Abstract
Background
An avoidable hospitalization (AH) is a condition that could have been prevented through
effective treatment in outpatient care. Diabetes is often referred to as an ambulatory
care-sensitive condition, and its associated hospitalizations are often referred to
as avoidable hospitalizations. There are limited data on avoidable hospitalizations
for individuals with diabetes in Taiwan.
Method
We used the National Health Interview Survey (NHIS) dataset to obtain diabetes-related
avoidable hospitalizations for subjects aged above 12 years. We included data from
20,826 subjects who had completed the interview between 2004 and 2005. Data were collected
from a total of 15,574 people, who had agreed to link their health information to
the Taiwan National Health Insurance Research Database, including basic demographic
variables, inpatient or outpatient medical events, admission date, discharge date,
and diagnosis. The 1005 individuals who self-reported having diabetes or had at least
1 hospitalization or 2 physician service claims for diabetes mellitus with an ICD-9
diagnosis of 250 were included in the analysis. We divided those with diagnosis of
diabetes into two groups: never hospitalized and hospitalized. The never hospitalized
group served as the control group. We further identified hospitalized subjects with
long-term complications due to diabetes (PQI-3) that included ICD-CM codes 250.4–250.9.
Results
The mean ages of patients with diabetes-related long-term complications in the hospitalized
and never hospitalized groups were 65 years and 58 years, respectively (p-value < 0.01). More than half (52%) of the patients with diabetes-related long-term complications
had a body mass index (BMI) lower than 24. The hospitalized group also had lower educational
status compared with that of patients in the never hospitalized group (equal to or
lower than elementary school, 63% vs. 50%; junior high school, 23% vs. 14%; equal
or higher than senior high school, 14% vs. 36%). Furthermore, hospitalized patients
tended to have lower household monthly income, were unmarried, and did not have private
medical insurance. There were no significance differences in ethnic composition between
the groups. Interestingly, patients with frequent retinal examination, and those with
lower body mass index had higher frequency of avoidable hospitalization (p < 0.01).
Conclusion
We found that the following factors were associated with a higher frequency of avoidable
hospitalization among patients with type 2 diabetes: elderly, male, lower body mass
index, lower household income, non-exercise, higher disease comorbidity, and frequent
retinal examination.
Keywords
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Article info
Publication history
Published online: March 06, 2014
Accepted:
February 2,
2014
Received in revised form:
January 28,
2014
Received:
November 18,
2013
Identification
Copyright
© 2014 Primary Care Diabetes Europe. Published by Elsevier Inc. All rights reserved.
