Emergency Department Use in Black Individuals With Diabetes.

Area of Science:

• Health Services Research
• Diabetes Management
• Health Disparities

Background:

• Diabetes disproportionately affects Black individuals, leading to higher emergency department (ED) utilization.
• Existing interventions need evaluation for effectiveness in diverse populations.

Purpose of the Study:

• To compare the efficacy of the Diabetes Interprofessional Team to Enhance Adherence to Medical Care (DM I-TEAM) intervention against usual medical care (UMC) in preventing diabetes-related ED visits and hospitalizations.
• To identify baseline factors associated with recurrent ED visits and hospitalizations in Black patients with diabetes.

Main Methods:

• A randomized controlled trial involving 200 Black individuals with diabetes post-ED visit.
• The DM I-TEAM intervention included diabetes education, behavioral activation, telehealth, and pharmacist recommendations.
• Usual Medical Care (UMC) served as the control group.

Main Results:

• No significant difference in return diabetes-related ED visits or hospitalizations between the DM I-TEAM and UMC groups over 12 months.
• Associated factors for return visits included longer diabetes duration, more chronic conditions, prior ED/hospitalizations, anticholinergic burden, and lower physician satisfaction/trust.
• All identified factors were statistically significant (P ≤0.05).

Conclusions:

• The DM I-TEAM intervention was not superior to UMC in preventing diabetes-related ED visits or hospitalizations among Black patients.
• High medical morbidity, medication burden, and poor physician-patient relationships are key drivers of adverse events.
• System-level changes addressing healthcare barriers, physician relationships, and community capacity are crucial for improving outcomes.