Quality of Care, Not Availability Key To Avoiding
Diabetic Hospitalizations
Doctor supply less crucial
Quality of care, not availability of care, appears
to be the key to preventing hospitalization among
patients with diabetes, Dr. James Bailey said at
the southern regional meeting of the American Federation
for Medical Research.
The findings
conflict with those of some previous studies suggesting
that various measures of primary
care access are associated with hospitalization rates
in such “ambulatory care sensitive patients,” said
Dr. Bailey of the University of Tennessee, Memphis.
Health services exposures were assessed for the
nearly 30,000 patients with diabetes in Tennessee's
Medicaid managed care program (TennCare), which serves
about a quarter of the state's population. Billing
data were used to calculate average utilization rates
for critical diabetic services for 2000, and the
data were aggregated by county.
For each of Tennessee's 95 counties, the average
number of outpatient, inpatient, and emergency department
visits was calculated, as were the number of eye
examinations, hemoglobin A1c measurements, and LDL
cholesterol measurements performed. The percentage
of patients receiving these services on an annual
basis also was calculated.
Wide
geographic variations in diabetes-related hospitalizations
were noted, with averages ranging from 0.69 to 3.59
per enrollee. Annual screening for hemoglobin A1c
was strongly associated with fewer diabetes-related
hospitalizations. But higher availability of primary
care physicians in a given area was associated with
a greater number of hospitalizations, Dr. Bailey
said.
