An expanded prevention quality diabetes composite: Quantifying the burden of preventable hospitalizations for older adults with diabetes

To expand the existing United States Agency for Health Research and Quality (AHRQ) Diabetes composite (AHRQ-DC) to include additional preventable hospitalizations specific or relevant to diabetes. A cross-sectional analysis of 834,696 veteran patients with diabetes aged ≥65 years in 2012. An Expande...

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Veröffentlicht in:Journal of diabetes and its complications 2018-05, Vol.32 (5), p.458-464
Hauptverfasser: Tseng, Chin-Lin, Soroka, Orysya, Pogach, Leonard M.
Format: Artikel
Sprache:eng
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Zusammenfassung:To expand the existing United States Agency for Health Research and Quality (AHRQ) Diabetes composite (AHRQ-DC) to include additional preventable hospitalizations specific or relevant to diabetes. A cross-sectional analysis of 834,696 veteran patients with diabetes aged ≥65 years in 2012. An Expanded Diabetes Composite (Expanded-DC) was developed utilizing: (1) the diabetes-specific category: the AHRQ-DC (short-term and long-term complications, uncontrolled diabetes, lower extremity amputations) and two proposed conditions: hypoglycemia and lower extremity ulcers/inflammation/infections (LEU) and (2) the diabetes-relevant category: the AHRQ-Acute Composite (dehydration, pneumonia, urinary tract infections) and one proposed condition, acute kidney injury (AKI). The study population was 98% male, 80% White, 10% Black, and 5% Hispanic; 71% had complex comorbidities. There were 64,243 (77.0 admissions/1000 patients) hospitalizations in the Expanded-DC, compared to 13,523 (16.2) in the AHRQ-DC, a 4.7 fold increase. Hospitalizations from AHRQ-Acute Composite and the three proposed conditions added 79% to the Expanded-DC. LEU and hypoglycemia added 39% to the diabetes-specific category. AKI added 18% to the diabetes-relevant category. Blacks incurred more preventable hospitalizations (85.9) than Whites (74.7); as did patients with complex comorbidities (93.6) versus those without (34.6). The AHRQ-DC substantially underestimates rates of clinically important preventable hospitalizations in older diabetes patients.
ISSN:1056-8727
1873-460X
DOI:10.1016/j.jdiacomp.2018.01.013