title: Emergency room visit: a red-flag indicator for poor diabetes care.
abstract: OBJECTIVE
  To determine the association between emergency room (ER) admission and quality of diabetes care in the community.
  
  
  METHODS
  In a nested case-control study of patients with Type 2 diabetes mellitus (DM) within a large health maintenance organization (HMO) in Israel, 919 patients who were admitted to one of West Jerusalem's ERs between 1 May and 30 June 2004 were compared with 1952 control subjects not admitted. Data on study covariates were retrieved from the HMO's computerized database and a subset of the study population was interviewed. Logistic regressions were conducted to estimate the odds ratios of being admitted according to different measures of quality of care, controlling for socio-demographic variables, co-morbidities and type of DM treatment.
  
  
  RESULTS
  The main indices of quality of primary care that were inversely associated with visiting an ER during the study period included performance of a cholesterol test in the year prior to the index date [adjusted odds ratio (OR) 0.23, 95% confidence interval (CI) 0.19-0.29, P < 0.001], performance of glycated haemoglobin test (OR 0.26, 95% CI 0.24-0.29, P < 0.001), visiting an ophthalmologist (OR 0.47, 95% CI 0.32-0.68, P = 0.001), and recommendations to stop smoking (OR 0.10, 95% CI 0.05-0.21, P < 0.001).
  
  
  CONCLUSIONS
  Admission to the ER can be used as an indicator for poor quality of diabetes care. There is an association between ER admission and poor quality of diabetes care.
authors.affiliation: Hadassah Hebrew University Hospital, Jerusalem, Israel. zvistern@hadassah.org.il
authors.forename: Z
authors.initials: Z
authors.lastname: Stern
authors.forename: R
authors.initials: R
authors.lastname: Calderon-Margalit
authors.forename: M
authors.initials: M
authors.lastname: Mazar
authors.forename: M
authors.initials: M
authors.lastname: Brezis
authors.forename: A
authors.initials: A
authors.lastname: Tirosh
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D016001:Confidence Intervals; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000191:economics / Q000628:therapy; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics / Q000592:standards*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008875:Middle Aged; D016017:Odds Ratio; D011787:Quality of Health Care / Q000191:economics / Q000592:standards*