title: Risk of hospitalization for diabetic macrovascular complications and in-hospital mortality with irregular physician visits using propensity score matching.
abstract: OBJECTIVE
  The objective of the present study was to evaluate the risk of diabetic macrovascular complications and in-hospital mortality among diabetic patients with irregular physician visits.
  
  
  METHODS
  We carried out a health insurance-based retrospective cohort study using claims data from diabetic patients who were newly hospitalized between April 2010 and September 2010 among beneficiaries of the Fukuoka National Health Insurance Organization. Regular visits were defined as physician visits for diabetes mellitus at least every 3 months between April 2009 and March 2010, whereas other visits or no visits were defined as irregular visits. We assigned 5,940 patients to the regular visit or the irregular visit groups using propensity score matching. We compared in-hospital mortality and hospitalization for diabetic macrovascular complications between the two groups by multiple logistic regression models.
  
  
  RESULTS
  The irregular visit group had a significantly higher risk of hospitalization for acute myocardial infarction (AMI), ischemic heart diseases (IHDs) except AMI, all IHDs, all strokes and diabetic macrovascular complications than did the regular visit group. Adjusted odds ratios for AMI, IHDs except AMI, all IHDs, all strokes, and diabetic macrovascular complications were 3.52 (95% confidence interval [CI] 1.79-6.96), 1.25 (95% CI 1.02-1.54), 1.37 (95% CI 1.12-1.66), 1.29 (95% CI 1.04-1.60), and 1.28 (95% CI 1.10-1.48), respectively.
  
  
  CONCLUSIONS
  The present study shows that the irregular visit group had significantly higher risks of hospitalization for IHD and stroke among diabetic patients. Insurers need to motivate diabetic beneficiaries to make regular visits to physicians.
authors.affiliation: Department of Health Care Administration and Management Graduate School of Medical Sciences Kyushu University Fukuoka Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Nishi
authors.affiliation: Department of Health Care Administration and Management Graduate School of Medical Sciences Kyushu University Fukuoka Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Babazono
authors.affiliation: Department of Health Care Administration and Management Graduate School of Medical Sciences Kyushu University Fukuoka Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Maeda
keywords: Diabetes; Diabetic macrovascular complications; Irregular visits