Paper
Saturday, July 24, 2004
This presentation is part of : Chronic-Illness Management
Chronic Disease Management: Trends in U.S. Hospital Characteristics and Economic Policies
Marsha Dowell, RN, PhD and Billie Rozell, RN, DSN. College of Nursing, University of Alabama in Huntsville, Huntsville, AL, USA
Learning Objective #1: Relate trends in hospital characteristics and selected economic policies to patients with type 2 diabetes
Learning Objective #2: Appreciate the usefulness of large secondary databases in health services research for economic policy analysis

Objective: To identify trends in chronic disease management related to economic policies and outcomes in US hospitalized patients with type 2 diabetes. Design: Longitudinal, descriptive, cross sectional study. Sample: Research utilized a secondary database, The Health Care Cost and Utilization Project (HCUP-3),1994-2000, with a stratified probability sample of hospitals proportional in each stratum to the number of all community hospitals. Discharge records of 4,140,461 patients with type 2 diabetes, 15 years of age and older from 28 US states comprised the sample. Variables: Location of hospital, type of hospital, payer, total charges, charges per day, disposition post-hospitalization and patient descriptive variables. Methods: Descriptive analyses, hierarchical random effects regression modeling and contrasts between covariate-adjusted means. Charge data were highly skewed in a positive direction, requiring a logarithmic transformation. Findings: Hospital charges increased at a significantly faster rate after the implementation of the Balanced Budget Act of 1997. The type of hospital and selected patient characteristics were significant factors in economic resource utilization. Additionally significant interaction effects were identified between selected hospital and patient characteristics over the years of the study. Conclusions: The rising economic burden related to treatment of type 2 diabetes continues to progress and dramatically escalate. Despite cost containment policies implemented in the late 1990ís, these data reflect disparity between the intended outcomes of the policies and chronic illness care in the hospital setting. Implications: Diabetes costs the US economy over $100 billion dollars each year with one of every $10 allocated for hospital expenditures. Further studies of the economic policies coupled with pre-hospital care patterns are needed to further understand the disparities in management and the economic burden of type 2 diabetes.

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