| Learning Objective #1: Relate trends in access, equity and outcomes of hospitalized patients with Type 2 diabetes to evidence based-decision making in health policy | |||
| Learning Objective #2: Appreciate the usefulness of large secondary databases in health services research for evidence-based decision making |
Health Policy Implications: Evidence of Disparities in Access, Equity and Outcomes of Hospitalized Patients with Type 2 Diabetes
Objective: To identify trends related to access, equity and outcomes in hospitalized patients with Type 2 diabetes and describe health policy implications of such trending.
Design: Longitudinal, descriptive, cross sectional study.
Sample: Research utilized a secondary database, The Health Care Cost and Utilization Project (HCUP-3),1994-1999, with a stratified probability sample of hospitals proportional in each stratum to the number of all community hospitals. Discharge records of 962,987 patients with Type 2 diabetes, 40 years of age and older from 22 U.S. states comprised the sample.
Variables: Admission status, principle or secondary diagnosis of Type 2 diabetes, number and type of co-morbid conditions, complications, length of stay, gender, age, ethnicity, procedures utilized, location of hospital, type of hospital, bed size of hospital, insurance provider, total charges, charges per day, disposition post-hospitalization.
Methods: Descriptive analyses, hierarchical random effects regression modeling and contrasts between covariate-adjusted means. Charge data required a logarithmic transformation.
Findings: Significant racial and gender disparities in healthcare access, equity and outcomes, with equity variables yielding alarming disparities in types of procedures (i.e. amputations, cardiac catheterizations) performed, length of stay and disposition.
Conclusions: Dissonance between recommended diabetes pre-hospital care forestalling disease progression and co-morbid disease and complications identified in hospitalizations. Health policy recommendations focus on access and equitable use of resources in a systematic framework of chronic disease diabetes management.
Implications: Health services research with large databases provides a strong argument for evidence based health policy decision-making in diabetes care.
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Back to 14th International Nursing Research Congress
Sigma Theta Tau International
10-12 July 2003