Intensive Discharge Intervention in Diabetes (IDID)

Mass General Brigham

Status: Completed

Conditions: Type II Diabetes; Cardiovascular Disease

Treatments: Other: Intensive discharge intervention

Study type: Interventional

Funder types: Other; Industry

Identifiers

NCT02122926

2010A056508

2011-P-000217 (Other Identifier)

Details and patient eligibility

About

The goal of this study is to design and implement an intensive discharge intervention for inpatients with type 2 diabetes and cardiovascular disease, and determine the effects of the intervention on post-discharge insulin adherence, glycemic control, cardiac medication adherence, hypoglycemic events, and emergency department visits and hospital readmissions.

Enrollment: 180 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adult inpatients at BWH on the medicine or cardiology services with a primary care physician who belongs to a participating practice or has not explicitly opted out of the study

• Type 2 diabetes

• Active cardiovascular disease

• Likely to be discharged home, and one of the following:

  1. prescribed insulin prior to admission
  2. prescribed two oral agents and with an A1c > 8.0 within 30 days of admission. - Practices that have already agreed to participate in this study for all their eligible patients.

Exclusion criteria

1. Discharge to a location other than home or rehabilitation (or to a caregiver's home)
2. Patient does not administer own medications and absence of a caregiver who lives with patient and administers all medications
3. Police custody, no telephone or homeless
4. Previous enrolment in the study within 90 days of discharge
5. Patient unable to communicate in either English or Spanish
6. Participation in the Integrated Care Management Program (iCMP)

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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180 participants in 2 patient groups

Intensive discharge intervention

Experimental group

Description:

The intervention is a multi-modal program consisting of the following: 1. Inpatient protocol for adjusting the discharge diabetes regimen; 2. Nurse practitioner "discharge advocate" to schedule follow-up appointments, prepare an after-hospital care plan, and patient education and counseling; 3. Inpatient pharmacist counseling (identifying and addressing previous barriers to medication adherence, performing enhanced medication reconciliation, and patient education); 4. Visiting nurse intervention after discharge; 5. Follow-up in a post-discharge clinic with the NP discharge advocate and pharmacist /certified diabetes educator within 3 days of discharge; 6. Telemonitoring of POC glucose levels to the study CDE, patient's PCP, or endocrinologist as appropriate; and 7. Follow-up with PCP or endocrinologist within 1 week of discharge.

Treatment:

Other: Intensive discharge intervention

Usual Care

No Intervention group

Description:

Patients in the control arm of this study receive usual care.