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© 2003 by the American Diabetes Association, Inc.
Clinical Care/Education/Nutrition |
Preventable Hospitalization Among Elderly Medicare Beneficiaries With Type 2 Diabetes
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
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.
Abbreviations: ACSC, ambulatory care-sensitive condition • CHF, congestive heart failure • COPD, chronic obstructive pulmonary disease • CVD, cardiovascular disease
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