Readmission of patients with diabetes is a problem that warrants consideration of the contributing factors. Readmission of patients within 30 days of discharge is considered to be an indicator of healthcare quality — along with other circumstances, such as patient lifestyle — that needs to be addressed from a patient care perspective and from a cost of care perspective (Dungan, 2012). A dismal statistic starkly represents the problem: Roughly 8% of the U.S. population is represented by patients with diabetes, yet this group accounts for 23% of the hospitalizations in the nation (Dungan, 2012). On top of this figure, between 14.4% to 21% of diabetic patients are readmitted, compared to 8.5% and 13.5% of U.S. hospital patients overall (Dungan, 2012). The problem is exacerbated by the rise in national rates of diabetes means that more patients will present from the general population and, accordingly, more patients with diabetes will experience readmission — unless the cycle of admission-readmission is prevented and absolute numbers are reduced.
Rubin, et al. (2014) explored the causes of readmission that occurred within 30 days of discharge among diabetic patients, a phenomenon the researchers refer to as early readmission. The purpose of the qualitative research was to understand the conditions that led to readmission from the perspective of the patients with diabetes, with an emphasis on “aspects of the inpatient to outpatient transition of care” (Rubin, et al., 2014, p. 1). Rubin, et al. (2014) developed their research to answer questions about the reasons for early readmission through the use of qualitative research. The research question is broadly stated and lends itself well to qualitative research, as the study is grounded in the qualitative tradition of personal accounts (interviews) and the philosophical orientation of epistemology: the study of knowledge. The study was designed to circumvent the constraints of previous research that depended upon retrospective, lack of clinical evidence-based data, and were restricted to “primary discharge diagnosis of diabetes,” which was confirmed through a review of the hospital records (Rubin, et al., 2014, p. 2).
The subjects were included in the study if they met the following inclusion criteria: eligible English-speaking patients with diabetes, who had been readmitted to the hospital within 30 days of discharge, and were at least 18 years of age. The patients were selected from Temple University Hospital, which is an urban academic medical center located in Philadelphia, Pennsylvania. The criteria for a diagnosis of diabetes included: ICD-9-CM code of250.xx, self-report, or outpatient use of a diabetes-specific medication. The list of potential participants, which excluded obstetrics patients, was generated through the use of an electronic medical record system. Of the original sampling frame, 6 patients declined to participate and 1 record was lost, resulting in a sample of 20 participants interviewed between September 2012 and February 2013. These procedures are consistent with qualitative research methodology.
A convenience sample was then identified and approached for consent, using the human subjects review process required by the Temple University Institutional Review Board. It is important to note that the study outcomes are intended to provide benefit to the participants, which is one of the tenets of ethical conduct provided in the Belmont Report (Polit & Beck, 2012). The Belmont Report argued for three standards of ethical conduct in research: Beneficence, respect for human dignity, and justice (Polit & Beck, 2012). Each of these principles is important, but the beneficence holds the most relevance for the study under review, such that the researchers are compelled to minimize harm and maximize benefit to the research participants or to others (Polit & Beck, 2012). The ethical treatment of study participants includes the provision of adequate information to establish informed consent, which means that participants understand they can refuse to participate or terminate their participation at any time without giving a reason. Informed consent also requires that participants understand how the data will be used, how long it will be retained, what happens to the data once the study ends or is published, what form it will take when shared, and that aggregate data will be preferred and individual data will not be associated with any personal identifier related to the study participants.
Data was collected from participants who had given informed consent through 20-minute interviews that were conducted in their hospital rooms. Three investigators independently conducted interviews, transcribed the interviews, and triangulated the interview narratives with discharge records to ensure the patients’ recall accuracy. Given that the study is perhaps one of the first to use qualitative methods to explore readmission of patients with diabetes, the investigators developed an interview guide derived in part from the literature and their collective professional experience. The 28-question interview protocol contained open-ended items in order to capture the actual words participants used when responding to questions asked by the interviewers. A pilot was conducted with three participants, but no changes were made to the interval protocol or guide following the pilot, so the pilot interviews were included in the study data. The interview process provided for data saturation, as interviews were conducted until thematic saturation was accomplished and no new information was likely to be derived from additional interviews. Moreover, the interviewers probed for more information when the study participants answered the questions with just “yes” or “no” responses. The interview protocol covered a multitude of topics, including ability to attend follow-up appointments, discharge instructions, home environments, needs after discharge, social support, transitions of care between the inpatient and outpatient settings, and other general questions about their experiences and perceptions of the current and recent hospitalizations.
Rigor was ensured in the data analysis process as each investigator coded their interviews individually, and then the group of investigators collectively reviewed each of the interviews in order to assure the coding was accurate, representative, and consistent. The data analysis process was entirely appropriate for the data collected since qualitative data is generally coded for emerging themes with related elements of the data being categorized as they are encountered in the review (Dye, et al., 2000). This process is sometimes referred to as the constant comparison method (Dye, et al., 2000). The process of coding the interviews according to emerging themes is appropriate to and consistent with qualitative data analysis techniques (Dye, et al., 2000). The thematic analysis indicated five themes that reflect contributions to the risk of readmission. The themes were as follows: 1) Poor health literacy, health system failure; 3) failure of expected protective factors; 4) social determinants of health impeding care; and 5) loss of control over illness (Rubin, et al., 2014, p. 4). Overall, the study participants had limited or mistaken information about their disease or about the factors that influenced the progression of their diabetes. Many participants had poor recall about their discharge and were unclear about important variables such as changes in medication or if follow-up medical visits were scheduled. Discharge instructions were found to lack information specific to diabetes even though all the participants had diabetes. Participants described situations that they perceived as interfering with their ability to follow discharge instructions. These conclusions are supported by the research conducted by Hellman (2014), which found that readmission rates could be reduced by “improved transitions of care, including medicine reconciliation, detailed education of the patient at the time of discharge, and appropriate, patient centered education and instruction for both the patient and the medical team caring for the patient” (p. 4).
A lack of support following discharge resulted in participants being readmitted, and many of these issues were fundamental, such as an inability to obtain insulin, medication, meals, or nursing care. Donnell-Jackson, et al. (2014) found similar results in a study about contributing factors to readmission of patients with diabetes, concluding that “the DC [discharge] process does not successfully communicate instructions to readmitted patients and instructions often fail to address diabetes” (p. 1). In Rubin, et al. (2014), diabetes management was insufficient to accomplish good glycemic control and many participants had an HbA1c>8%. While social support was considered by participants to be adequate, it typically was not and the same obstacles seemed to reoccur. Indeed, participants were often unable to obtain their meds, get transportation to medical appointments, or prepare their own meals. Many participants were discouraged by their illness and felt inadequate to the challenge of managing their life situations and their diabetes. This attitude often resulted in non-adherence to medicine, blood testing, and diet regimens. The contributing factors represented in the thematic breakdown were observed to interact in such a way that the presence of more than one variable could result in more extensive difficulties and challenges that the participants were unable to overcome. One of the most important findings was the degree to which feelings of loss of control over chronic illness appeared to contribute to readmission risk.
The investigators identified several areas of future research that are entirely relevant since the current research is recent. Future research is needed to confirm the themes identified and to determine if other diseases result in similar risk for readmission. The recommendations made by the researchers also need to be refined and tested with those at risk of readmission. Indeed, Dungan (2012) argues that important readmission predictors are likely to be common to a plethora of chronic diseases, and that these predictors include educational, psychosocial, and socioeconomical disparities. Dungan (2012) further asserts that targeting interventions at high-risk groups appropriately has the potential of dramatically optimizing the cost-to-benefit ration, and vastly improving patient safety, patient care, and quality of life for patient with diabetes.
References
Donnell-Jackson, K., Ram M. Jhingan, R.M. And Rubin, D.J. (2013). Early Readmissions among hospitalized patients with diabetes: A qualitative assessment of contributing factors. Paper presented at Diabetes: Diagnosis, Complications & Outcomes, The Endocrine Society’s 95th Annual Meeting and Expo, from June 15 — 18, 2013, in San Francisco, California.
Dungan, K.M. (2012, September). The effect of diabetes on hospital readmissions. Journal of Diabetes Science Technology, 6(5), 1045-1052. Retreived from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3570838/
Dye, J. G, Schatz, I.M., Rosenberg, B.A., and Coleman, S.T. (2000, January). Constant comparison method: A kaleidoscope of data. The Qualitative Report, 4(1/2).
Hellman, R. (2014, October). An individualized inpatient diabetes education and hospital transition program for poorly controlled hospitalized patients with diabetes. Endocrine Practice, 20(10), 1097-1099.
Polit, D.F. And Beck, C.T. (2012). Ethics in nursing research. Nursing Research, Chapter 7: Generating and assessing evidence for nursing practice (9th ed.). Baltimore, MD: Lippincott Williams & Wilkins.
Rubin, D., Donnell-Jackson, K., Jhingan, R., Golden, S.H., Paranjape, A. (2014, November). Early readmission among patients with diabetes: A qualitative assessment of contributing factors. Journal of Diabetes and its Complications, 28(6), 869-73.
Get Professional Assignment Help Cheaply
Are you busy and do not have time to handle your assignment? Are you scared that your paper will not make the grade? Do you have responsibilities that may hinder you from turning in your assignment on time? Are you tired and can barely handle your assignment? Are your grades inconsistent?
Whichever your reason is, it is valid! You can get professional academic help from our service at affordable rates. We have a team of professional academic writers who can handle all your assignments.
Why Choose Our Academic Writing Service?
- Plagiarism free papers
- Timely delivery
- Any deadline
- Skilled, Experienced Native English Writers
- Subject-relevant academic writer
- Adherence to paper instructions
- Ability to tackle bulk assignments
- Reasonable prices
- 24/7 Customer Support
- Get superb grades consistently
Online Academic Help With Different Subjects
Literature
Students barely have time to read. We got you! Have your literature essay or book review written without having the hassle of reading the book. You can get your literature paper custom-written for you by our literature specialists.
Finance
Do you struggle with finance? No need to torture yourself if finance is not your cup of tea. You can order your finance paper from our academic writing service and get 100% original work from competent finance experts.
Computer science
Computer science is a tough subject. Fortunately, our computer science experts are up to the match. No need to stress and have sleepless nights. Our academic writers will tackle all your computer science assignments and deliver them on time. Let us handle all your python, java, ruby, JavaScript, php , C+ assignments!
Psychology
While psychology may be an interesting subject, you may lack sufficient time to handle your assignments. Don’t despair; by using our academic writing service, you can be assured of perfect grades. Moreover, your grades will be consistent.
Engineering
Engineering is quite a demanding subject. Students face a lot of pressure and barely have enough time to do what they love to do. Our academic writing service got you covered! Our engineering specialists follow the paper instructions and ensure timely delivery of the paper.
Nursing
In the nursing course, you may have difficulties with literature reviews, annotated bibliographies, critical essays, and other assignments. Our nursing assignment writers will offer you professional nursing paper help at low prices.
Sociology
Truth be told, sociology papers can be quite exhausting. Our academic writing service relieves you of fatigue, pressure, and stress. You can relax and have peace of mind as our academic writers handle your sociology assignment.
Business
We take pride in having some of the best business writers in the industry. Our business writers have a lot of experience in the field. They are reliable, and you can be assured of a high-grade paper. They are able to handle business papers of any subject, length, deadline, and difficulty!
Statistics
We boast of having some of the most experienced statistics experts in the industry. Our statistics experts have diverse skills, expertise, and knowledge to handle any kind of assignment. They have access to all kinds of software to get your assignment done.
Law
Writing a law essay may prove to be an insurmountable obstacle, especially when you need to know the peculiarities of the legislative framework. Take advantage of our top-notch law specialists and get superb grades and 100% satisfaction.
What discipline/subjects do you deal in?
We have highlighted some of the most popular subjects we handle above. Those are just a tip of the iceberg. We deal in all academic disciplines since our writers are as diverse. They have been drawn from across all disciplines, and orders are assigned to those writers believed to be the best in the field. In a nutshell, there is no task we cannot handle; all you need to do is place your order with us. As long as your instructions are clear, just trust we shall deliver irrespective of the discipline.
Are your writers competent enough to handle my paper?
Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.
What if I don’t like the paper?
There is a very low likelihood that you won’t like the paper.
Reasons being:
- When assigning your order, we match the paper’s discipline with the writer’s field/specialization. Since all our writers are graduates, we match the paper’s subject with the field the writer studied. For instance, if it’s a nursing paper, only a nursing graduate and writer will handle it. Furthermore, all our writers have academic writing experience and top-notch research skills.
- We have a quality assurance that reviews the paper before it gets to you. As such, we ensure that you get a paper that meets the required standard and will most definitely make the grade.
In the event that you don’t like your paper:
- The writer will revise the paper up to your pleasing. You have unlimited revisions. You simply need to highlight what specifically you don’t like about the paper, and the writer will make the amendments. The paper will be revised until you are satisfied. Revisions are free of charge
- We will have a different writer write the paper from scratch.
- Last resort, if the above does not work, we will refund your money.
Will the professor find out I didn’t write the paper myself?
Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.
What if the paper is plagiarized?
We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.
When will I get my paper?
You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.
Will anyone find out that I used your services?
We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.
How our Assignment Help Service Works
1. Place an order
You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.
2. Pay for the order
Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.
3. Track the progress
You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.
4. Download the paper
The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.
PLACE THIS ORDER OR A SIMILAR ORDER WITH US TODAY AND GET A PERFECT SCORE!!!
