Expired CME Article

The Effects of Outpatient Management on Hospitalization for Ambulatory Care Sensitive Conditions Associated with Diabetes Mellitus

Authors: Elizabeth A. Warner, MD, Anita U. Ziboh, PharmD, BCPS

Abstract

Background: Ambulatory care sensitive conditions (ACSC) related to diabetes mellitus can potentially be prevented by good quality outpatient care. The purpose of this study was to evaluate which characteristics of ambulatory patients with diabetes were associated with ACSC hospitalizations.


Methods: Retrospective chart review of 65 adults with an ACSC diabetes-related hospitalization, and 130 controls with diabetes without ACSC hospitalizations. The primary outcome measure was the difference in hemoglobin A1c between groups.


Results: Patients with an ACSC hospitalization had poorer glucose control (mean A1c 9.24 versus 7.68, P < 0.001), but there was no difference in blood pressure or lipid control.


Conclusions: Prevention of diabetes-related hospitalizations related more closely to glycemic control, rather than other important aspects of comprehensive care.


Key Points


* Glucose control was the main factor in determining hospitalization for an ambulatory care sensitive condition related to diabetes.


* Blood pressure and lipid control were not associated with hospitalization for an ambulatory care-sensitive condition related to diabetes.


* Insulin use, but not oral hypoglycemic use, was related to hospitalization.


* Mean A1c was >9.5 in 39% of the hospitalized patients, versus 17% of the controls.

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References

1.Agency for Healthcare Research and Quality. AHRQ Quality Indicators—Guide to Prevention Quality Indicators: Hospital Admission for Ambulatory Care Sensitive Conditions. Revision 4 (November 24, 2004). AHRQ Pub. No. 02-R0203. Available at: http://www.qualityindicators.ahrq.gov/archives/pqi/pqi_guide_rev4.pdf. Accessed June 27, 2007.
2.Gilmer TP, O’Connor PJ, Rush WA, et al. Predictors of health care costs in adults with diabetes. Diabetes Care 2005;28:59–64.
3.Menzin J, Langley-Hawthorne C, Friedman M, et al. Potential short-term economic benefits of improved glycemic control: a managed care perspective. Diabetes Care 2001;24:51–55.
4.Russo CA, Andrews RM, Coffey RM. Racial and Ethnic Disparities in Potentially Preventable Hospitalizations, 2003. HCUP Statistical Brief #10. Rockville, MD, Agency for Healthcare Research and Quality, 2006. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb10.pdf. Accessed June 27, 2007.
5. Helmer DA, Tseng CL, Brimacombe M, et al. Applying diabetes-related Prevention Quality Indicators to a national cohort of veterans with diabetes. Diabetes Care 2003;26:3017–3023.
6. Selby JV, Karter AJ, Akerson LM, et al. Developing a prediction rule from automated clinical databases to identify high-risk patients in a large population with diabetes. Diabetes Care 2001;24:1547–1555.
7. Moss SE, Klein R, Klein BE. Risk factors for hospitalization in people with diabetes. Arch Intern Med 1999;159:2053–2057.