Health care resource utilization associated with a diabetes center and a general medicine clinic.
OBJECTIVE
Studies have proposed that the features of diabetes clinics may decrease hospital utilization and costs by reducing complications and providing more efficient outpatient care. We compared the health care utilization associated with a diabetes center (DC) and a general medicine clinic (GMC).


METHODS
Retrospective cohort study.


METHODS
An urban academic medical center.


METHODS
Type 2 diabetes patients (N = 601) under care in a DC and GMC before March 1996.


RESULTS
We compared baseline patient characteristics and outpatient care for the period of March 1996 to August 1997. Using administrative data from March 1996 to October 2000, we compared the probability of a hospitalization, length of stay, costs of hospitalizations, the probability of an emergency room visit, and costs of emergency room visits. Diabetes center patients had a longer mean duration of diabetes (12 years vs 6 years, P <.01), more baseline microvascular disease (65% vs 44%, P <.01), and higher baseline glucose levels (hemoglobin A1c 8.6% vs 7.9%, P <.01) than GMC patients. Diabetes center patients received more intensive outpatient care directed toward glucose monitoring and control. In all crude and adjusted analyses of hospitalizations and emergency room visits, we found no statistically significant differences for inpatient utilization or cost outcomes comparing clinic populations.


CONCLUSIONS
Diabetes center attendance did not have a definitive positive or negative impact on inpatient resource utilization over a 4-year period. However, DC patients had more severe diabetes but no greater hospital utilization compared with GMC patients. Clear demonstration of the clinical and financial benefits of features of diabetes centers will require long-term controlled trials of interventions that promote comprehensive diabetes care, including cardiovascular prevention.
Huang
Elbert S
ES
General Medicine Division, University of Chicago, Chicago, Illinoos 60637, USA. ehuang@medicine.bsd.uchicago.edu
Gleason
Suzanne
S
Gaudette
Ronald
R
Cagliero
Enrico
E
Murphy-Sheehy
Patricia
P
Nathan
David M
DM
Singer
Daniel E
DE
Meigs
James B
JB
D000046:Academic Medical Centers / Q000191:economics / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000628:therapy*; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006302:Health Services Research; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008511:Medicine / Q000706:statistics & numerical data; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D010348:Patient Care Team; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013038:Specialization