According to Nadine Palermo, DO, an endocrinologist at Brigham and Women’s Sleep Medicine and Endocrinology Center at Brigham and Women’s Faulkner Hospital, many patients with diabetes who are not engaged in chronic care need to rely on acute care services to manage their diabetes, often resulting in a hospital admission, return ED visits and hospital readmissions.
Brigham and Women’s Faulkner Hospital’s Emergency Department Diabetes Rapid-Referral Program (EDRP), a new pilot program funded by a grant from the Partners Center for Population Health Management and in partnership with Brigham and Women’s Sleep Medicine and Endocrinology Center and BWFH Emergency Medicine, seeks to reengage patients presenting to the emergency department with acute diabetes needs and transition them to a rapid diabetes-focused follow-up. It’s also a great example of work toward BWFH’s 2018 Strategic Goal of Care Redesign & Innovation.
“The goal is to decrease readmission/repeated ED visit rates but most importantly to increase patient quality of care and satisfaction,” says Luis Lobón, MD, MS, Chief of Emergency Medicine at Brigham and Women’s Faulkner Hospital and Vice Chair of Community Emergency Medicine at Brigham Health.
Under the new pilot program, patients with acute diabetes needs who present in the ED are connected to rapid follow-up with the diabetes-focused clinicians in Brigham and Women’s Sleep Medicine and Endocrinology Center within 48 business hours. “The hypothesis is simple,” says Dr. Palermo. “Eliminating the barrier to scheduling diabetes-focused ambulatory care and preventing unnecessary hospitalizations for patients with diabetes should improve patient outcomes and reduce healthcare expenditures. In our previous analysis of the program’s outcomes* we learned that when patients access the EDRP their chances of returning to the ED and of being hospitalized are about 50 percent lower than those who don’t. We also saw decreased ED recidivism, improved glycemic control and decreased healthcare expenditures.”
Dr. Palermo hopes the EDRP will help her and her colleagues further identify the barriers to patients’ self-care of diabetes and better understand which elements of this intervention are most beneficial to patients. “If the findings are reproducible, we hope similar rapid referral programs for not only diabetes but also other chronic conditions can be implemented and improve patient care,” she says.
Dr. Lobón says piloting the program here at BWFH is ideal for both patients and providers. “There is a strong collaboration between Emergency Medicine and the Division of Endocrinology here, and it’s convenient for patients to follow up here the next day,” he says. “I’m very excited about this project. We’re focused on working together for the same goal.”
*Palermo NE, Modzelewski KL, Farwell AP, Fosbroke J, Shankar KN, Alexanian SM, Baker WE, Simonson DC, McDonnell ME. “Open Access to Diabetes Center from the Emergency Department Reduces Hospitalizations in the Subsequent Year.” Endocrine Practice. 2016.
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