title: Diabetes-related avoidable hospitalizations in Taiwan.
abstract: BACKGROUND
  An avoidable hospitalization (AH) is a condition that could have been prevented through effective treatment in outpatient care. Diabetes is often referred to as an ambulatory care-sensitive condition, and its associated hospitalizations are often referred to as avoidable hospitalizations. There are limited data on avoidable hospitalizations for individuals with diabetes in Taiwan.
  
  
  METHODS
  We used the National Health Interview Survey (NHIS) dataset to obtain diabetes-related avoidable hospitalizations for subjects aged above 12 years. We included data from 20,826 subjects who had completed the interview between 2004 and 2005. Data were collected from a total of 15,574 people, who had agreed to link their health information to the Taiwan National Health Insurance Research Database, including basic demographic variables, inpatient or outpatient medical events, admission date, discharge date, and diagnosis. The 1005 individuals who self-reported having diabetes or had at least 1 hospitalization or 2 physician service claims for diabetes mellitus with an ICD-9 diagnosis of 250 were included in the analysis. We divided those with diagnosis of diabetes into two groups: never hospitalized and hospitalized. The never hospitalized group served as the control group. We further identified hospitalized subjects with long-term complications due to diabetes (PQI-3) that included ICD-CM codes 250.4-250.9.
  
  
  RESULTS
  The mean ages of patients with diabetes-related long-term complications in the hospitalized and never hospitalized groups were 65 years and 58 years, respectively (p-value<0.01). More than half (52%) of the patients with diabetes-related long-term complications had a body mass index (BMI) lower than 24. The hospitalized group also had lower educational status compared with that of patients in the never hospitalized group (equal to or lower than elementary school, 63% vs. 50%; junior high school, 23% vs. 14%; equal or higher than senior high school, 14% vs. 36%). Furthermore, hospitalized patients tended to have lower household monthly income, were unmarried, and did not have private medical insurance. There were no significance differences in ethnic composition between the groups. Interestingly, patients with frequent retinal examination, and those with lower body mass index had higher frequency of avoidable hospitalization (p<0.01).
  
  
  CONCLUSIONS
  We found that the following factors were associated with a higher frequency of avoidable hospitalization among patients with type 2 diabetes: elderly, male, lower body mass index, lower household income, non-exercise, higher disease comorbidity, and frequent retinal examination.
authors.affiliation: Department of Endocrinology and Metabolism, Chung-Shan Medical University Hospital, 110th JianGuo North Road, 1st Section, 402 Taichung, Taiwan; Institute of Medicine of Chung-Shan Medical University, Taichung, Taiwan. Electronic address: korn3lius82@gmail.com.
authors.forename: Edy
authors.initials: E
authors.lastname: Kornelius
authors.affiliation: Department of Endocrinology and Metabolism, Chung-Shan Medical University Hospital, 110th JianGuo North Road, 1st Section, 402 Taichung, Taiwan; Institute of Medicine of Chung-Shan Medical University, Taichung, Taiwan.
authors.forename: Chien-Ning
authors.initials: CN
authors.lastname: Huang
authors.affiliation: Department of Endocrinology and Metabolism, Chung-Shan Medical University Hospital, 110th JianGuo North Road, 1st Section, 402 Taichung, Taiwan; Institute of Medicine of Chung-Shan Medical University, Taichung, Taiwan.
authors.forename: Yi-Sun
authors.initials: YS
authors.lastname: Yang
authors.affiliation: Department of Endocrinology and Metabolism, Chung-Shan Medical University Hospital, 110th JianGuo North Road, 1st Section, 402 Taichung, Taiwan; Institute of Medicine of Chung-Shan Medical University, Taichung, Taiwan.
authors.forename: Ying-Li
authors.initials: YL
authors.lastname: Lu
authors.affiliation: Institute of Biotechnology, HungKuang University, 34th Chung Chie Road, Shalu County, Taichung, Taiwan.
authors.forename: Chiung-Huei
authors.initials: CH
authors.lastname: Peng
authors.affiliation: Chung Shan Medical University, School of Health Policy and Management, 110th JianGuo North Road, 1st Section, Taichung, Taiwan. Electronic address: tom@csmu.edu.tw.
authors.forename: Jeng-Yuan
authors.initials: JY
authors.lastname: Chiou
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D016022:Case-Control Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D048909:Diabetes Complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D004522:Educational Status; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D057185:Sedentary Behavior; D012737:Sex Factors; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
keywords: Ambulatory care; Avoidable hospitalization; Diabetes mellitus; Primary health care