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Nutritionist Visits, Diabetes Classes, and Hospitalization Rates and Charges: the Urban Diabetes Study

¹ Philadelphia Department of Public Health, Phildelaphia, PA
² Drexel University College of Medicine
³ University of the Sciences in Philadelphia

jessica.robbins{at}phila.gov

ABSTRACT

Objectives: We evaluated the association of different types of educational visits for diabetic patients of the 8 Philadelphia Health Care Centers (PHCCs), (public safety-net primary care clinics), with hospital admission rates and charges reported to the Pennsylvania Health Care Cost Containment Council.

Research Design and Methods: The study population included 18,404 patients who had a PHCC visit with a diabetes diagnosis recorded between March 1, 1993 and December 31, 2001 and had at least one month follow-up time.

Results: A total of 31,657 hospitalizations were recorded for 7,839 (42.6%) patients in the cohort. After adjustment for demographic variables, baseline comorbid conditions, hospitalizations prior to the diabetes diagnosis, and number of other primary care visits, having had any type of educational visit was associated with 9.18 fewer hospitalizations per 100 person years (95% confidence interval [CI] 5.02 to 13.33), and $11,571 less (95% CI $6,377 to $16,765) in hospital charges per person. Each nutritionist visit was associated with 4.70 fewer hospitalizations per 100 person years (95% CI 2.23 to 7.16) and a $6,503 reduction (95% CI $3,421 to $9,586) in total hospital charges.

Conclusions: Any type of educational visit was associated with lower hospitalization rates and charges. Nutritionist visits were more strongly associated with reduced hospitalizations than diabetes classes. Each nutritionist visit was associated with a substantial reduction in hospital charges, suggesting that providing these services in the primary care setting may be highly cost-effective for the health care system.

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