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Trends in Avoidable Hospitalizations for Diabetes

Experience of a Large Clinically Integrated Health Care System

Yaqoob, Maidah; Wang, Jihan; Sweeney, Ann T.; Wells, Cynthia; Rego, Virginia; Jaber, Bertrand L.

The Journal for Healthcare Quality (JHQ): May/June 2019 - Volume 41 - Issue 3 - p 125–133
doi: 10.1097/JHQ.0000000000000145
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ABSTRACT Prevention quality indicators (PQIs) are used in hospital discharge data sets to identify quality of care for ambulatory care–sensitive conditions, such as diabetes. We examined the impact of clinical integration efforts on diabetes-related PQIs in a large community-based health care organization. Inpatient and observation hospitalizations from nine acute care hospitals were trended over 5 years (2012–2016). Using established technical specifications, annual hospitalizations rates were calculated for four diabetes-related PQIs: uncontrolled diabetes, short-term complications, long-term complications, and lower extremity amputations. The mean (±standard error of the mean) annual hospitalization rate for uncontrolled diabetes and short-term complications gradually increased from 1.3 ± 1.1 and 3.2 ± 2.5 per 1,000 discharges to 2.4 ± 1.7 (p < .001) and 7.1 ± 3.2 (p < .001) per 1,000 discharges, respectively. Conversely, the annual hospitalization rate for long-term complications and lower extremity amputations gradually decreased from 12.6 ± 1.1 and 88.6 ± 1.0 per 1,000 discharges to 6.5 ± 1.0 (p = .004) and 82.2 ± 1.0 per 1,000 discharges (p < .001). Trends generally persisted across payers, age, sex, and race. There was an inverse correlation between county income-per-capita and hospitalization rate for short-term complications (p = .04), long-term complications (p = .03), and lower extremity amputations (p < .001). Study limitations included use of administrative data, evolving coding practices, and ecological fallacy. Ambulatory-based efforts to optimize diabetes care can prevent long-term complications and reduce avoidable hospitalizations.

For more information on this article, contact Bertrand L. Jaber at bertrand.jaber@steward.org.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article at (www.jhqonline.com).

© 2019 National Association for Healthcare Quality
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