title: Can ambulatory care prevent hospitalization for metabolic decompensation?
abstract: OBJECTIVE
  Metabolic decompensations (MD) are hospitalizations considered preventable with appropriate ambulatory care. We tested for associations between diabetes care and MD.
  
  
  METHODS
  We retrospectively compared care between cases (MD; n = 2714) and controls (without MD; n = 10,856) using merged Veterans Health Administration and Medicare data. Logistic regression tested for associations between MD and diabetes care controlling for patient characteristics.
  
  
  METHODS
  Veterans Health Administration users with diabetes stratified into high [hemoglobin A1c (HA1c) > or =9%; n = 2532] and low (HA1c <9%; n = 6176) risk groups.
  
  
  METHODS
  The outcome was hospitalization for MD. Care was defined as quarterly or semiannual diabetes visits and HA1c testing during individualized 12-month baseline periods.
  
  
  RESULTS
  : Cases averaged more diabetes visits and HA1c tests than controls (P < 0.001 for both) in the 12-month baseline period. Among the high-risk, 29.8% of cases made 4 quarterly visits compared with 29.6% of controls (P = 0.004); among the low-risk, there was no difference in semiannual visits. Among the high-risk, models showed having no visit was associated with higher odds of MD (adjusted odds ratio: 3.05; 95% confidence interval: 1.69-5.49) compared with 4 visits; individuals with 1-4 visits had similar odds of MD. More HA1c testing was weakly associated with higher odds of MD.
  
  
  CONCLUSIONS
  MD was associated with more diabetes care, even controlling for patient characteristics. This inconsistency with the theoretical association between appropriate ambulatory care and lower MD rates indicates that MD rates may not accurately reflect diabetes care quality.
authors.affiliation: Center for Healthcare Knowledge Management, Veterans Administration-New Jersey Health Care System, East Orange, New Jersey, USA. drew.helmer@va.gov
authors.forename: Drew A
authors.initials: DA
authors.lastname: Helmer
authors.forename: Chin-Lin
authors.initials: CL
authors.lastname: Tseng
authors.forename: Mangala
authors.initials: M
authors.lastname: Rajan
authors.forename: Stephen
authors.initials: S
authors.lastname: Crystal
authors.forename: Yujing
authors.initials: Y
authors.lastname: Shen
authors.forename: Donald R
authors.initials: DR
authors.lastname: Miller
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.forename: Anjali
authors.initials: A
authors.lastname: Tiwari
authors.forename: Leonard
authors.initials: L
authors.lastname: Pogach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000378:metabolism / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000378:metabolism / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data
chemical_list: D006442:Glycated Hemoglobin