Robbins, Tim (2020) Factors associated with poor outcomes when patients with diabetes are discharged from hospital : a health informatics approach. PhD thesis, University of Warwick.

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Abstract

Background: People with diabetes are at increased risk of adverse events, whilst admitted to hospital. Significant research has characterised this increased risk. There is also evidence that patients with diabetes are at increased risk, following hospital discharge; however, much less research has considered this area. This thesis aims to explore approaches and associations to understanding the risk of readmission and mortality, when patients are discharged from hospital with diabetes.

Methods: Initial patient public involvement grounded this research in areas that were most important to patients themselves. A systematic review of known risk factors for readmission, when patients are discharged from hospital with diabetes, was conducted. A subsequent comparison was made to risk factors identified in the literature for mortality outcomes. Extraction of retrospective data was performed for all adult patients discharged, with a diagnosis of diabetes, from a major UK tertiary referral centre over a 3-year period. The data extraction and subsequent analysis were directly informed by systematic review results. Associations between risk factors and adverse events were identified and evaluated with calculation of effect size statistics.

Results: Forty-seven studies identified statistically significant risk factors for readmission. This resulted in 72 distinct risk factors divided across 7 separate categories. Similar categories could be identified when considering mortality outcomes, however a much smaller number of studies and risk factors were identified. Analysis of extracted retrospective data identified utility of effect size measures in evaluating associations, with particularly important associations noted for socio-economic and biochemistry related factors. Clear associations are reported between socio-economic status and readmission for patients with T1DM and socioeconomic status and mortality for patients with T2DM. Hba1c values are further demonstrated statistically significantly associated with 30-day readmission and 365-day mortality

Discussion: This thesis identifies new knowledge regarding negative outcomes when patients with diabetes are discharged from hospital. This understanding is important to developing interventions to reduce such outcomes. Future work will look to understand causal links between these risk factors and outcomes, as well as developing informatics-based algorithms targeting at understanding each person’s individual risk.

Item Type:	Thesis or Dissertation (PhD)
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RC Internal medicine
Library of Congress Subject Headings (LCSH):	Diabetes -- Complications, Diabetes -- Mortality, Hospitals -- Admission and discharge
Official Date:	July 2020
Dates:	Date Event July 2020 UNSPECIFIED
Institution:	University of Warwick
Theses Department:	Warwick Manufacturing Group
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Arvanitis, Theodoros N. ; Keung, Sarah Lim Choi
Sponsors:	Warwick Manufacturing Group ; University Hospitals Coventry and Warwickshire NHS Trust
Format of File:	pdf
Extent:	155 leaves : illustrations (some colour)
Language:	eng

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