173-OR: Associations between Post-Discharge Care (PDC) and Cognitive Impairment-Related Hospital Readmissions for Ketoacidosis and Severe Hypoglycemia in Adults with Diabetes

Cognitive Impairment (CI) is associated with an increased risk of ketoacidosis (DKA) and severe hypoglycemia (SH) in persons with diabetes (DM) .Post-discharge Care (PDC) in nursing homes and home care facilities provides continuous medical care after hospital discharges. This study examined whether PDC is associated with lower CI-related hospital readmission for DKA and SH in US adults with DM (age >18) . Our study population includes 43,467 and 166,221 adults admitted for DKA and SH from the 2016-2018 National Readmission Database, among which 1492 (3.43%) and 822 (0.49%) had CI, respectively. Readmission was defined as hospitalization for all causes within 30 days after discharge. CI-related readmission risk was estimated by comparing those with and without CI using a multiple logistic regression model, adjusting for age, sex, primary payer, income level, disease severity, mortality risk at the index discharge, and PDC status. PDC as an effect modulator was tested as an interaction term of PDC and CI. For patients initially admitted for DKA, CI was associated with 62% (adjusted odds ratio (aOR) =1.62, 1.25-2.11) higher odds of readmission among those who were discharged to home. The CI-related increase in readmission risk disappeared if patients received PDC (aOR=1.05, 0.88-1.26) . For patients initially admitted for SH, CI was associated with 34% (aOR=1.34, 95% CI 1.08-1.66) higher odds of readmission among those discharged to home and a 32% lower odds of readmission if patients received PDC (aOR=0.68, 0.59-0.81) . CI was associated with increased readmission risks for SH and DKA among adults with DM discharged to home. This CI-related readmission risk was substantially lower in patients who received PDC, indicating the importance of PDC for people with DM and CI.