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Half of hospital costs for diabetes patients are linked to the subset of patients with multiple hospitalizations

Among diabetes patients examined in a new study by H. Joanna Jiang, Ph.D., Daniel Stryer, M.D., Bernard Friedman, Ph.D., and Roxanne Andrews, Ph.D., of the Agency for Healthcare Research and Quality, 30 percent had two or more hospital stays that contributed to more than 50 percent of total hospitalizations and total hospital costs. For example, the hospital cost per patient (for all patient stays) was nearly three times as high ($23,119 vs. $8,508) for patients with multiple versus single hospital stays.

The researchers used 1999 Healthcare Cost and Utilization Project (HCUP) discharge data for five States to identify 648,748 patients aged 1 or older who had one or more hospitalizations listing diabetes and unrelated to childbirth (total of 993,074 hospitalizations). These hospitalizations varied by age, race/ethnicity, payer, and income.

The most vulnerable groups are most likely to have multiple hospital stays, according to the study. After controlling for patient age, sex, and clinical characteristics, the likelihood of having multiple hospitalizations was higher for elderly Hispanics (37 percent) and blacks (34 percent) compared with whites (31 percent), as well as for patients covered by Medicare or Medicaid and those living in low-income areas. Nonelderly whites were less likely than blacks and Hispanics to have multiple hospitalizations.

The presence and type of diabetes complications among patients with multiple hospitalizations varied by age group, race/ethnicity, and insurance status. Acute complications of diabetes was the primary or coexisting condition for the more than 60 percent of children with diabetes who had multiple hospitalizations, compared with only 10 percent for nonelderly adults and less than 5 percent for the elderly. In contrast, adults were more likely to be hospitalized for chronic complications of diabetes. Among adults, the acute complication rate was much higher for blacks than for other racial/ethnic groups, and it was more than twice as high for uninsured as for insured patients.

Many of these complications and related hospitalizations might be prevented with quality outpatient care. The authors conclude that clinical and policy interventions should be developed to target particular groups of patients who would have a higher probability of preventable readmissions.

See "Multiple hospitalizations for patients with diabetes," by Drs. Jiang, Stryer, Friedman, and Andrews, in the May 2003 Diabetes Care 26(5), pp. 1421-1426.

Reprints (AHRQ Publication No. 03-R037) are available from the AHRQ Publications Clearinghouse.

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