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 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 & 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

Self-Care Behaviors and Glycemic Control in Low-Income Adults in México With Type 2 Diabetes Mellitus May Have Implications for Patients of Mexican Heritage Living in the United States

2015 ◽  
Vol 25 (2) ◽  
pp. 120-138 ◽  
Author(s):  
Lidia G. Compeán Ortiz ◽  
Beatriz Del Ángel Pérez ◽  
Eunice Reséndiz González ◽  
Socorro Piñones Martínez ◽  
Nora H. González Quirarte ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
United States ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycemic Control ◽  
Low Income ◽  
Self Care ◽  
The United States ◽  
Mexican Heritage

scholarly journals Healthcare utilisation and out-of-pocket expenditure of type 2 diabetes patients with and without comorbidity: A study in primary care in Bhubaneswar, India.

2020 ◽  
Author(s):  
Sandipana Pati ◽  
Subhashisa Swain ◽  
Marjan van den Akker ◽  
F. (François) G. Schellevis ◽  
Jako S. Burgers
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Chronic Conditions ◽  
Healthcare Expenditure ◽  
Healthcare Utilisation ◽  
Comorbid Conditions ◽  
Healthcare Facilities ◽  
Number Of Visits ◽  
Diabetes Patients

Abstract Background: Globally, non-communicable diseases (NCD) demand a higher healthcare expenditure. Amongst the NCDs, diabetes mellitus, is often associated with multiple, co-existing chronic conditions. In low- and middle-income countries where most of the healthcare expenditure is borne out of pocket, diabetes management may pose a significant financial stress.Methods: A cross-sectional study was conducted in 17 urban primary healthcare facilities of Bhubaneswar to assess the healthcare utilisation and out-of-pocket expenditure among type 2 diabetes patients attending these facilities. Healthcare utilisation was determined by the number of visits to healthcare facilities in the last six months, and out-of-pocket expenditure was assessed by outpatient consultation fees, medicines, travels to health care facilities and diagnostic tests. Total out-of-pocket expenditure was defined as the sum of these costs.Results: The median number of visits in 6 months for diabetes patients with any comorbidity was 4 and 5 for diabetes patients with more than 4 comorbidities. Among the comorbid conditions, depression, stroke, auditory impairment and acid peptic disease were associated with higher healthcare utilisation. The total out-of-pocket expense was 2.3 times higher among diabetes patients with any comorbid condition compared to patients with diabetes only. The total median expenditure was higher for diabetes patients having stroke, heart diseases, kidney diseases and cancer compared to other comorbid conditions. The association of comorbidity in diabetes patients with health care utilization and out-of-pocket expenditure is statistically significant after adjustment for sociodemographic characteristics and diabetes duration.Conclusion: Considerable expenditure is incurred by diabetes patients attending primary healthcare facilities for the management of diabetes and other chronic conditions. This is a significant burden for diabetes patients below the poverty line and with limited or no insurance cover. There is a need to increase the coverage of insurance schemes to address the chronic conditions management expenditure of outpatients.

Designing Healthier Built Environments

2018 ◽  
Author(s):  
Pedro Gullón ◽  
Gina S. Lovasi
Keyword(s):  
Mental Health ◽  
Physical Activity ◽  
Type 2 Diabetes ◽  
Built Environment ◽  
Health Outcomes ◽  
Low Income ◽  
Built Environments ◽  
Street Connectivity ◽  
Research Challenges

The “built environment” is comprised of human-made structures and systems, and aspects include access to and attractiveness of walkable destinations (e.g., retail stores, parks) and community design features (e.g., street connectivity, sidewalk access). A variety of built environment characteristics can influence health outcomes and behaviors, including physical activity, obesity, type 2 diabetes, hypertension, and mental health, as well as sleep and use of tobacco and alcohol. This chapter discusses the large and complex accumulated research on the built environment as well as the methods used to study it, research challenges, policy implication, and how to bring together partnerships for policy change. This chapter also discusses the research conducted across populations (e.g., children, low-income individuals) and geographies (e.g., urban and rural geographies).

scholarly journals TRENDS OF INDICATORS CHARACTERIZING THE BURDEN OF TYPE 2 DIABETES ON HEALTH CARE SYSTEMS IN UKRAINE AND SOME DEVELOPED COUNTRIES

2020 ◽  
Vol 46 (3) ◽  
Author(s):  
G. P. Mykhalchyshyn
Keyword(s):  
United States ◽  
Type 2 Diabetes ◽  
Health Care ◽  
Health Care Systems ◽  
Developed Countries ◽  
The United States ◽  
Life Years ◽  
Care Systems ◽  
The Usa

Abstract Purpose of the study. Is to compare the epidemiological trends (2000–2017) of indicators characterizing the burden of type 2 diabetes on health care systems in Ukraine and some developed countries. Materials and methods. The trends in morbidity, prevalence, mortality, years lived with disability (YLDs), as well as disability adjusted life years (DALYs) in type 2 diabetes (per 100 thousand of population) were analyzed. Results. Over a period of 2000–2017, the incidence of type 2 diabetes in Ukraine increased by 10,4%, in Belarus – by 9,2%, in Poland – by 28,1%, in Germany – by 32,1% and in the United States – by 69,6%. Accordingly, the largest increase in the prevalence occurred in the United States (by 83,2%), Germany (by 40,0%) and Poland (by 42,6%) and the least in Ukraine (by 9,9%). The mortality rate in Ukraine as of 2017 was lower than in the USA, Poland and Germany, respectively: 4,0 against 17,4; 13,8; 20,6 per 100 thousand of population. The largest increase in YLDs and DALY occurred in the United States (by 81,0% and 45,6%), Germany (by 45,2% and 28,8%), Poland (by 41,6% and 45,4%), against the background of a slight increase in Ukraine (by 10,2% and 7,8%). Conclusions. Over a period of 2000–2017, the trends of indicators characterizing the burden of type 2 diabetes on the health care systems of Ukraine and other countries differ, which requires further analysis and clarification of this situation. Keywords: burden, incidence, prevalence, YLDs, DALY, type 2 diabetes.

scholarly journals Impact of Antidepressant Use on Healthcare Utilization among Individuals with Type 2 Diabetes and Depression Symptoms in the United States: Sociodemographic, Clinical, and Behavioral Factors Matter

2018 ◽  
Vol 15 (9) ◽  
pp. 1904
Author(s):  
Ammena Binsaleh ◽  
Alexandra Perez ◽  
Ioana Popovici ◽  
Silvia Rabionet
Keyword(s):  
United States ◽  
Type 2 Diabetes ◽  
Health Care ◽  
Healthcare Utilization ◽  
Access To Health Care ◽  
The United States ◽  
Depression Symptoms ◽  
Behavioral Factors ◽  
Antidepressant Use

Individuals with diabetes are twice as likely to struggle from depressive symptoms than individuals without diabetes. However, this joint condition is undertreated in nearly two-thirds of patients. Failure to monitor the comorbidity may lead to suboptimal therapy. This study evaluated the association of antidepressant use with healthcare utilization in a national sample of patients with type 2 diabetes and depression symptoms in the United States. It further assessed the differences in sociodemographic, clinical, and behavioral factors between those who use antidepressants and those who do not. This study was a secondary data analysis using the National Health and Nutrition Examination Survey (NHANES) for the period 2005–2014. To assess if there were significant differences in sociodemographic, clinical, and behavioral factors between those who were taking antidepressants or not, Chi Square and independent t-tests were used. To assess if there was a significant association between antidepressant use and healthcare utilization, univariate and multivariate regression analyses were conducted. Of the 955 participants, only 33% were on antidepressants. There were significant differences in sociodemographic, clinical, and behavioral factors among those who used antidepressants and those who did not. Regardless of antidepressant use, the study population had access to health care. Those on antidepressants had fewer diabetes specialists’ visits and more mental health care. There might be underlying health care disparities related to the use of, and access to, antidepressants. Further studies are needed to comprehensively explore the management of these comorbidities.

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