Issue 152 Item 12 Quality of Care, Not Availability Key To Avoiding Diabetic Hos

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.