Diabetes Prevalence and Influence on Resource Use in Washington State Inpatient Rehabilitation Facilities, 2001 to 2007

Abstract Weeks DL, Daratha KB, Towle LA. Diabetes prevalence and influence on resource use in Washington State inpatient rehabilitation facilities, 2001 to 2007. Objective To determine the prevalence of diabetes in inpatient rehabilitation facilities in Washington State from 2001 to 2007, and to determine the impact of diabetes on length of stay (LOS) and charges per day. Design Longitudinal retrospective cohort analysis of inpatient rehabilitation discharge data from the Washington State Department of Health Comprehensive Hospital Abstract Reporting System. Setting Inpatient rehabilitation. Participants Adults (N=56,382) who were discharged from inpatient rehabilitation in Washington State between 2001 and 2007. Interventions Not applicable. Main Outcome Measures Evidence of an established diagnosis of diabetes from International Classification of Diseases , 9th Revision , Clinical Modification (ICD-9-CM) diagnosis codes; comorbid conditions reported in ICD-9-CM codes; LOS; and charges per stay. Results For all discharges from 2001 to 2007, diabetes prevalence was 17.8%; prevalence within specific impairment groups was 21.3% for the stroke subgroup, 14.2% for the orthopedic disorders subgroup, and 25% for the medically complex conditions subgroup. For all discharges, and within each impairment subgroup, prevalence did not change significantly from year to year. When adjusted for burden of nondiabetes comorbidities, LOS was significantly shorter for all discharges with diabetes younger than 65 years. The association between a diabetes codiagnosis and LOS in specific impairment groups was complex, ranging from a significantly shorter LOS for discharges with diabetes in the stroke subgroup to a finding of no significant difference in LOS among discharges with or without diabetes in the orthopedic impairments subgroup. Across all discharges, charges per day from 2003 to 2007 were significantly greater in discharges with diabetes. Within each specific impairment subgroup, charges per day across the entire study period were significantly greater for discharges with diabetes. Conclusions The high prevalence of diabetes, coupled with its impact on resource use, suggests that substantial pressures may be placed on the inpatient rehabilitation care system to respond to the needs of those with diabetes.