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Early Impact of the State Innovation Models Initiative on Diagnosed Diabetes Prevalence Among Adults and Hospitalizations Among Diagnosed Adults

Fulton, Brent D. PhD, MBA*; Hong, Nianyi BA; Rodriguez, Hector P. PhD, MPH

doi: 10.1097/MLR.0000000000001161
Original Articles

Background: The State Innovation Models (SIM) Initiative invested $254 million in 6 states in Round 1 to accelerate delivery system and payment reforms.

Objective: The objective of this study was to examine the association of early SIM implementation and diagnosed diabetes prevalence among adults and hospitalization rates among diagnosed adults.

Research Design: Quasi-experimental design compares diagnosed diabetes prevalence and hospitalization rates before SIM (2010–2013) and during early implementation (2014) in 6 SIM states versus 6 comparison states. County-level, difference-in-differences regression models were estimated.

Subjects: The annual average of 4.5 million adults aged 20+ diagnosed with diabetes with 1.4 million hospitalizations in 583 counties across 12 states.

Measures: Diagnosed diabetes prevalence among adults and hospitalization rates per 1000 diagnosed adults.

Results: Compared with the pre-SIM period, diagnosed diabetes prevalence increased in SIM counties by 0.65 percentage points (from 10.22% to 10.87%) versus only 0.10 percentage points (from 9.64% to 9.74%) in comparison counties, a difference-in-differences of 0.55 percentage points. The difference-in-differences regression estimates ranged from 0.49 to 0.53 percentage points (P<0.01). Regression results for ambulatory care-sensitive condition and all-cause hospitalization rates were inconsistent across models with difference-in-differences estimates ranging from −5.34 to −0.37 and from −13.16 to 0.92, respectively.

Conclusions: SIM Round 1 was associated with higher diagnosed diabetes prevalence among adults after a year of implementation, likely because of SIM’s emphasis on detection and care management. SIM was not associated with lower hospitalization rates among adults diagnosed with diabetes, but the SIM’s long-term impact on hospitalizations should be assessed.

*Health Economics and Policy, School of Public Health

School of Public Health

Henry J. Kaiser Endowed Chair in Organized Health Systems, School of Public Health, University of California, Berkeley, Berkeley, CA

This publication was made possible by Cooperative Agreement Number (5U18DP006123) jointly funded by the US Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases. N.H.’s effort was partially supported by the Agency for Healthcare Research and Quality (4T32HS022241).

The authors declare no conflict of interest.

Reprints: Brent D. Fulton, PhD, MBA, Room 5302, University of California, Berkeley, 2121 Berkeley Way West, Berkeley, CA 94720-7360. E-mail:

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