Use of Services by Diabetes Patients in Managed Care Organizations: Development of a diabetes surveillance system

  1. CDC Diabetes In Managed Care Work Group
  1. Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention Atlanta, Georgia
  2. Battelle Centers for Public Health Research and Evaluation Seattle, Washington
  3. Group Health Cooperative of Puget Sound Seattle, Washington
  4. Lovelace Health Systems, Lovelace Respiratory Research Institute Albuquerque, New Mexico
  5. Southwest Center for Managed Care Research, Lovelace Respiratory Research Institute Albuquerque, New Mexico
  6. United Health Care Minnetonka, Minnesota
  1. Address correspondence and reprint requests to Michael M. Engelgau, MD, Division of Diabetes Translation, Mailstop K-10, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Atlanta, GA 30341–3724. E-mail: mxel{at}cdc.gov

Abstract

OBJECTIVE Computerized inpatient, pharmacy, outpatient, and laboratory records were used to develop an algorithm to identifydiabetes patients and to develop surveillance indicators common to the three participating MCOs. Using 1993 data, the availability, specifications, and limitations of various surveillance indicators weredetermined.

RESEARCH DESIGN AND METHODS Computerized inpatient, pharmacy, outpatient, and laboratory records were used to develop an algorithm to identify diabetes patients and to develop surveillance indicators common to the three participating MCOs. Using 1993 data, the availability, specifications, and limitations of various surveillance indicators were determined

RESULTS An extensive set of diabetes surveillance indicators was identified from the four sources of data. Consistent data specifications across MCOs needed to consider variation in the type of data collected, a lack of documentation on level of coverage, differences in codingdata, and different models of health care delivery. A total of 16,363 diabetes patients were identified. The age-adjusted prevalence of diabetes ranged from 24 to 29 per 1,000 enrollees. Approximately one-third of patients with diabetes (32–34%) were taking insulin. The majority had one or more visits to a primary care physician during the year (72–;94%). Visits to specialists were less frequent. Ophthalmologists and optometrists were the most commonly used specialists: 29–;60% of the patients with diabetes at the three MCOs had visited an ophthalmologist or optometrist. About one-fifth had an overnight hospital stay during the year.

CONCLUSIONS This diabetes surveillance system is a useful tool for MCOs to track trends in prevalence of diabetes, use of health services, and delivery of preventive care to individuals with diabetes. This system may also be useful for health care planning and for assessing use changes after new developments in diabetes care or new quality management initiatives.

  • Received July 24, 1998.
  • Revision received September 3, 1998.
  • Accepted September 3, 1998.
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