title: Diabetes, kidney disease and cardiovascular disease patients. Assessing care of complex patients using outpatient testing and visits: additional metrics by which to evaluate health care system functioning.
abstract: BACKGROUND
  The triad of cardiovascular disease (CVD), chronic kidney disease (CKD) and diabetes mellitus (DM) share many fundamental disease pathways. Patients with these conditions contribute excessively to health care costs. Opportunities for system redesign require metrics by which to evaluate the impact.
  
  
  METHODS
  Using a provincial comprehensive set of administrative billing databases (outpatient visits, laboratory tests, pharmacy and hospital inpatient services), we itemized the prevalence of each and combination of conditions, resource utilization associated with each condition and combinations, using ICD 9-10 billing codes and standard definitions. Three consecutive years (2003-2005) were used to establish stability of findings.
  
  
  RESULTS
  CKD, CVD and DM diagnoses are found in 422 124 persons within a province of 4.3 million individuals (10%); 1.7% had all three conditions. The median age of each cohort varied significantly between those with multiple conditions (67-79 years) versus those with single condition (56-72 years). The median number of physician visits was 26 per patient year. Duplicate testing accounted for expenditures of $3 million/annum; 7.55% of patients accounted for 34.4% of duplicate tests. Those with DM or CKD had similar use of medications, physician visits and hospital days. Those with all conditions (CVD-CKD-DM) had a median of 6 in-hospital days/year. A significant proportion were not on ACE/ARB or statin medications (30 and 45%, respectively).
  
  
  CONCLUSIONS
  Patients with chronic, complex conditions consume a large number of outpatient and inpatient resources. Documenting these allows identification of a set of metrics by which to design and measure health care system redesign initiatives. Potential targets to benchmark in designing more effective systems have been identified.
authors.affiliation: University of British Columbia, Vancouver, Canada. alevin@providencehealth.bc.ca
authors.forename: Adeera
authors.initials: A
authors.lastname: Levin
authors.forename: Munaza R
authors.initials: MR
authors.lastname: Chaudhry
authors.forename: Ognjenka
authors.initials: O
authors.lastname: Djurdjev
authors.forename: Monica
authors.initials: M
authors.lastname: Beaulieu
authors.forename: Paul
authors.initials: P
authors.lastname: Komenda
mesh_terms: D000368:Aged; D001955:British Columbia; D002318:Cardiovascular Diseases / Q000150:complications* / Q000628:therapy*; D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D048909:Diabetes Complications / Q000628:therapy*; D003928:Diabetic Nephropathies / Q000150:complications* / Q000628:therapy*; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data