Effects of diabetes self-management programs on time-to-hospitalization among patients with type 2 diabetes: a survival analysis model.
OBJECTIVE
This study compared time-to-hospitalization among subjects enrolled in different diabetes self-management programs (DSMP). We sought to determine whether the interventions delayed the occurrence of any acute event necessitating hospitalization.


METHODS
Electronic medical records (EMR) were obtained for 376 adults enrolled in a randomized controlled trial (RCT) of Type 2 diabetes (T2DM) self-management programs. All study participants had uncontrolled diabetes and were randomized into either: personal digital assistant (PDA), Chronic Disease Self-Management Program (CDSMP), combined PDA and CDSMP (COM), or usual care (UC) groups. Subjects were followed for a maximum of two years. Time-to-hospitalization was measured as the interval between study enrollment and the occurrence of a diabetes-related hospitalization.


RESULTS
Subjects enrolled in the CDSMP-only arm had significantly prolonged time-to-hospitalization (Hazard ratio: 0.10; p=0.002) when compared to subjects in the control arm. Subjects in the PDA-only and combined PDA and CDSMP arms showed no improvements in comparison to the control arm.


CONCLUSIONS
CDSMP can be effective in delaying time-to-hospitalization among patients with T2DM.


CONCLUSIONS
Reducing unnecessary healthcare utilization, particularly inpatient hospitalization is a key strategy to improving the quality of health care and lowering associated health care costs. The CDSMP offers the potential to reduce time-to-hospitalization among T2DM patients.
Department of Health Policy & Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, USA. Electronic address: adepoju@srph.tamhsc.edu.
Omolola E
OE
Adepoju
Department of Health Policy & Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, USA.
Jane N
JN
Bolin
Department of Health Policy & Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, USA.
Charles D
CD
Phillips
Department of Epidemiology & Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, USA.
Hongwei
H
Zhao
Department of Health Policy & Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, USA.
Robert L
RL
Ohsfeldt
Department of Health Policy & Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, USA.
Darcy K
DK
McMaughan
Department of Health Policy & Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, USA.
Janet W
JW
Helduser
Department of Epidemiology & Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, USA; Department of Health Promotion & Community Health Sciences, School of Rural Public Health, Texas A&M Health Science Center, College Station, USA; Department of Family & Community Medicine, Scott & White Healthcare, College of Medicine, Texas A&M Health Science Center, Temple, USA.
Samuel N
SN
Forjuoh
D000328:Adult; D034201:Computers, Handheld; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006296:Health Services / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies; D012648:Self Care; D016019:Survival Analysis; D013781:Texas; D013997:Time Factors
Disease management; Health-care utilization