Abstract
Background
Diabetes-related preventable hospitalizations (DRPHs) are indicators of primary care effective services. The aim of this study is to compute the trends of DRPHs, and to assess the risk factors for increased in-hospital length of stay (LOS) and costs in an Italian region.
Methods
DRPHs were computed following the AHRQ definitions, which include four types: short-term complications (PQI-1), long-term complications (PQI-3), uncontrolled diabetes (PQI-14), lower-extremity amputations (PQI-16). Trends were direct standardized on in-habitants in 2006. Negative binomial regression model was used.
Results
In the study period PQI-1 increased +426.9 %, PQI-3 +175.5%, PQI-14 +231.7% and PQI-16 decreased -26.2%. Prolonged LOS was related to type 2 diabetes (p < 0.001), peripheral vascular disease (p = 0.045), uncomplicated hypertension (p < 0.001), liver disease (p < 0.001) for PQI-1; type 2 diabetes (p < 0.001), uncomplicated hypertension (p < 0.001), complicated hypertension (p < 0.001) for PQI-3; type 2 diabetes (p < 0.001 ), complicated hypertension (p = 0.001), metastasis (p = 0.042) for PQI-14; female gender (p = 0.001), congestive heart failure (CHF) (p = 0.001), valvulopathy (p = 0.024), BPCO (p = 0.028), renal failure (p < 0.001), liver disease (p = 0.015) for PQI-16.Considerable factors affecting the costs were female gender (p = 0.005), peripheral vascular disease (p = 0.006), renal failure (p = 0.050) for PQI-1; type 2 diabetes (p = 0.002), arrhythmia (p = 0.002), peripheral vascular disease (p < 0.001), BPCO (p < 0.001), renal failure (p < 0.001) for PQI-3; peripheral vascular disease (p = 0.004), uncomplicated hypertension (p = 0.005), BPCO (p = 0.011), renal failure (p = 0.009), liver disease (p < 0.001), psychosis (p = 0.027) for PQI-14; CHF (p = 0.014), arrhythmia (p = 0.001 ), uncomplicated hypertension (p = 0.003), renal failure (p = 0.008), deficiency anemia (p = 0.032) for PQI-16.
Conclusions
DRPHs has been increasing and some comorbidities need to be better managed in outpatient setting to reduce LOS and costs.
Key messages
This study addresses the effect of multimorbidity on the burden of diabetes-related preventable hospitalizations using administrative data from an entire italian region over 10 years period. This study uses Prevention Quality Indicators to measure their burden on regional public health and produces useful evidences for the improvement of diabetes management in outpatient setting.
Prevalence of peripheral vascular disease and its association with carotid intima-media thickness and arterial stiffness in type 2 diabetes: The Chennai Urban Rural Epidemiology Study (CURES 111)
