Evaluation of Diabetes Primary Care and Effects on Health Care Charges in Elderly Patients With Diabeties

This study assessed diabetes out-patient care at a single institution in Medicare patients with significant health care expenditures and correlated the control of these patients with hospital admission rates and charges. A retrospective review was performed at a university health sciences center’s clinics and affiliated hospital. Medicare patients with Type 2 diabetes, >65 years, and hospitalized >1 in the past year with annual incurred Medicare charges of >$6,000 were included in the study. Data collected over a year period included: hospitalization and emergency department use and charges, and key out-patient diabetes-related quality of care outcomes. These outcomes were compared with national benchmark National Health and Nutrition Examination Survey (NHANES) data. Ninety-three patients were identified (median age of 72). More patients were at goal hemoglobin A1c, low-density lipoprotein cholesterol, and blood pressure than benchmark National Health and Nutrition Examination Survey data. There was a significant correlation between HbA1c and diabetes-related and all cause hospitalizations and ER visits per patient (P < 0.025) and diabetes-related charges (P=0.0291). There were no differences between an endocrinologist and general practitioners in the quality of care except for documented microalbuminuria and aspirin use. Diabetes care at this institution was better than national benchmark data. HbA1c correlated with diabetes-related hospitalizations, all-cause combined hospitalizations and emergency department visits and charges. There were no major differences in the care of patients between the endocrinologist and general practitioners.