Multiple hospitalizations for patients with diabetes
Multiple hospitalizations for patients with diabetes
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DOI：
10.2337/diacare.26.5.1421
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发表时间：
2003-05-01
期刊：
影响因子：
16.2
通讯作者：
Andrews, R
中科院分区：
文献类型：
--
作者：
Jiang, HJ;Stryer, D;Andrews, R
目的-描述糖尿病患者住院治疗在多大程度上反映了同一人的多次住院，并检查多次住院治疗如何随患者人口统计和社会经济特征而变化。研究设计和方法-使用医疗保健成本和利用项目1999年五个州(加利福尼亚州、密苏里州、纽约州、田纳西州和弗吉尼亚州)的完整出院数据，我们确定了648,748名非新生儿、非产妇患者，他们有一次或多次住院治疗，列出了糖尿病。以多次住院患者的百分比、多次住院患者占总住院患者的百分比和每位患者的平均住院次数来衡量多次住院。还检查了总住院费用。分层分析和回归分析评估了年龄、性别、种族/民族、付款人、地点和收入的差异。结果：在住院的糖尿病患者中，30%的患者有两次或两次以上的住院时间，占总住院和住院费用的50%。在控制了患者的年龄、性别和临床特征后，拉美裔和非拉美裔黑人多次住院的可能性高于非拉美裔白人，以及接受联邦医疗保险或医疗补助的患者以及生活在低收入地区的患者。在有多次住院的患者中，糖尿病并发症和多种情况的患病率因年龄、种族/民族和付款人而不同。结论：多次住院在糖尿病患者中很常见，但因年龄、种族/民族、付款人和收入而异，传统上被认为更脆弱的人群经历多次住院的可能性更高。减少糖尿病患者多次住院的比例有很大的机会。为改善这些患者的护理质量和结果而进行的临床和政策干预应进行相应的设计，并有可能产生重大红利。
OBJECTIVE - To describe the extent to which hospitalizations for patients with diabetes reflect multiple stays by the same individuals and to examine how multiple hospitalizations vary by patient demographic and socioeconomic characteristics.RESEARCH DESIGN AND METHODS - Using the Healthcare Cost and Utilization Project complete discharge data For five states (California, Missouri, New York, Tennessee, and Virginia) in 1999, we identified 648,748 nonneonatal, nonmaternal patients who had one or more hospitalizations listing diabetes. Multiple hospitalizations were measured as percent of patients with multiple stays, percent of total stays represented by multiple stays, and average number Of Stays Per patient. Total hospital costs were also examined. Stratified analysis and regression were performed to assess differences by age, sex, race/ethnicity, payer, location, and income.RESULTS - Among patients with diabetes who had been hospitalized, 30% had two or more stays accounting for >50% of total hospitalizations and hospital costs. Controlled for patient age, sex, and clinical characteristics, the likelihood of having multiple hospitalizations was higher for Hispanics and non-Hispanic blacks compared with non-Hispanic whites, as well as for patients covered by Medicare or Medicaid and those living in low-income areas. The prevalence of diabetes complications and multiple conditions differed by age, race/ethnicity, and payer among patients with multiple stays.CONCLUSIONS - Multiple hospitalizations are common among patients With diabetes but vary by age, race/ethnicity, payer, and income, with those populations traditionally considered to be more vulnerable experiencing higher likelihoods of multiple stays. Significant opportunities exist to reduce the proportion of multiple hospitalizations for patients with diabetes. Clinical and policy interventions to improve the quality of care and Outcomes for these patients shou be designed accordingly and have the potential to pay major dividends.