| Learning Objective #1: Identify 6 predictors of emergency/hospital admission for low-income persons with type 2 diabetes | |||
| Learning Objective #2: Describe interventions and clinical strategies that may decrease admission rates in this population |
Objective. The purpose of this study is to identify characteristics of low-income adults receiving primary care for type 2 diabetes that place them at risk for high cost emergency department and hospital utilization. Diabetes is a high demand disease with costs attributed to hospitalization estimated at $27 billion per year. Low-income persons are at disproportionate risk for hospital utilization.
Variables Studied. Iezzoni’s (1997) effectiveness model informed the identification of clinical and nonclinical dimensions of risk with relevance to diabetes. Access to care, utilization, risk behavior, self-care behavior, demographic, social support, and clinical indicator data were examined.
Methods/Sample. Data were collected by a one-year audit of a sample of charts (N=446) representing an ethnically diverse, low-income adult population. The average subject was a 54-year-old female who had diabetes for 6 years and 3.7 medical diagnoses in addition to diabetes.
Findings. Eighteen percent of the sample had at least one emergency department (ED) or hospital admission during the audit year (mean = .61 ± 1.7 ED admissions/year, .28 ± .85 hospital admissions/year). Results of logistic regression analysis revealed 6 significant (p<.05) predictors of admission: moderate/severe acute glycemic events (odds ratio [OR], 2.88), male sex (OR, 0.51), inactivity (OR, 0.28), alcohol abuse (OR, 2.57), clinic phone visits (OR, 1.05), and not receiving primary care exclusively from nurse practitioner/physician assistant providers during the audit year (OR, 0.30).
Conclusions/Implications. Interventions designed to be relevant to men that target improved glycemic control, promotion of exercise and limiting alcohol intake, as well as clinical strategies that enhance patient-clinic communication and the nurse practitioner role in providing primary care to low-income people with diabetes may decrease hospital admission rates in this population. Diabetes care protocols should be tailored to address these specific areas and to empower better self-management and health care system utilization in low-income persons with diabetes.
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