TY - JOUR
T1 - Preventable hospitalization among elderly medicare beneficiaries with type 2 diabetes
AU - Niefeld, Marlene R.
AU - Braunstein, Joel B.
AU - Wu, Albert W.
AU - Saudek, Christopher D.
AU - Weller, Wendy E.
AU - Anderson, Gerard F.
PY - 2003/5/1
Y1 - 2003/5/1
N2 - 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, of 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.
AB - 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, of 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.
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U2 - 10.2337/diacare.26.5.1344
DO - 10.2337/diacare.26.5.1344
M3 - Article
C2 - 12716786
AN - SCOPUS:0041667999
SN - 0149-5992
VL - 26
SP - 1344
EP - 1349
JO - Diabetes care
JF - Diabetes care
IS - 5
ER -