SUN-615 Does Patient Location (Urban or Rural) Influence Risk Factors and Incidence Rate for 30-Day Readmission for Diabetic Ketoacidosis?

Introduction Nearly 1 in 10 individuals in the US have Diabetes Mellitus [1]. One potential preventable complication is Diabetic Ketoacidosis (DKA). Urban and rural patients may have different mortality [2]. Better understanding of the risk factors for readmissions of DKA will allow the development and implementation of specific patient-centered interventions to decrease future readmissions. We determined the 30-day all-cause readmission rate for adults (age >= 18) admitted with a principal diagnosis of DKA and compare the risk factors for urban and rural patients. Methods We utilized Agency of Healthcare Research and Quality’s (AHRQ) 2014 Nationwide Readmission Database to identify admissions with a principal diagnosis of DKA related ICD-9 diagnosis (250.10, 250.11, 250.12, and 250.13) associated with both Type 1 and Type 2 Diabetes Mellitus. Applicable admissions were all adults (age >= 18) with an index hospitalization between January 1 to November 30, 2014. Patients who died during index admission and those with missing covariates were excluded. The 2013 NCHS Urban-Rural Classification System was used to classify if originating from an urban or rural location. All-cause readmission within 30-days of DKA were analyzed. Predictors for readmission were determined using logistic regression model. Results A total of 65,249 patients met criteria for inclusion. Of which, there was 12,561 readmissions (19.25 %) within 30-days of the index admission. Patients originating from urban locations had a readmission rate of 19.36% compared to 18.56 % for patients from rural locations (p=0.07). Multivariate analysis showed patients from either rural or urban location each had a higher likelihood of readmission if their disposition was home health or AMA, younger age (<65), female, Medicare as payer, LOS 7-14 days, absence of obesity, and presence of renal failure. In addition, disposition to short term hospital increased the odds for readmission from rural patients. Conclusion Almost 1 in 5 patients discharged with a principal diagnosis of DKA will be readmitted within 30 days. No difference was noted in rates of readmissions for patients originating from urban or rural locations. Risk factors are similar with further research needed to better understand the drivers of readmission. References: [1] CDC: National Diabetes Statistics Report (2017) [2] Ferdinand AO, et al. (2017). Diabetes-Related Hospital Mortality in Rural America: A Significant Cause for Concern. Policy Brief #3. Southwest Rural Health Research Center