Diabetes Hospitalization

Why Is This Important?

Hospitalization is costly for individuals, families and society. Based on 2012 American Diabetes Association estimates, direct medical as well as nonmedical costs for diagnosed diabetes and undiagnosed diabetes were about $1.8 billion in New Mexico alone. This 2012 estimate includes the costs of hospitalization, office visits, prescription medications, inability to work due to disability, reduced productivity at work, and lost productivity capacity due to early mortality. This does not include costs due to prediabetes, over the counter medications, prevention programs, research programs, and productivity loss for informal caregivers. Diabetes hospitalizations are considered potentially preventable hospitalizations, that is, some proportion of these inpatient stays are preventable. According to the Agency for Healthcare Research and Quality (AHRQ), "with high-quality, community-based primary care, hospitalization for these illnesses often can be avoided". AHRQ includes diabetes as one such illness. Key prevention strategies include regular physical activity and healthy nutrition; effective self-management; regular and effective management support; and, access to specialty or ambulatory care as appropriate. Environmental prevention strategies include accessible and affordable vegetables and fruits; readily accessible safe places for physical activity; and school, work and community cultures visibly supporting physical activity for all ages and abilities. To accomplish this there is a role for all sectors, from families to businesses to health systems to government. One public health role is to build supports, structures and conditions that make it easy for as many people as possible to be active, to eat a healthy diet daily, and to access primary care when needed. A vital part of this role is linking clinical systems with community supports, such as the National Diabetes Prevention Program, diabetes self-management education, and other community-based prevention programs.

Definition

The number of hospital inpatient discharges for diabetes per 10,000 population, ICD9-CM code 250 and, after October 1, 2015, ICD10-CM codes E10-E14. Except for age-specific rates, rates are age-adjusted to the 2000 US Standard Populations.

Data Sources

• New Mexico Population Estimates: University of New Mexico, Geospatial and Population Studies (GPS) Program.
  (http://gps.unm.edu/)
• U.S. Health and Human Services, Agency for Healthcare Research and Quality (ARHQ), Healthcare Cost and Utilization Project (HCUP), National Inpatient Sample
  (https://www.hcup-us.ahrq.gov/)
• Hospital Inpatient Discharge Data, New Mexico Department of Health.

How the Measure is Calculated

How Are We Doing?

The first chart shows diabetes discharge rates for the diabetes as the first-listed (primary) diagnosis and for diabetes as any-listed diagnosis, for NM and the US, and give a general view of diabetes hospitalization. The New Mexico Diabetes Hospitalization rate for Diabetes as the primary diagnosis has been relatively stable for years. However, the rate for the most recent year available, 2017, was statistically significantly higher than the preceding three years. As any diagnosis, the diabetes hospitalization rate from 2010 through 2015 had been statistically significantly higher than rates of previous years. However, rates for the two most recent years, 2016 and 2017, were statistically significantly lower than preceding years, approaching the rates seen prior to 2010. RATES by AGE: As primary diagnosis, the hospitalization rates of the youngest age group has remained stable. That of the age group 15 to 44 years of age has been stable during the current decade but these rates are statistically significantly higher than those of the previous decade. The hospitalization rate for the age group 45 to 64 years of age has remained stable. For the most part, the rate of the age group 65 or older has remained stable. However, the 2017 rate for this age group was statistically significantly higher than the preceding three years, 2014-2016. As any diagnosis, the hospitalization rate of the youngest age group, 0-14, has remained stable. The rate of the age group 15 to 44 years of age has been stable during the current decade but these rates were statistically significantly higher than those of the previous decade. The rates of the two older age groups, 45-64 and 65 or older, were statistically significantly higher during the years 2011-2014 over previous years but have been statistically significantly lower the past three years, 2015-2017. RATES by REGION: Graphs of diabetes hospitalizations show rates for primary diagnosis and for any-listed diagnosis by the five NM Health Regions. Each region has its own unique mix of factors which influence hospital and provider practice and make it tricky to compare across regions. Secondly, the lack of Indian Health Service (which affects the Northwest, Metro, and Northeast Regions) and Veterans Affairs (which affects Metro Region) records each year means some regional rates may be higher than what is shown. Only comparisons of rates across time within a region will be made. As the primary diagnosis, in 2017, the hospitalization rate for the Northwest region was statistically significantly higher than the rates for all other regions. The rate for the Northeast region was statistically significantly higher than the remaining three regions, Metro, Southeast, and Southwest. The Northwest and Northeast regions were both statistically significantly higher than the rate of the state, over all. As any diagnosis, in 2017, the hospitalization rate of the Northeast region was statistically significantly lower than that of all other regions. That of the Metro region was statistically significantly lower than the rates for the other three regions. The rate of the Northwest region was statistically significantly higher than the rates of all other regions.

How Do We Compare With the U.S.?

Making area-to-area comparisons of hospital rates is not straightforward. Many factors drive the variation in hospitalization rates across states and within a state. There are area-to-area differences in medical practice, in reasons or algorithms for admitting or not admitting into a hospital, and in the resources and effectiveness of local medical and social systems in diabetes treatment and management. Lastly, US rates are from the National Hospital Discharge Survey and are based on a sample of short-stay, nonfederal hospitals in the US and are based on diabetes as any of seven diagnoses examined (rather than the nine diagnoses used in NM rates). One should keep these caveats in mind in when reading the comparisons below. US rates were higher than NM rates for primary and for any-listed diabetes hospitalizations. From 2000 to 2009 (the last year of data for the US), US any-listed rates fluctuated between 157 and 176 diabetes-related hospitalizations per 10,000 persons, compared to NM rates that were between 111 and 119. For primary diagnosis rates, the 2009 US rate was 60% higher than the corresponding NM rate. For any-listed rates, the 2009 US rate was 30% higher than the 2009 NM rate. At this time, there are no 2010 or later US rates available. The national survey of hospital discharges has been redesigned; the survey had been conducted annually from 1965-2010. Equivalent US rates subsequent years have not been published.

What Is Being Done?

The NM Department of Health Diabetes Prevention and Control Program (DPCP) works with health care providers and community partners, agencies and coalitions to provide multiple diabetes prevention and management services and programs. Services and programs include: professional development trainings and resources for diabetes prevention and management; the National Diabetes Prevention Program (National DPP), a proven community-based physical activity and nutrition intervention to prevent or delay diabetes in persons at high risk; community resources to help people manage their diabetes through skill building, such as the Chronic Disease Self-Management and Diabetes Self-Management Education Programs; Kitchen Creations cooking schools; and health system disease management interventions that improve blood glucose, blood pressure, and cholesterol. The DPCP provides education, information, and resources about prediabetes and diabetes, particularly to health care providers, to increase screening, testing and referral to prevention and management programs. This includes a centralized referral and data system that helps providers easily make referrals to the above programs. DPCP?s partners support built environment improvements so people at risk for or with diabetes can be physically active and initiatives that increase access to healthy foods. Both are essential components of effective population-based diabetes prevention and control. The DPCP consults with populations that are disproportionately affected by diabetes and/or those that serve them to develop programs and services that are culturally appropriate for these populations.

Evidence-based Practices

Diabetes and its complications can be prevented, delayed and/or managed through participation in evidence-based programs, including the National Diabetes Prevention Program or NDPP (provided in a clinical, community, or web-based setting), the Diabetes Self-Management Education Program or DSMEP (provided in a community or web-based setting), and Diabetes Self-Management Education and Support programs or DSME/S (usually provided in a clinical setting). Improving the quality of clinical care for people with and at risk for diabetes is also an evidence-based practice. The following DPCP activities are in alignment with these accepted programs and practices: 1. Increase use of the NDPP to prevent or delay onset of type 2 diabetes among people at high risk by raising awareness about prediabetes and the NDPP, increasing delivery sites, facilitating the screening and referral process, and working to obtain health insurance coverage (including Medicaid) for the program. 2. Increase access to sustainable self-management education and support services (DSMEP and DSME/S) to improve control of A1C, blood pressure, and cholesterol, and to promote tobacco cessation, by increasing delivery sites, facilitating the referral process, and working to obtain health insurance coverage (including Medicaid) for the programs. 3. Implement evidence-based worksite programs and policies that help people prevent or manage diabetes and related chronic conditions, promote tobacco cessation, and help employees improve control of their A1C, blood pressure, and cholesterol. 4. Improve health outcomes for people with and at risk for diabetes by supporting health care organizations to improve quality of care through use of the Planned Care Model, Patient Centered Medical Home, and Electronic Health Record. Within these organizations, support policy and protocol implementation that institutionalize and help sustain quality care improvements. 5. Promote the sustainability of Community Health Workers (CHWs) involved in providing diabetes prevention and management services.

Other Objectives

There are 16 Healthy People 2020 (HP 2020) diabetes objectives. The only HP 2020 objective directly related to hospitalization is Objective D-4: Reduce the rate of lower extremity amputations in persons with diagnosed diabetes. Other HP 2020 diabetes objectives include: D-5: Improve glycemic control among the population with diagnosed diabetes; D-7: Increase the proportion of the population with diagnosed diabetes whose blood pressure is under control; and Objective D-13: Increase the proportion of adults with diabetes who perform self-blood glucose monitoring at least once daily. While these three do not refer directly to hospitalization, good glycemic and blood pressure control (which are also part of self-management) and daily glucose monitoring can impact hospitalization rates. New Mexico Community Health Status Indicator (CHSI)

Available Services

-Professional development opportunities provided by the New Mexico Diabetes Advisory Council, with continuing education credits, focusing on prediabetes and diabetes, and other related chronic health conditions such as obesity, smoking, and cardiovascular disease. -Technical assistance to clinics and primary care providers to support system changes that improve health outcomes (e.g. AIC, blood pressure, LDL cholesterol and smoking cessation) -Support for community-based prevention and management initiatives such as the National Diabetes Prevention Program, Diabetes and Chronic Disease Self-Management Programs, and Kitchen Creations cooking schools for people with diabetes. -Technical assistance with data, surveillance, and epidemiology For more information on programs or services provided by the NM Department of Health, Diabetes Prevention and Control Program, call (505) 841-5859.

More Resources

For more information on programs or services provided by the NM Department of Health, Diabetes Prevention and Control Program, call (505) 841-5859. Centers for Disease Control and Prevention (CDC), National Diabetes Prevention Program www.cdc.gov/diabetes/prevention/about.htm CDC Registry of Recognized (NPPP) Programs https://nccd.cdc.gov/DDT_DPRP/Registry.aspx CDC Registry of Recognized (NPPP) Programs: Virtual or Online Programs https://nccd.cdc.gov/DDT_DPRP/State.aspx?STATE=OTH Healthy People 2020 Diabetes Objectives: http://healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=8 The Community Guide- Guide to Community Preventive Services: www.thecommunityguide.org/diabetes/index.html American Diabetes Association: www.diabetes.org/home.jsp US Preventive Services Task Force www.uspreventiveservicestaskforce.org/Page/Name/tools-and-resources-for-better-preventive-care; www.uspreventiveservicestaskforce.org/Tools/ConsumerInfo/Index/information-for-consumers Costs for Diabetes and Prediabetes in New Mexico, 2012, American Diabetes Association, 2014.