Abstract：
BACKGROUND: Hospitalization of patients with DKA creates a significant burden on the US healthcare system. While previous studies have identified multiple potential contributors, a comprehensive review of the factors leading to DKA readmissions within the US healthcare system has not been done. This scoping review aims to identify how access to care, treatment adherence, socioeconomic status, race, and ethnicity impact DKA readmission-related patient morbidity and mortality and contribute to the socioeconomic burden on the US healthcare system. Additionally, this study aims to integrate current recommendations to address this multifactorial issue, ultimately reducing the burden at both individual and organizational levels.
METHODS: The PRISMA-SCR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) was used as a reference checklist throughout this study. The Arksey and O\'Malley methodology was used as a framework to guide this review. The framework methodology consisted of five steps: (1) Identify research questions; (2) Search for relevant studies; (3) Selection of studies relevant to the research questions; (4) Chart the data; (5) Collate, summarize, and report the results.
RESULTS: A total of 15 articles were retained for analysis. Among the various social factors identified, those related to sex/gender (n = 9) and age (n = 9) exhibited the highest frequency. Moreover, race and ethnicity (n = 8) was another recurrent factor that appeared in half of the studies. Economic factors were also identified in this study, with patient insurance type having the highest frequency (n = 11). Patient income had the second highest frequency (n = 6). Multiple studies identified a link between patients of a specific race/ethnicity and decreased access to treatment. Insufficient patient education around DKA treatment was noted to impact treatment accessibility. Certain recommendations for future directions were highlighted as recurrent themes across included studies and encompassed patient education, early identification of DKA risk factors, and the need for a multidisciplinary approach using community partners such as social workers and dieticians to decrease DKA readmission rates in diabetic patients.
CONCLUSIONS: This study can inform future policy decisions to improve the accessibility, affordability, and quality of healthcare through evidence-based interventions for patients with DM following an episode of DKA.
METHODS: The PRISMA-SCR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) was used as a reference checklist throughout this study. The Arksey and O\'Malley methodology was used as a framework to guide this review. The framework methodology consisted of five steps: (1) Identify research questions; (2) Search for relevant studies; (3) Selection of studies relevant to the research questions; (4) Chart the data; (5) Collate, summarize, and report the results.
RESULTS: A total of 15 articles were retained for analysis. Among the various social factors identified, those related to sex/gender (n = 9) and age (n = 9) exhibited the highest frequency. Moreover, race and ethnicity (n = 8) was another recurrent factor that appeared in half of the studies. Economic factors were also identified in this study, with patient insurance type having the highest frequency (n = 11). Patient income had the second highest frequency (n = 6). Multiple studies identified a link between patients of a specific race/ethnicity and decreased access to treatment. Insufficient patient education around DKA treatment was noted to impact treatment accessibility. Certain recommendations for future directions were highlighted as recurrent themes across included studies and encompassed patient education, early identification of DKA risk factors, and the need for a multidisciplinary approach using community partners such as social workers and dieticians to decrease DKA readmission rates in diabetic patients.
CONCLUSIONS: This study can inform future policy decisions to improve the accessibility, affordability, and quality of healthcare through evidence-based interventions for patients with DM following an episode of DKA.
摘要：
背景：DKA患者的住院给美国医疗保健系统带来了巨大的负担。虽然以前的研究已经确定了多个潜在的贡献者，尚未对导致美国医疗保健系统内DKA再入院的因素进行全面审查.这项范围界定审查旨在确定如何获得护理，治疗依从性，社会经济地位,种族,和种族影响DKA再入院相关患者的发病率和死亡率,并导致美国医疗系统的社会经济负担。此外,这项研究旨在整合当前的建议，以解决这个多因素问题，最终减轻个人和组织层面的负担。
方法：PRISMA-SCR（系统评价和Meta分析扩展范围评价的首选报告项目）在整个研究中用作参考清单。Arksey和O\'Malley方法被用作指导本综述的框架。框架方法论包括五个步骤：（1）确定研究问题；（2）搜索相关研究；（3）选择与研究问题相关的研究；（4）绘制数据图表；（5）整理，总结，并报告结果。
结果：共保留15篇用于分析。在确定的各种社会因素中，与性别/性别（n=9）和年龄（n=9）相关的频率最高。此外，种族和民族(n=8)是另一个反复出现的因素,出现在一半的研究中.在这项研究中还确定了经济因素，患者保险类型的频率最高(n=11)。患者收入频率第二高（n=6）。多项研究确定了特定种族/族裔患者与治疗机会减少之间的联系。注意到DKA治疗的患者教育不足会影响治疗的可及性。对未来方向的某些建议被强调为纳入研究的经常性主题，包括患者教育。DKA危险因素的早期识别，需要采用多学科方法，利用社区合作伙伴，如社会工作者和营养师，以降低糖尿病患者的DKA再入院率。
结论：这项研究可以为未来的政策决定提供信息，以提高可访问性，负担能力，通过对DKA发作后的DM患者进行循证干预，提高医疗保健质量。
方法：PRISMA-SCR（系统评价和Meta分析扩展范围评价的首选报告项目）在整个研究中用作参考清单。Arksey和O\'Malley方法被用作指导本综述的框架。框架方法论包括五个步骤：（1）确定研究问题；（2）搜索相关研究；（3）选择与研究问题相关的研究；（4）绘制数据图表；（5）整理，总结，并报告结果。
结果：共保留15篇用于分析。在确定的各种社会因素中，与性别/性别（n=9）和年龄（n=9）相关的频率最高。此外，种族和民族(n=8)是另一个反复出现的因素,出现在一半的研究中.在这项研究中还确定了经济因素，患者保险类型的频率最高(n=11)。患者收入频率第二高（n=6）。多项研究确定了特定种族/族裔患者与治疗机会减少之间的联系。注意到DKA治疗的患者教育不足会影响治疗的可及性。对未来方向的某些建议被强调为纳入研究的经常性主题，包括患者教育。DKA危险因素的早期识别，需要采用多学科方法，利用社区合作伙伴，如社会工作者和营养师，以降低糖尿病患者的DKA再入院率。
结论：这项研究可以为未来的政策决定提供信息，以提高可访问性，负担能力，通过对DKA发作后的DM患者进行循证干预，提高医疗保健质量。
