TeDia - A Telemedicine-Based Treatment Model for Inpatient and Interprofessional Diabetes Care

Abstract

Introduction

The proportion of hospitalized patients with diabetes as a secondary diagnosis increases continuously. Therefore, we have developed a team-based interprofessional and telemedicine-based diabetes management system named TeDia (“Telemedical Diabetology”) and implemented it in an inpatient setting. The aim of the retrospective real-world study was to show the clinical impact of TeDia following its implementation.

Material and methods

TeDia is characterized by an interpersonal and telemedicine-based exchange of hospital routine data between specially trained nurses (“diabetes managers”) and external diabetologists. It was implemented in three acute hospitals of the Düsseldorf Catholic Hospital Group in Düsseldorf, Germany. Clinical awareness of diabetes, diabetes-related complications and diagnosis-related group (DRG)-based revenues were analyzed using ICD routine coding. Furthermore, the frequency of HbA1c determinations as well as hospitalization days were investigated.

Results

Before (2010), during (2012) and after the implementation of TeDia (2014), the number of patients with ICD coding for diabetes, decompensated diabetes, diabetic neuropathy, diabetic nephropathy as well as complicated diabetes increased by +18%, +93%, +101%, +113% and +89%, respectively. Using the same DRG grouper, revenues increased by +53% (from 27 (2013) to 42 (2014) DRG points). Frequency of HbA1c determinations rose by +85%, whereas the time for an average length of stay decreased by −12% (−0, 91 days) in comparison to patients without diabetes.

Conclusion

TeDia improved clinical awareness for diabetes and its complications. This new treatment model increased revenues and reduced hospital days indicating enhanced treatment quality. Our findings emphasize the necessity of novel technologies in inpatient settings for the improvement of efficacy, safety and efficiency of diabetes care.

Keywords:

• telemedicine
• diabetes
• inpatient care

Acknowledgments

We thank Yasemin Kempf for proofreading the paper.

Abbreviations

G-DRG, German diagnosis-related group; HbA1c, hemoglobin A1c; TeDia, Telemedical Diabetology.

Ethics Statement

Approval of the research protocol was obtained from the ethics committee of the Medical Council North Rhine (Ärztekammer Nordrhein No. 2011294). No human or animal data were collected, only routine data were used.

Availability of Data and Materials

The data used to support the findings of this study are available from the corresponding author upon request.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

Dr Kerstin Kempf reports personal fees from Verlag Kirchheim GmbH & Co. KG, outside the submitted work; Prof. Dr. Stephan Martin reports grants from Sanofi Aventis, during the conduct of the study. The authors report no other conflicts of interest in this work.

Additional information

Funding

The study was financially supported by Sanofi-Aventis Deutschland GmbH. The funder had no influence on study design, data collection, data analysis, manuscript preparation and/or publication decisions.