By Melinda Young
About one in 10 Americans are diagnosed with diabetes, and the Hispanic/Latino population is disproportionately affected. Their risk is higher — and their outcomes are worse — than the white, non-Hispanic population. Researchers designed a transition of care model and pilot to see if they could improve outcomes.1
“What we wanted to address is we know that patients with diabetes get admitted to the hospital, and they have a high risk of being readmitted and going to the emergency department,” says Leonor Corsino, MD, MHS, an associate professor of medicine in the division of endocrinology, metabolism, and nutrition and an associate professor in population health sciences at Duke University School of Medicine. “We know this is true for patients who are Hispanic/Latino, for many reasons. We wanted a model designed to ameliorate the risk of being readmitted within 30 days of discharge.”
These were Corsino and colleagues’ goals:
- Gather information from providers and patients to understand their perspective, challenges, and opportunities based on what they perceive is the process;
- Develop a new transitional care model to prevent ED visits within 30 days of discharge and to prevent unscheduled readmissions.
“This was a pilot study, and we focused on the population where we are located,” Corsino notes. “We interviewed patients with diabetes who were recently discharged from the hospital within 30 days, and we interviewed providers to get their perspective.”
Questions included:
- What do you think about the process?
- What is working?
- What are some of the challenges?
“Then, based on that information, we developed a new transitional care model that would be used with people in the pilot study,” Corsino says.
The original plans were to conduct a randomized, controlled study in which the non-intervention cohort received standard care. But the COVID-19 pandemic hit, and traditional/usual care was no longer an option.
“Every institution in the country had to change how they did things,” Corsino explains. “We thought it would be an unrealistic reflection of what was happening at the time, so we switched our study design to something called a plan-do-study-act framework.”
This framework is used for quality improvement projects, but traditionally not in pragmatic research. “We used it to continually improve the process of what we were trying to do,” she adds.
One of the practical changes was to conduct all interviews via Zoom, since in-person meetings were not possible during the early phase of the pandemic. “We used interviews to identify a common theme that was generated from patients and providers,” Corsino says. “Based on that information, we developed a new transitional care model that we tested with 12 patients.”
Financial considerations also influenced the research. “There were a lot of layers of complexity with COVID. With money running out, we couldn’t do the whole plan we had in place,” Corsino explains.
Instead, researchers were flexible, testing what they could. Early results, which have yet to be published, show this could help prevent 30-day readmissions and ED visits.
“The patients felt the new discharge summary they were getting for transitional care was easier for them to follow. It was shorter, with more pictures, and it was less wordy,” Corsino says. “Usually, discharge summaries have a lot of words and things people don’t understand — even if they speak English.”
Patients wanted a simplified version of discharge instructions. The discharge summary was written in English or Spanish, depending on their preference. Investigators designed a document that included more pictures and tables to reflect what they learned from patients and providers.
“We worked together to make sure it had fewer words and was very straight forward,” Corsino says. “Our summary was an add-on to what they received when they were discharged.”
In addition to the simplified discharge summaries, Corsino and colleagues called patients 30 days after discharge to confirm patients had seen a provider.
“We asked them how easy they felt the instructions were and if there was something missing that we should include,” Corsino says. “Most people felt it was useful and easy to follow.”
This research was a first step in achieving the goal of providing recommendations to prevent readmissions and inequities in care coordination of Hispanic/Latino patients.
“Keeping discharge instructions simple and short is the key,” Corsino emphasizes. “Recognize that a lot of patients with diabetes who are Hispanic/Latino have low literacy, low health literacy, and low numeracy.”
To achieve success, organizations need institutional buy-in to obtain bilingual resources. For example, Duke University invested in a Spanish version of the Duke MyChart patient portal to facilitate communication for non-English speakers.
Projects that improve transitions of care are important, especially for patients with low literacy and English language barriers.
“The goal is to make it easier for our patients with diabetes to actually manage their disease after a big transition, and to avoid confusion over what they need to do,” Corsino says. “This has a huge impact on reducing the likelihood that they come back to the ER because they didn’t know what to do.”
It is important to continue this type of research, but for now the funding is lacking. “Twelve patients are not enough to [draw] a definitive conclusion of how good this is, so we’ll hopefully get some support to do this on a larger scale,” Corsino says.
REFERENCE
- Corsino L, Padilla BI. A transition of care model from hospital to community for Hispanic/Latino adult patients with diabetes: Design and rationale for a pilot study. Pilot Feasibility Stud 2022;8:246.
About one in 10 Americans are diagnosed with diabetes, and the Hispanic/Latino population is disproportionately affected. Their risk is higher — and their outcomes are worse — than the white, non-Hispanic population. Researchers designed a transition of care model and pilot to see if they could improve outcomes.
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