title: Nutritionist visits, diabetes classes, and hospitalization rates and charges: the Urban Diabetes Study.
abstract: OBJECTIVE
  We evaluated the association of different types of educational visits for diabetic patients of the eight Philadelphia Health Care Centers (PHCCs) (public safety-net primary care clinics), with hospital admission rates and charges reported to the Pennsylvania Health Care Cost Containment Council.
  
  
  METHODS
  The study population included 18,404 patients who had a PHCC visit with a diabetes diagnosis recorded between 1 March 1993 and 31 December 2001 and had at least 1 month follow-up time.
  
  
  RESULTS
  A total of 31,657 hospitalizations were recorded for 7,839 (42.6%) patients in the cohort. After adjustment for demographic variables, baseline comorbid conditions, hospitalizations before the diabetes diagnosis, and number of other primary care visits, having had any type of educational visit was associated with 9.18 (95% CI 5.02-13.33) fewer hospitalizations per 100 person-years and $11,571 ($6,377 to $16,765) less in hospital charges per person. Each nutritionist visit was associated with 4.70 (2.23-7.16) fewer hospitalizations per 100 person-years and a $6,503 ($3,421 to $9,586) reduction in total hospital charges.
  
  
  CONCLUSIONS
  Any type of educational visit was associated with lower hospitalization rates and charges. Nutritionist visits were more strongly associated with reduced hospitalizations than diabetes classes. Each nutritionist visit was associated with a substantial reduction in hospital charges, suggesting that providing these services in the primary care setting may be highly cost-effective for the health care system.
authors.affiliation: Philadelphia Department of Public Health, Division of Ambulatory Health Services, Philadelphia, PA 19146, USA. jessica.robbins@phila.gov
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Robbins
authors.forename: Gail E
authors.initials: GE
authors.lastname: Thatcher
authors.forename: David A
authors.initials: DA
authors.lastname: Webb
authors.forename: Vivian G
authors.initials: VG
authors.lastname: Valdmanis
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000534:rehabilitation*; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D010351:Patient Discharge; D010353:Patient Education as Topic; D015143:Philadelphia; D044469:Racial Groups; D012648:Self Care; D014505:Urban Population