Home care problems can put patients with diabetes at risk for visits to the emergency room or hospitalization
Research Activities, June 2009, No. 346
A "black box" of factors that contribute to adverse events in home care was investigated in a recent pilot study of 50 patients with diabetes being cared for at home. The study population, which was largely black and Hispanic women, developed hyperglycemia or hypoglycemia during the course of the home care stay, 1 of the 13 home care adverse events defined by the Centers for Medicare & Medicaid Services. Of the 48 percent of patients who developed hyperglycemia (abnormally high blood-sugar levels), three-fourths went to the emergency department (ED) and more than one-third (37.5 percent) were subsequently admitted to the hospital. Of the 38 percent of patients who developed hypoglycemia (abnormally low blood-sugar levels), all of them landed in the ED and nearly two-thirds (63.2 percent) were subsequently admitted to the hospital. Type of glycemic event was unknown for 14 percent of the population.
Ten percent of these and other care visits were probably avoidable if home care had been optimal, 56 percent were potentially avoidable, and 34 percent were unavoidable (some of these patients were judged to be too unstable to have been discharged from the hospital), according to the researchers. Deficient care processes were found in every one of the cases studied. For example, home care nurses failed to teach patients about the signs and symptoms of uncontrolled diabetes, appropriate diet, and medications in 40 percent, 37 percent, and 43 percent of cases, respectively.
In nearly half the cases, there was no documentation that the doctor had been notified when blood glucose level was outside target levels. In 54 percent of the cases, these problems were compounded by patients' or families' inability or unwillingness to adhere to the care plan. Other factors compromising home care included lack of care coordination among home care providers and lack of procedures to ensure communication between physicians and home care nurses. The study was supported by the Agency for Healthcare Research and Quality (HS11962).
See "Exploring diabetic care deficiencies and adverse events in home healthcare," by Margaret V. McDonald, M.S.W., Lori J. King, B.A., Marcia Moodie, M.S.N., R.N., and Penny H. Feldman, Ph.D., in the November/December 2008 Journal for Healthcare Quality 30(6), pp. 5-12.