Preventable Hospitalization Among Elderly Medicare Beneficiaries With Type 2 Diabetes

• Published in: Diabetes care Vol. 26; no. 5; pp. 1344 - 1349
• Main Authors: NIEFELD, Marlene R, BRAUNSTEIN, Joel B, WU, Albert W, SAUDEK, Christopher D, WELLER, Wendy E, ANDERSON, Gerard F
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.05.2003
• Subjects: Aged; Aged patients; Analysis; Analysis. Health state; Associated diseases and complications; Biological and medical sciences; Care and treatment; Comorbidity; Complications and side effects; Diabetes; Diabetes Mellitus, Type 2 - economics; Diabetes Mellitus, Type 2 - therapy; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Epidemiology; General aspects; Health Services Misuse - economics; Health Services Misuse - statistics & numerical data; Hospital utilization; Hospitalization; Hospitalization - statistics & numerical data; Humans; Medical sciences; Medicare; Older people; Prevalence; Prevention; Public health. Hygiene; Public health. Hygiene-occupational medicine; Type 2 diabetes; United States; United States; Endocrinopathy; Human; Prevention; Concomitant disease; Risk factor; Hospitalization; Non insulin dependent diabetes; Epidemiology; Elderly; Care
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.26.5.1344

Preventable Hospitalization Among Elderly Medicare Beneficiaries With Type 2 Diabetes Marlene R. Niefeld , MPP 1 , Joel B. Braunstein , MD 2 , Albert W. Wu , MD, MPH 1 , Christopher D. Saudek , MD 3 , Wendy E. Weller , PHD 1 and Gerard F. Anderson , PHD 1 1 Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 2 Division of Cardiology and Robert Wood Johnson Clinical Scholars Program, Johns Hopkins Medical Institution, Baltimore, Maryland 3 Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland Abstract OBJECTIVE —To examine the impact of comorbid conditions on preventable hospitalizations among Medicare beneficiaries aged ≥65 years with type 2 diabetes. RESEARCH DESIGN AND METHODS —Data were drawn from the 1999 Medicare Standard Analytic Files, a 5% nationally representative random sample of Medicare beneficiaries. The analysis sample included 193,556 Medicare beneficiaries aged ≥65 years with type 2 diabetes (ICD-9-CM codes 250.xx) who were enrolled in fee-for-service Medicare. Preventable hospitalization was assessed by measuring ambulatory care-sensitive conditions, an accepted measure of hospitalizations that could have been prevented with appropriate outpatient care. Multivariable analyses controlled for demographics; mortality; renal, ophthalmic, or neurological manifestations of diabetes; type of physician providing the outpatient care; and per capita community-level indicators of income and hospital beds. RESULTS —Ninety-six percent of beneficiaries in the sample had a comorbidity, and 46% had five or more comorbidities. Among beneficiaries with type 2 diabetes, cardiovascular-related comorbidities were common and accounted for increased odds of preventable hospitalization, controlling for other factors. The likelihood of a preventable hospitalization increased in the presence of a claim for comorbid congestive heart failure, cardiomyopathy, coronary atherosclerosis, hypertension, or cardiac dysrythmias. Noncardiovascular comorbidities associated with a greater likelihood of preventable hospitalization included chronic obstructive pulmonary disease, asthma and lower respiratory disorders, Alzheimer’s disease/dementia, personality/anxiety disorders, depression, and osteoporosis. Our data suggest that nearly 7% of all hospitalizations could be avoided. CONCLUSIONS —These findings support the need for improved outpatient care strategies to reduce the impact of comorbidity on unnecessary hospitalization in patients aged ≥65 years with type 2 diabetes. ACSC, ambulatory care-sensitive condition CHF, congestive heart failure COPD, chronic obstructive pulmonary disease CVD, cardiovascular disease Footnotes Address correspondence and reprint requests to Marlene R. Niefeld, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, P.O. Box 578, Baltimore, MD 21205. E-mail: mniefeld{at}jhsph.edu . Received for publication 18 September 2002 and accepted in revised form 15 January 2003. Additional information for this article can be found in an online appendix at http://care.diabetesjournals.org . A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. DIABETES CARE