Multiple hospitalizations for patients with diabetes.
OBJECTIVE
To describe the extent to which hospitalizations for patients with diabetes reflect multiple stays by the same individuals and to examine how multiple hospitalizations vary by patient demographic and socioeconomic characteristics.


METHODS
Using the Healthcare Cost and Utilization Project complete discharge data for five states (California, Missouri, New York, Tennessee, and Virginia) in 1999, we identified 648,748 nonneonatal, nonmaternal patients who had one or more hospitalizations listing diabetes. Multiple hospitalizations were measured as percent of patients with multiple stays, percent of total stays represented by multiple stays, and average number of stays per patient. Total hospital costs were also examined. Stratified analysis and regression were performed to assess differences by age, sex, race/ethnicity, payer, location, and income.


RESULTS
Among patients with diabetes who had been hospitalized, 30% had two or more stays accounting for >50% of total hospitalizations and hospital costs. Controlled for patient age, sex, and clinical characteristics, the likelihood of having multiple hospitalizations was higher for Hispanics and non-Hispanic blacks compared with non-Hispanic whites, as well as for patients covered by Medicare or Medicaid and those living in low-income areas. The prevalence of diabetes complications and multiple conditions differed by age, race/ethnicity, and payer among patients with multiple stays.


CONCLUSIONS
Multiple hospitalizations are common among patients with diabetes but vary by age, race/ethnicity, payer, and income, with those populations traditionally considered to be more vulnerable experiencing higher likelihoods of multiple stays. Significant opportunities exist to reduce the proportion of multiple hospitalizations for patients with diabetes. Clinical and policy interventions to improve the quality of care and outcomes for these patients should be designed accordingly and have the potential to pay major dividends.
Jiang
H Joanna
HJ
Center for Organization and Delivery Studies, Agency for Healthcare Research and Quality, Rockville, Maryland 20852, USA. jjiang@ahrq.gov
Stryer
Daniel
D
Friedman
Bernard
B
Andrews
Roxanne
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D003710:Demography; D003920:Diabetes Mellitus / Q000191:economics / Q000628:therapy*; D005006:Ethnicity; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008396:Maryland; D008875:Middle Aged; D044469:Racial Groups; D012424:Rural Population; D012959:Socioeconomic Factors; D014505:Urban Population