and length of stay. Methods of study are well brought out and depended on searches of databases such as MEDLINE, CINAHL, EMBASE, BNI, and PubMed. Search criteria used key terms including mortality, readmission, ‘LOS’, and ‘IDE’ to acquire the required literature. Results of the study used about eight studies in total that had achieved inclusion criteria and a total of 3, 828 participants took part. The LOS outcomes were evaluated using the seven studies where the median LOS was 26.67% while the mean LOS was 16.5% which were all lower when compared to the IDE group. The readmission rates were found to be lower by 15.9% for the IDE patients compared to the non-IDE patients. Also, results showed mortality reduced by 36.6% to the IDE patients when compared with the non-Ide group. The concluding remarks from the abstract are that the study depicted the importance of the IDE program in reducing readmission, mortality, and length of stay. I feel that the abstract is strongly developed and structured and presently briefly every other part of the study and the reader is able to get a vivid picture of the entire study from the background, methods, and results to a conclusion. Relationship Of Diabetes Education With Readmission Rates Discussion
Introduction
The introduction section is perfectly done. The study is able to capture important data about t prevalence of diabetes in the UK and starts by showing the growing concern for this disease. However, there is little information about the regional and global prevalence of the disease which would have given the reader a better understanding of the importance of this study. However, the introduction provides important information about the negative effects of diabetes on patients, families, and the nation at large. For example, it is stated that an estimated 13 billion pounds were spent in 2012 by the National Health Service (NHS) in managing diabetes-related issues. The introduction brings out in a clear manner the importance of inpatient diabetes education in reducing readmission rates. For instance, the benefits of IDE are stated as one that helps in reinforcing the patients’ understanding and knowledge of diabetes management skills outside the normal healthcare setting. Additionally, the introduction part gave the core elements of IDE to patients including correct insulin administration, identifying classic signs of dysglycaemia, and being aware of the most appropriate treatment. The introduction was superb even though it left out some crucial data on diabetes both from the regional and global perspectives. I feel that the introduction was comprehensive and satisfies the readers’ approach to the art of the study.
Review of literature
The study has no specific section on the literature review. However, there is huge information from other authors that are based on literature and provides diverse opinions and ideas of other authors concerning the topic of study. The study has used 42 sources that range from 1997-2020. The sources are appropriate as many are recent ones from 2009 hence making the study viable in terms of addressing emerging issues. In addition, the sources are well cited throughout the paper using the right manner and capture every piece of information that has been reviewed by specific authors. I feel that the sources and the literature used are well assimilated throughout the study and this makes the different parts of the study flow and readability.
Sample
The sample size for the study was gotten from five bibliographical databases including BNI, PubMed, EMBASE, MEDLINE, and CINAHL. The literature search was done electronically to the five databases in relation to readmission, mortality rates, and LOS. Studies used were independently selected to eliminate any aspect of bias the participants recruited were only those over 18 years and who were suffering from diabetes. At the start an estimated 1, 609 articles including PubMed 135, MEDLINE 257, EMBASE 1, 015, CINAHL 179, and BNI 23 were selected using electronic search systems. After screening only 8 articles were found relevant to the study. The sample size for the 8 articles was 3, 828 participants. I feel that the sample size was adequate for this study and for the generalization of the results.
Instrumentation
An electronic system was used to make the search for the articles to be used and also to screen and filter the most appropriate ones. Findings from selected studies were extracted and presented using a table format. The findings were presented into two categories including study results and characteristics. Descriptive and demographic profiles including age, gender, study design, demographic, and time of intervention were used. Also, narrative synthesis was used in the discussion of the results while PRISMA-Preferred reporting items for systematic reviews and meta-analysis tool were applied. I feel the instruments used were efficient in data collection and analysis and in ensuring valid findings were presented. Relationship Of Diabetes Education With Readmission Rates Discussion
Experimental procedures
The evaluation procedure considered the critical areas in the study including the readmission rates, length of stay, and mortality rates. The quality of the methodology of the selected studies was independently done and assessed by the author through the use of the Cochrane Handbook used in the systematic review. Also, the risk of bias was eliminated using the Cochrane Review Manager software of version 5.3 Copenhagen. I feel that these procedures were effective in this study as they helped eliminate bias emanating from the articles used.
Results
The results found out that there was a reduction of 15% in the readmission rates in the IDE patients compared to the non-IDE patients. The mortality rates were also found to be lower by 36.6% for the IDE patients’ compared to the non-IDE patients. Additionally, the length of stay was found to be lower after median calculation by 26.67% in the IDE patients’ compared to the non-IDE patients. The results were clear and were presented using the mean and medium calculations. I feel that the study was straight to the point and evaluated the three main clinical outcomes in relation to the IDE.
Discussion
The discussion synthesized all the results and findings of the study concerning the effects of IDE on readmission rates, LOS, and mortality rates. For instance, giving education to diabetes patients’ had indicated a positive influence on reducing LOS. In addition, one study was involved in the evaluation of mortality rates among the IDE group. The results indicated that inpatients who received IDE showed lower mortality rates compared to non-IDE patients. The discussion evaluated the nature of readmission and showed that inpatients exposed to IDE had less readmission rates which are attributed to improved skills by patients from this education. The discussion is an interesting one and depicts the ideal nature and importance of IDE to inpatients towards reducing readmission, mortality rates, and length of stay. I feel that the study is worthwhile and influential in determining the importance of inpatient diabetes education (IDE)Relationship Of Diabetes Education With Readmission Rates Discussion.
Primary source
Hussain, Zeeshan & Alkharaiji, Mohammed & Idris, Iskandar. (2020). Evaluating the effect of inpatient diabetes education on length of stay, readmission rates, and mortality rates: a systematic review. British Journal of Diabetes. 20. 10.15277/bjd.2020.256.
References
Faridani, L., Abazari, P., Heidarpour, M., Melali, H., & Akbari, M. (2021). The effect of home care on readmission and mortality rate in patients with diabetes who underwent general surgeries. Journal of education and health promotion, 10, 418. https://doi.org/10.4103/jehp.jehp_81_21
Kozioł, M., Towpik, I., Żurek, M., Niemczynowicz, J., Wasążnik, M., Sanchak, Y., Wierzba, W., Franek, E., & Walicka, M. (2021). Predictors of Rehospitalization and Mortality in Diabetes-Related Hospital Admissions. Journal of clinical medicine, 10(24), 5814. https://doi.org/10.3390/jcm10245814
Obesity is characterized by a body mass index (BMI) of greater than or equal to the 95th percentile and currently affects nearly 17% of children and adolescents in the United States. Causes of childhood obesity are very similar to those of an adult, including behavioral factors, genetics, and community factors. Obesity is not just about being “larger in size” compared to others their age. Obesity represents a picture of an individual’s overall health and can significantly impact their current and future health. According to the Centers for Disease Control and prevention (2018), children who have obesity are more likely to have hypertension, high cholesterol, cardiovascular disease (CVD), type 2 diabetes, asthma, sleep apnea, joint and musculoskeletal discomfort, fatty liver, gallstones, GERD, psychological illnesses, self-esteem problems, social problems, and adult obesity. To promote better health for our future generations, we must gain control of childhood obesity. The U.S. Preventive Services Task Force (USPSTF) (2017)Relationship Of Diabetes Education With Readmission Rates Discussion, recommends all children from six to eighteen years of age be screened for obesity, and to be provided appropriate and effective interventions when necessary. This study not only evaluated multiple physicians screening practices, but it also looked to see if these physicians met the proper guidelines to refer patients who screened positive.
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Title
The title of this article was specific and appropriately guided the reader to understand what the report would be discussing, free of jargon. The overall nature of the topic was addressed without revealing the results to the reader. The primary variables, such as screening and treatment practices, were detectable through the title. By identifying ‘childhood obesity’, I feel that the specific population, the pediatric population, was immediately identifiable. Causality was not recognizable by the title but was mentioned later in the abstract. Overall, I do feel that the title was sufficient and appropriate in guiding the reader as to what the study would be discussing.
Abstract
The purpose of the study was clearly stated in the first sentence of the abstract. Immediately following, the authors began to explain their methodology of research. For this research in particular, the authors delivered a 26-question questionnaire to pediatric providers, the majority of which were in primary clinics. Approximately 57 providers completed the survey, which provided us with the sample size. The abstract then begins to yield the study results. Of the pediatricians that participated in the survey, 88% of the providers screened for obesity, but only 7% met the guidelines for referring patients who had a positive screening for obesity for appropriate weight management. It then starts to explain that of these 57 providers, only six offered appropriate interventions. The barriers to offering services included the lack of reimbursement and poor compliance by families. Implications for future research included a solution for overcoming these treatment barriers should be identified. Although it gives us the overall results of their survey, it never explains to the reader what the actual guidelines or interventions were. I feel that a glimpse of this within the abstract would give the reader slightly more information and would have been more effective for setting up the article Relationship Of Diabetes Education With Readmission Rates Discussion.
Introduction
Due to the layout of the article, it was difficult to see where the abstract ended and where the introduction began. The introduction started by outlining the importance and significance of the research. According to the article, obesity is characterized by a body mass index (BMI) higher than the 95th percentile, which currently affects 17% of our youth population in the United States. For us to gain control of this problem, there must be screenings and interventions in place. The researchers made sure to provide the national recommendation that grounded the purpose of this research, which is that all children over 6 years of age should be screened for obesity and should be referred appropriately for intensive interventions for obesity treatment. Where the interventions were not initially discussed in the abstract, the authors made sure to include them in the introduction. Interventions should include dietary, physical activity, and behavioral counseling. This study not only sought out to document how these pediatric primary care providers managed their patient’s weight, but also whether they followed clinic practice guidelines. One guideline in particular that they chose to study was for Type 2 Diabetes screening for all patients with a BMI over the 85th percentile. This was the first time this was discussed. If they were choosing to include this in their study, I believe it should have been mentioned in the abstract as well. Key terms were identified and explained within the introduction. I do not see a specific theory tied to this research paper. Overall, I do feel like the introduction was effective and appropriate for the research produced.
Review of Literature
The process behind how each piece of literature was selected was not discussed in this study. There were a total of 17 pieces of literature with the majority ranging anywhere from 2007 to 2015, with one outlier article from 1990. Of those references, nine of them were within five years, and seven were within 10 years from the date that the study was published, in 2017. I feel that the researchers used up-to-date literature to help guide them in their own research. I believe the literature was cited appropriately throughout the article, and opinions and actual research findings were distinguished and recognizable to the reader. The literature was used appropriately throughout, allowing the authors to use their resources to outline the importance of this new research. I do not feel that there was an overuse of quotations, for the majority was paraphrased and cited. I believe the resources used were appropriate; however, I do wish they would have explained their process of selection to the reader. Relationship Of Diabetes Education With Readmission Rates Discussion
Sample
For this particular study, the researchers used a random sampling approach. A survey was either emailed or hand-delivered to a total of 677 healthcare providers located in 164 clinics in 28 cities within Louisiana. An additional 675 were given to stakeholders, with a letter requesting them to forward the survey to other primary care providers. Of the total 1,352 sent, approximately 70 providers responded. Of the 70 providers that responded, 13 were excluded due to only answering one question on the survey, which yielded a total sample size of 57. The participants within the sample size were located in 17 cities across Louisiana. Of those that responded, although 75% were pediatricians, there were also a few nurse practitioners, dietitians, exercise physiologists, and clinical psychologists that also provided information. Although I do believe that a larger sample size would have been more adequate, I do think that the authors presented the reader with an appropriate and effective background as to how their sample size was chosen, as well as to whom it included.
Instrumentation
This study took a qualitative approach, by producing a 26 multiple-choice and open-ended question survey pertaining to the provider’s current practices in childhood obesity and T2DM screening and the pediatric weight management services offered at that facility. The surveys were given to physicians across the state of Louisiana within a 6-month timeframe, which I feel to be appropriate for the research being obtained. The authors provided the reader with a small sample of what the survey looked like, allowing the reader to view how the data was obtained. The online survey was deployed by the Research Electronic Data Capture (REDCap) website, which is a web-based application to collect and store data for research. Hard-copy surveys were also entered into REDCap once sent back to the researchers. Due to how the data was collected and stored, I do believe the data was accurate and valid. Relationship Of Diabetes Education With Readmission Rates Discussion
Experimental Procedures
There seemed to be three different groups within this study that were evaluated. Within this survey, the three groups of focus were: those who screened for obesity, those who screened for DM2, and those who initiated appropriate interventions when a child screened positive for obesity. Participants were not randomly assigned to a group, and conditions for research were equal, for all providers answered the same questions, and the results were grounded by their responses. The setting of the experiment took place in Louisiana, where a total of 17 cities were included in the sample size. I do believe the author’s procedures were ethical, for the survey was developed through Research Electronic Capture (REDCap)Relationship Of Diabetes Education With Readmission Rates Discussion. All responses were uploaded through REDCap, which was a secure,non-biased way to collect and store their data for research purposes. Protocols were followed, and I do feel that the procedures were appropriate for this research.
Results
The researchers used a qualitative approach in this article by producing a survey, which I felt was appropriate and effective for this research. The survey enlisted a variety of questions that ultimately determined if these providers were screening for childhood obesity. If a positive screen was detected, were the providers then conducting screening for T2DM and providing or referring these children for appropriate interventions, such as diet, behavioral counseling, and exercise? All results were then compared to the national recommendation by the U.S. Preventive Services Task Force (USPSTF). Approximately 88% of the providers reported screening for obesity by calculating the patient’s BMI. Of these, 63% reported testing for T2DM. Around 64% of the providers offered some type of intervention or service, such as nutrition therapy, medical monitoring, and exercise services. However, there are a total of 7 national recommendations regarding the screening and interventions. This study found that only 5 of the 57 providers met at least half of the seven recommendations, with only 1 provider meeting six of the seven. The intervention recommendations were hardly met, with only 6 providers offering all three recommended interventions (dietary, physical activity, and behavioral counseling). It is sometimes easy to get lost in the wording, so the authors made sure to provide the reader with graphs and examples of their data collection in comparison to the national recommendations. The results were adequate, and I felt like this section was very effective in providing the reader with an appropriate understanding of the yielded results Relationship Of Diabetes Education With Readmission Rates Discussion.
Discussion
The results were discussed and summarized for the readers to gain an understanding of what the findings of the research yielded. The authors did an excellent job of referencing previous literature, that enabled the reader to compare these results to past results founded. It is stated that providers noted multiple factors that created barriers to the provision of services, such as lack of resources, lack of reimbursement for nutritional counseling services, and poor compliance by patients and families. Proposed future research would include recognizing the reasons behind barriers and offering solutions to overcome these barriers. Overall, I feel that the conclusions presented positively reflect the data obtained.
In conclusion, I find this to be quality research regarding the importance surrounding proper screening and intervening with childhood obesity. The authors provided a great amount of literature that outlined the true epidemic surrounding childhood obesity and the complications that can accompany these children in the present and future. I did not recognize any significant flaws of this study, other than the fact that I would have liked to see a larger sample size. However, with the nature of how the research was conducted, providing a survey can often result in few responses. This research relates to my researchable problem because I tend to do a chart audit in a rural town in Arkansas, to see if providers in that clinic are properly screening for childhood obesity and providing interventions if there is a positive screen. I too will then compare that to the national recommendation to see if that clinic is below or above the national recommendation. Overall, I do believe this to be a worthy study, and I would have allowed my name to be on the article Relationship Of Diabetes Education With Readmission Rates Discussion.
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5321613/
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References
Centers for Disease Control and Prevention. (2018). Retrieved from
https://www.cdc.gov/obesity/data/adult.html
Staiano, A., Marker, A., Liu, M., Hayden, E., Daniel, H., & Broyles, S. (2017). Childhood obesity
screening and treatment practices of pediatric healthcare providers. Louisiana State Medical Society, 169(1), 2-10. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5321613/
U.S. Preventive Services Task Force. (2017). Retrieved from
https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/obesity-in-children-and-adolescents-screening1?ds=1&s=obesity Relationship Of Diabetes Education With Readmission Rates Discussion