The findings also suggest a need for inclusion of discharge readiness assessment into transitional care practices to improve predischarge identification of patients at risk for recidivism, and a need for sequential postdischarge follow-up for a longer period of time.
In the ambulatory setting, it would be useful to include PDCDS assessment, which includes only 10 simple questions.
"It might help you to identify somebody who’s struggling at home who could benefit from referral right then and there – at least warranting some follow-up. That could absolutely very easily be done in ambulatory setting," she said, noting that inclusion of a family stress assessment into transition planning is also important.
The findings suggest that diabetes educators have the potential to positively affect the transition experiences of hospitalized older adults and their family caregivers (the hospital from which patients for this study were recruited had no diabetes educators on staff).
Dr. LaManna reported having no disclosures.