Impact of two different health systems on the burden of type 2 diabetes

2013 ◽  
Vol 19 (2) ◽  
pp. 69-76 ◽  
Author(s):  
Naomh Gallagher ◽  
Kathleen Bennett ◽  
Susan M Smith ◽  
Dermot O’Reilly
Keyword(s):  
Type 2 Diabetes ◽  
Health Systems

scholarly journals Hospital utilization for hypoglycemia among patients with type 2 diabetes using pooled data from six health systems

2021 ◽  
Vol 9 (Suppl 1) ◽  
pp. e002153
Author(s):  
Scott J Pilla ◽  
Jennifer L Kraschnewski ◽  
Erik B Lehman ◽  
Lan Kong ◽  
Erica Francis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Health Systems ◽  
Emergency Department Visits ◽  
Hospital Utilization ◽  
Electronic Health Record Data ◽  
Icd 10

IntroductionHypoglycemia is the most common serious adverse effect of diabetes treatment and a major cause of medication-related hospitalization. This study aimed to identify trends and predictors of hospital utilization for hypoglycemia among patients with type 2 diabetes using electronic health record data pooled from six academic health systems.Research design and methodsThis retrospective open cohort study included 549 041 adults with type 2 diabetes receiving regular care from the included health systems between 2009 and 2019. The primary outcome was the yearly event rate for hypoglycemia hospital utilization: emergency department visits, observation visits, or inpatient admissions for hypoglycemia identified using a validated International Classification of Diseases Ninth Revision (ICD-9) algorithm from 2009 to 2014. After the transition to ICD-10 in 2015, we used two ICD-10 code sets (limited and expanded) for hypoglycemia hospital utilization from prior studies. We identified independent predictors of hypoglycemia hospital utilization using multivariable logistic regression analysis with data from 2014.ResultsYearly rates of hypoglycemia hospital utilization decreased from 2.7 to 1.6 events per 1000 patients from 2009 to 2014 (p-trend=0.023). From 2016 to 2019, yearly event rates were stable ranging from 5.6 to 6.6, or 6.3 to 7.3, using the limited and expanded ICD-10 code sets, respectively. In 2014, the strongest independent risk factors for hypoglycemia hospital utilization were chronic kidney disease (OR 2.86, 95% CI 2.33 to 3.57), ages 18–39 years (OR 2.43 vs age 40–64 years, 95% CI 1.78 to 3.31), and insulin use (OR 2.13 vs no diabetes medications, 95% CI 1.67 to 2.73).ConclusionsRates of hypoglycemia hospital utilization decreased from 2009 to 2014 and varied considerably by clinical risk factors such that younger adults, insulin users, and those with chronic kidney disease were at especially high risk. There is a need to validate hypoglycemia ascertainment using ICD-10 codes, which detect a substantially higher number of events compared with ICD-9.

scholarly journals Quantifying Variation in Treatment Utilization for Type 2 Diabetes Across Five Major University of California Health Systems

2021 ◽  
Author(s):  
Thomas A. Peterson ◽  
Valy Fontil ◽  
Suneil K. Koliwad ◽  
Ayan Patel ◽  
Atul J. Butte
Keyword(s):  
Type 2 Diabetes ◽  
Los Angeles ◽  
Health Systems ◽  
San Francisco ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
University Of California ◽  
Treatment Utilization ◽  
Matching Techniques

<b>Objective:</b> Using the newly created University of California Health Data Warehouse (UCHDW), we present the first study to analyze antihyperglycemic treatment utilization across the five large University of California (UC) academic health systems (Davis, Irvine, Los Angeles, San Diego, and San Francisco). <p><b>Research Design:</b> Retrospective analysis using deidentified Electronic Health Records (EHRs; 2014-2019) including 97,231 type 2 diabetes patients from 1,003 UC-affiliated clinical settings. Significant differences between health systems and individual providers were identified using binomial probabilities with cohort matching.</p> <p><b>Results</b>: Our analysis reveals statistically different treatment utilization patterns not only between health systems but also among individual providers within health systems. We identified 21 differences among health systems, and 29 differences among individual providers within these health systems, with respect to treatment intensifications within existing guidelines on top of either metformin monotherapy or dual therapy with metformin and a sulfonylurea. Next, we identified variation for medications within the same class (e.g., glipizide vs. glyburide among sulfonylureas), with 33 differences among health systems and 86 among individual providers. Finally, we identified two health systems and 55 individual providers that more frequently utilized medications with known cardioprotective benefits for patients with high cardiovascular disease risk, but also one health system and 8 providers who prescribed such medications less frequently for these patients.</p> <p><b>Conclusions:</b> Our study utilized cohort matching techniques to highlight real-world variation in care between health systems and individual providers. This demonstrates the power of EHRs to quantify differences in treatment utilization, a necessary step towards standardizing precision care for large populations.</p>

349-P: Hospital Utilization for Hypoglycemia among Patients with Type 2 Diabetes Using Pooled Data from Six Health Systems

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 349-P
Author(s):  
SCOTT J. PILLA ◽  
JENNIFER L. KRASCHNEWSKI ◽  
ERIK LEHMAN ◽  
LAN KONG ◽  
ERICA FRANCIS ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Health Systems ◽  
Hospital Utilization ◽  
Pooled Data

scholarly journals Assessing the influence of health systems on Type 2 Diabetes Mellitus awareness, treatment, adherence, and control: A systematic review

PLoS ONE ◽  
2018 ◽  
Vol 13 (3) ◽  
pp. e0195086 ◽  
Author(s):  
Suan Ee Ong ◽  
Joel Jun Kai Koh ◽  
Sue-Anne Ee Shiow Toh ◽  
Kee Seng Chia ◽  
Dina Balabanova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Treatment Adherence ◽  
Health Systems ◽  
And Control

Public health and health systems: implications for the prevention and management of type 2 diabetes in south Asia

2018 ◽  
Vol 6 (12) ◽  
pp. 992-1002 ◽  
Author(s):  
Andrew P Hills ◽  
Anoop Misra ◽  
Jason M R Gill ◽  
Nuala M Byrne ◽  
Mario J Soares ◽  
...  
Keyword(s):  
Public Health ◽  
Type 2 Diabetes ◽  
South Asia ◽  
Health Systems

scholarly journals Continuity of Care for Patients with Obesity-Associated Chronic Conditions: Protocol for a Multisite Retrospective Cohort Study (Preprint)

2020 ◽  
Author(s):  
Yilu Lin ◽  
James E Bailey ◽  
Satya Surbhi ◽  
Sohul A Shuvo ◽  
Christopher D Jackson ◽  
...  
Keyword(s):  
United States ◽  
Type 2 Diabetes ◽  
Health Care ◽  
Health Outcomes ◽  
Health Systems ◽  
Continuity Of Care ◽  
Low Income ◽  
Chronic Conditions ◽  
Obesity And Diabetes

BACKGROUND Obesity affects nearly half of adults in the United States and is contributing substantially to a pandemic of obesity-associated chronic conditions such as type 2 diabetes, hypertension, and arthritis. The obesity-associated chronic condition pandemic is particularly severe in low-income, medically underserved, predominantly African-American areas in the southern United States. Little is known regarding the impact of geographic, income, and racial disparities in continuity of care on major health outcomes for patients with obesity-associated chronic conditions. OBJECTIVE The aim of this study is to assess, among patients with obesity-associated chronic conditions, and within this group, patients with type 2 diabetes, (1) whether continuity of care is associated with lower overall and potentially preventable emergency department and hospital utilization, (2) the effect of geographic, income, and racial disparities on continuity of care and on health care utilization, (3) whether continuity of care particularly protects individuals at risk for disparities from adverse health outcomes, and (4) whether characteristics of health systems are associated with higher continuity of care and better outcomes. METHODS Using 2015-2018 data from 4 practice-based research networks participating in the Southern Obesity and Diabetes Coalition, we will conduct a retrospective cohort analysis and distributed meta-analysis. Patients with obesity-associated chronic conditions and with type 2 diabetes will be assessed within each health system, following a standardized study protocol. The primary study outcomes are overall and preventable emergency department visits and hospitalizations. Continuity of care will be calculated at the facility level using a modified version of the Bice-Boxerman continuity of care index. Race will be assessed using electronic medical record data. Residence in a low-income area or a health professional shortage area respectively will be assessed by linking patient residence ZIP codes to the Centers for Medicare &amp; Medicaid Services database. RESULTS In 4 regional health systems across Tennessee, Mississippi, Louisiana, and Arkansas, a total of 53 adult hospitals were included in the study. A total of 147,889 patients with obesity-associated chronic conditions who met study criteria were identified in these health systems, of which 45,453 patients met the type 2 diabetes criteria for inclusion. Results are expected by the end of 2020. CONCLUSIONS This study should reveal whether health system efforts to increase continuity of care for patients with obesity and diabetes have potential to improve outcomes and reduce costs. Analyzing disparities in continuity of care and their effect on major health outcomes can help demonstrate how to improve care and use of health care resources for vulnerable patients with obesity-associated chronic conditions, and within this group, patients with type 2 diabetes. Better understanding of the association between continuity and health care utilization for these vulnerable populations will contribute to the development of higher-value health systems in the southern United States. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/20788

scholarly journals Continuity of Care for Patients with Obesity-Associated Chronic Conditions: Protocol for a Multisite Retrospective Cohort Study

10.2196/20788 ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. e20788
Author(s):  
Yilu Lin ◽  
James E Bailey ◽  
Satya Surbhi ◽  
Sohul A Shuvo ◽  
Christopher D Jackson ◽  
...  
Keyword(s):  
United States ◽  
Type 2 Diabetes ◽  
Health Care ◽  
Health Outcomes ◽  
Health Systems ◽  
Continuity Of Care ◽  
Low Income ◽  
Chronic Conditions ◽  
Obesity And Diabetes

Background Obesity affects nearly half of adults in the United States and is contributing substantially to a pandemic of obesity-associated chronic conditions such as type 2 diabetes, hypertension, and arthritis. The obesity-associated chronic condition pandemic is particularly severe in low-income, medically underserved, predominantly African-American areas in the southern United States. Little is known regarding the impact of geographic, income, and racial disparities in continuity of care on major health outcomes for patients with obesity-associated chronic conditions. Objective The aim of this study is to assess, among patients with obesity-associated chronic conditions, and within this group, patients with type 2 diabetes, (1) whether continuity of care is associated with lower overall and potentially preventable emergency department and hospital utilization, (2) the effect of geographic, income, and racial disparities on continuity of care and on health care utilization, (3) whether continuity of care particularly protects individuals at risk for disparities from adverse health outcomes, and (4) whether characteristics of health systems are associated with higher continuity of care and better outcomes. Methods Using 2015-2018 data from 4 practice-based research networks participating in the Southern Obesity and Diabetes Coalition, we will conduct a retrospective cohort analysis and distributed meta-analysis. Patients with obesity-associated chronic conditions and with type 2 diabetes will be assessed within each health system, following a standardized study protocol. The primary study outcomes are overall and preventable emergency department visits and hospitalizations. Continuity of care will be calculated at the facility level using a modified version of the Bice-Boxerman continuity of care index. Race will be assessed using electronic medical record data. Residence in a low-income area or a health professional shortage area respectively will be assessed by linking patient residence ZIP codes to the Centers for Medicare & Medicaid Services database. Results In 4 regional health systems across Tennessee, Mississippi, Louisiana, and Arkansas, a total of 53 adult hospitals were included in the study. A total of 147,889 patients with obesity-associated chronic conditions who met study criteria were identified in these health systems, of which 45,453 patients met the type 2 diabetes criteria for inclusion. Results are expected by the end of 2020. Conclusions This study should reveal whether health system efforts to increase continuity of care for patients with obesity and diabetes have potential to improve outcomes and reduce costs. Analyzing disparities in continuity of care and their effect on major health outcomes can help demonstrate how to improve care and use of health care resources for vulnerable patients with obesity-associated chronic conditions, and within this group, patients with type 2 diabetes. Better understanding of the association between continuity and health care utilization for these vulnerable populations will contribute to the development of higher-value health systems in the southern United States. International Registered Report Identifier (IRRID) DERR1-10.2196/20788

scholarly journals Oral Hypoglycemic Drugs for Type 2 Diabetes Mellitus: Comparisson of Prices in Brazil and Other Universal Health Systems

2018 ◽  
Vol 17 ◽  
pp. 135-141
Author(s):  
Gustavo L.A. de Oliveira ◽  
Jans B. Izidoro ◽  
Felipe Ferré ◽  
Samuel R.A. e Sousa ◽  
Francisco A. Acurcio
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Health Systems ◽  
Oral Hypoglycemic Drugs ◽  
Universal Health

Quantifying Variation in Treatment Utilization for Type 2 Diabetes Across Five Major University of California Health Systems

Diabetes Care ◽  
2021 ◽  
pp. dc200344
Author(s):  
Thomas A. Peterson ◽  
Valy Fontil ◽  
Suneil K. Koliwad ◽  
Ayan Patel ◽  
Atul J. Butte
Keyword(s):  
Type 2 Diabetes ◽  
Health Systems ◽  
University Of California ◽  
Treatment Utilization
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