Simmons, D, Yu, D, Bunn, C, Cohn, S, Wenzel, H and Prevost, T (2015) Hospitalisation among patients with diabetes associated with a Diabetes Integrated Care Initiative: a mixed methods case study. Future Hospital Journal, 2 (2). 92 - 98 (7). ISSN 2055-3331

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Integrated care has been postulated to result in improvements to diabetes outcomes, including reduced hospitalisation. The Diabetes Integrated Care Initiative (DICI) aimed to integrate primary, secondary and community diabetes care in East Cambridgeshire and Fenland (ECF). The aims of this study were to describe changes in care and hospitalisation rates over the first 3 years of the initiative, 2009–2012. The evaluation involved a mixed-methods approach, including a before-after design with controls from adjacent geographical areas and from patients without diabetes, alongside a 30-month ethnographic study including interviews with patients and health professionals. Over the three years, admission rates among patients with diabetes in the intervention area continued to grow. In fact, the increases in admissions in ECF were 7.4% (95% CI 5.2–9.2) and 45.5% (95% CI 42.5–48.5) greater than in the neighbouring areas of Huntingdonshire and Greater Cambridge, respectively. The rates of increase in diabetic foot, non-elective or other hospital admissions were not reduced. In summary, the DICI was not associated with improved diabetes care or reduced diabetes hospitalisation over the 3 years studied, despite substantial investment. While the principle of integration remains an ideal, linking different providers in ECF, especially those that are positioned between primary and secondary care, created barriers rather than bridges to better diabetes outcomes.

Item Type: Article
Uncontrolled Keywords: Diabetes, integrated care, hospital admission, HbA1c hypophysitis, encephalopathy
Subjects: R Medicine > RA Public aspects of medicine
R Medicine > RC Internal medicine > RC660 Diabetes
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Depositing User: Symplectic
Date Deposited: 14 Oct 2015 14:17
Last Modified: 28 Feb 2019 10:24

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