Preventable Hospitalization Among Elderly Medicare Beneficiaries With Type 2 Diabetes
- Marlene R. Niefeld, MPP1,
- Joel B. Braunstein, MD2,
- Albert W. Wu, MD, MPH1,
- Christopher D. Saudek, MD3,
- Wendy E. Weller, PHD1 and
- Gerard F. Anderson, PHD1
- 1Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- 2Division of Cardiology and Robert Wood Johnson Clinical Scholars Program, Johns Hopkins Medical Institution, Baltimore, Maryland
- 3Division 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
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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
