title: Characteristics driving higher diabetes-related hospitalization charges in Pennsylvania.
abstract: OBJECTIVE
  To evaluate the characteristics driving higher diabetes-related hospitalization charges.
  
  
  METHODS
  Hospital discharge data on 216,858 hospitalizations from 2001 to 2011 with primary discharge diagnosis of diabetes were linked to the Pennsylvania death registry. Multiple linear regression analysis was used to evaluate the association between inpatient hospitalization charges and complications, sociodemographic status, comorbidities, readmission, length of stay, admission type, region, procedures, payer type, and hospitalization misadventures.
  
  
  RESULTS
  Diabetes-related adjusted hospitalization charges were higher for those with long-term complications [renal manifestations (75%), peripheral circulatory disorders (38%), neurological manifestations (30%), ophthalmic manifestations (16%)], acute complications [ketoacidosis (48%), hyperosmolarity (41%), coma (40%)], amputations (91%) or other medical procedure(s) (70%), emergency/urgent admissions (7%), comorbidity (3% per modified Charlson Comorbidity Index score item), medical misadventure (20%), different regions [Philadelphia (135%), and Pittsburgh (8%)], and for minorities [non-Hispanic black (12%), Hispanic (21%), and non-Hispanic other (14%)]. Readmission adjusted charges were not different from the initial admission charges.
  
  
  CONCLUSIONS
  To reduce diabetes-related hospitalizations and curb hospitalization charges, public health and healthcare policy makers should be cognizant of high-impact drivers: diabetes-related complications, unnecessary procedures, race/ethnicity, and region. Inpatient are should focus on preventing unnecessary readmissions and misadventures. These findings are timely as the Affordable Care Act reduces Medicare payments to hospitals with high readmission rates, and as states consider Medicaid expansion.
authors.affiliation: Pennsylvania Department of Health, Bureau of Epidemiology, 625 Forster St, Harrisburg, PA 17120. E-mail: zma@pa.gov.
authors.forename: Zhen-qiang
authors.initials: ZQ
authors.lastname: Ma
authors.forename: Monica A
authors.initials: MA
authors.lastname: Fisher
mesh_terms: D000328:Adult; D000368:Aged; D048909:Diabetes Complications / Q000191:economics / Q000628:therapy; D003920:Diabetes Mellitus / Q000191:economics* / Q000628:therapy; D005260:Female; D006291:Health Policy / Q000191:economics; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D010414:Pennsylvania; D044469:Racial Groups / Q000706:statistics & numerical data; D012307:Risk Factors; D055815:Young Adult