Jacobett Wasonga-Agak, DNP, MSN, MSHCM, RN, PHN, AGCNS-BC

Abstract:

Background: Despite the increasing cardiovascular risks (microcoagulation, hyperlipidemia, hypertension, and hyperglycemia), there is currently no standard continuum of care for patients with type 2 diabetes (T2DM) complicated by COVID-19. Objectives: The purpose of this quality improvement project was to evaluate the implementation of a 3-month enhanced continuum of care (ECC) model, including four pre-scheduled post-discharge appointments, education support, and medication reconciliation, and how it impacts cardiovascular risks in patients with diabetes and a history of COVID-19 infection (DAHOCI) following hospital discharge. Methods: Participants were adults with T2DM admitted to a community hospital compared to age and sex matched patients admitted prior to the beginning of the project. Exclusion criteria were minors, pregnant women, prisoners, employees, and patients admitted to the Intensive Care Unit (ICU) due to prognosis. Appointments took place in person and over the phone. Primary outcomes were a reduction in HgA1C, PT/PTT, lipids, and blood pressure. Secondary outcomes were patient adherence to diabetes self-care behaviors measured with the Hill-Bone Adherence Scale, hospital readmission for any reason, provider adoption, and nurse engagement. Results: Nine patients were enrolled in the intervention group. Average age for the intervention group was 50.6 years (51.6 years for non-equivalent group), 55% were female, 88.9% were Hispanic-White. LDL (p=0.04), PT (p=0.027), and PTT (p=0.038) decreased in the intervention group at baseline compared to non-equivalent group. Patients were more likely to miss their appointments (37.5%; p=0.055) at study completion. There was no difference in level of sodium intake, likelihood to keep appointments and adherence to medications at completion. Adherence to appointments varied with 88%, 22%, 55%, and 77% of patients attending post discharge visits at time 1, 2, 3, and 4 respectively. Readmission rate was 66%, provider adoption was 55.6%, and nurse engagement and 88.9%. Conclusion: Findings provide preliminary evidence for the establishment of an enhanced continuum of care model for patients with diabetes and a history of COVID-19 infection (DAHOCI) and that multiple follow-up appointments for patients with diabetes following COVID infection can reduce LDL, PT, and PTT levels.Key words: Diabetes; COVID-19; Follow-up Care; Microcoagulation; Cardiovascular Risks.

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