title: OPEN ACCESS TO DIABETES CENTER FROM THE EMERGENCY DEPARTMENT REDUCES HOSPITALIZATIONS IN THE SUSEQUENT YEAR.
abstract: OBJECTIVE
  Patients who present to the emergency department (ED) for diabetes without hyperglycemic crisis are at risk of unnecessary hospitalizations and poor outcomes. To address this, the ED Diabetes Rapid-referral Program (EDRP) was designed to provide ED staff with direct booking into the diabetes center. The objective of this study was to determine the effects of the EDRP on hospitalization rate, ED utilization rate, glycemic control, and expenditures.
  
  
  METHODS
  We conducted a single-center analysis of the EDRP cohort (n = 420) and compared 1-year outcomes to historic controls (n = 791). We also compared EDRP patients who arrived (ARR) to those who did not show (NS). The primary outcome was hospitalization rate over 1 year. Secondary outcomes included ED recidivism rate, hemoglobin A1c (HbA1c), and healthcare expenditures.
  
  
  RESULTS
  Compared with controls, the EDRP cohort was less likely to be hospitalized (27.1% vs. 41.5%, P<.001) or return to the ED (52.2% vs. 62.3%, P = .001) at the end of 1 year. Total hospitalizations were also lower in the EDRP (157 ± 19 vs. 267 ± 18 per 1,000 persons per year, P<.001). The EDRP cohort had a greater reduction in HbA1c (-2.66 vs. -2.01%, P<.001), which was more pronounced when ARR patients were compared with NS (-2.71% vs. -1.37%, P<.05). The mean per patient institutional healthcare expenditures were lower by $5,461 compared with controls.
  
  
  CONCLUSIONS
  Eliminating barriers to scheduling diabetes-focused ambulatory care for ED patients was associated with significant reductions in hospitalization rate, ED recidivism rate, HbA1c, and healthcare expenditures in the subsequent year.
  
  
  BACKGROUND
  ARR = arrived ED = emergency department EDRP = emergency department diabetes rapid-referral Program HbA1c = hemoglobin A1c NS = no show.
authors.forename: Nadine E
authors.initials: NE
authors.lastname: Palermo
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Modzelewski
authors.forename: Alan P
authors.initials: AP
authors.lastname: Farwell
authors.forename: Jennifer
authors.initials: J
authors.lastname: Fosbroke
authors.forename: Kalpana N
authors.initials: KN
authors.lastname: Shankar
authors.forename: Sara M
authors.initials: SM
authors.lastname: Alexanian
authors.forename: William E
authors.initials: WE
authors.lastname: Baker
authors.forename: Donald C
authors.initials: DC
authors.lastname: Simonson
authors.forename: Marie E
authors.initials: ME
authors.lastname: McDonnell
mesh_terms: D022126:Access to Information; D000328:Adult; D000553:Ambulatory Care / Q000191:economics / Q000379:methods / Q000458:organization & administration / Q000706:statistics & numerical data; D001786:Blood Glucose / Q000378:metabolism; D016022:Case-Control Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000458:organization & administration* / Q000706:statistics & numerical data
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin