Health Highlight Report for San Juan County
Diabetes Hospitalizations: Hospitalizations per 10,000 Population, Age-adjusted, 2015-2017
San Juan County20.1 95% Confidence Interval(18.7 - 21.6)Description of the Confidence IntervalThe confidence interval indicates the range of probable true values for the level of risk in the community.
A value of "DNA" (Data Not Available) will appear if the confidence interval was not published with the IBIS indicator data for this measure.
Statistical StabilityStableDescription of Statistical Stability
- Stable = This count or rate is relatively stable and should provide a good estimate of your community risk.
- Unstable = This count or rate is statistically unstable (RSE >0.30), and may fluctuate widely due to random variation (chance).
- Very Unstable = This count or rate is extremely unstable (RSE >0.50). This value should not be used to represent your population risk. You should combine years or otherwise increase the population denominator in this calculation.
- DNA = Data Not Available. The required community value and/or confidence interval was not available for this measure.
New Mexico13.8 U.S. DNADNA=Data not available.
San Juan County Compared to State
Description of Dashboard Gauge
Description of the Dashboard GaugeThis "dashboard" type graphic is based on the community data on the right. It compares the community value on this indicator to the state overall value.
The community value is considered statistically significantly different from the state value if the state value is outside the range of the community's 95% confidence interval. If the community's data or 95% confidence interval information is not available, a blank gauge image will be displayed with the message, "missing information."NOTE: The labels used on the gauge graphic are meant to describe the community's status in plain language. The placement of the gauge needle is based solely on the statistical difference between the community and state values. When selecting priority health issues to work on, a community should take into account additional factors such as how much improvement could be made, the U.S. value, the statistical stability of the community number, the severity of the health condition, and whether the difference is clinically significant.
- Excellent = The community's value on this indicator is BETTER than the state value, and the difference IS statistically significant.
- Watch = The community's value is BETTER than state value, but the difference IS NOT statistically significant.
- Improvement Needed = The community's value on this indicator is WORSE than the state value, but the difference IS NOT statistically significant.
- Reason for Concern = The community's value on this indicator is WORSE than the state value, and the difference IS statistically significant.
Why Is This Important?Hospitalization is costly for individuals, families and society. Based on 2012 American Diabetes Association estimates, direct medical as well as nonmedical costs for diagnosed diabetes and undiagnosed diabetes were about $1.8 billion in New Mexico alone. This 2012 estimate includes the costs of hospitalization, office visits, prescription medications, inability to work due to disability, reduced productivity at work, and lost productivity capacity due to early mortality. This does not include costs due to prediabetes, over the counter medications, prevention programs, research programs, and productivity loss for informal caregivers. Diabetes hospitalizations are considered potentially preventable hospitalizations, that is, some proportion of these inpatient stays are preventable. According to the Agency for Healthcare Research and Quality (AHRQ), "with high-quality, community-based primary care, hospitalization for these illnesses often can be avoided". AHRQ includes diabetes as one such illness. Key prevention strategies include regular physical activity and healthy nutrition; effective self-management; regular and effective management support; and, access to specialty or ambulatory care as appropriate. Environmental prevention strategies include accessible and affordable vegetables and fruits; readily accessible safe places for physical activity; and school, work and community cultures visibly supporting physical activity for all ages and abilities. To accomplish this there is a role for all sectors, from families to businesses to health systems to government. One public health role is to build supports, structures and conditions that make it easy for as many people as possible to be active, to eat a healthy diet daily, and to access primary care when needed. A vital part of this role is linking clinical systems with community supports, such as the National Diabetes Prevention Program, diabetes self-management education, and other community-based prevention programs.
Risk and Resiliency FactorsMany inter-related risk factors contribute to diabetes-related hospitalizations, ranging from individual behaviors to socio-economic and environmental conditions that influence individual behavior. Individual behaviors include inadequate physical activity, poor nutrition/unhealthy eating, and not maintaining a healthy weight. Critical social and environmental factors include poverty, lack of safe public places for physical activity, community norms that do not encourage regular or daily physical activity, schools and work sites that do not actively support healthy behaviors, and healthy food and effective treatments that are not routinely accessible.
How Are We Doing?The first chart shows diabetes discharge rates for the diabetes as the first-listed (primary) diagnosis and for diabetes as any-listed diagnosis, for NM and the US, and give a general view of diabetes hospitalization. The New Mexico Diabetes Hospitalization rate for Diabetes as the primary diagnosis has been relatively stable for years. However, the rate for the most recent year available, 2017, was statistically significantly higher than the preceding three years. As any diagnosis, the diabetes hospitalization rate from 2010 through 2015 had been statistically significantly higher than rates of previous years. However, rates for the two most recent years, 2016 and 2017, were statistically significantly lower than preceding years, approaching the rates seen prior to 2010. RATES by AGE: As primary diagnosis, the hospitalization rates of the youngest age group has remained stable. That of the age group 15 to 44 years of age has been stable during the current decade but these rates are statistically significantly higher than those of the previous decade. The hospitalization rate for the age group 45 to 64 years of age has remained stable. For the most part, the rate of the age group 65 or older has remained stable. However, the 2017 rate for this age group was statistically significantly higher than the preceding three years, 2014-2016. As any diagnosis, the hospitalization rate of the youngest age group, 0-14, has remained stable. The rate of the age group 15 to 44 years of age has been stable during the current decade but these rates were statistically significantly higher than those of the previous decade. The rates of the two older age groups, 45-64 and 65 or older, were statistically significantly higher during the years 2011-2014 over previous years but have been statistically significantly lower the past three years, 2015-2017. RATES by REGION: Graphs of diabetes hospitalizations show rates for primary diagnosis and for any-listed diagnosis by the five NM Health Regions. Each region has its own unique mix of factors which influence hospital and provider practice and make it tricky to compare across regions. Secondly, the lack of Indian Health Service (which affects the Northwest, Metro, and Northeast Regions) and Veterans Affairs (which affects Metro Region) records each year means some regional rates may be higher than what is shown. Only comparisons of rates across time within a region will be made. As the primary diagnosis, in 2017, the hospitalization rate for the Northwest region was statistically significantly higher than the rates for all other regions. The rate for the Northeast region was statistically significantly higher than the remaining three regions, Metro, Southeast, and Southwest. The Northwest and Northeast regions were both statistically significantly higher than the rate of the state, over all. As any diagnosis, in 2017, the hospitalization rate of the Northeast region was statistically significantly lower than that of all other regions. That of the Metro region was statistically significantly lower than the rates for the other three regions. The rate of the Northwest region was statistically significantly higher than the rates of all other regions.
What Is Being Done?The NM Department of Health Diabetes Prevention and Control Program (DPCP) works with health care providers and community partners, agencies and coalitions to provide multiple diabetes prevention and management services and programs. Services and programs include: professional development trainings and resources for diabetes prevention and management; the National Diabetes Prevention Program (National DPP), a proven community-based physical activity and nutrition intervention to prevent or delay diabetes in persons at high risk; community resources to help people manage their diabetes through skill building, such as the Chronic Disease Self-Management and Diabetes Self-Management Education Programs; Kitchen Creations cooking schools; and health system disease management interventions that improve blood glucose, blood pressure, and cholesterol. The DPCP provides education, information, and resources about prediabetes and diabetes, particularly to health care providers, to increase screening, testing and referral to prevention and management programs. This includes a centralized referral and data system that helps providers easily make referrals to the above programs. DPCP?s partners support built environment improvements so people at risk for or with diabetes can be physically active and initiatives that increase access to healthy foods. Both are essential components of effective population-based diabetes prevention and control. The DPCP consults with populations that are disproportionately affected by diabetes and/or those that serve them to develop programs and services that are culturally appropriate for these populations.
Evidence-based PracticesDiabetes and its complications can be prevented, delayed and/or managed through participation in evidence-based programs, including the National Diabetes Prevention Program or NDPP (provided in a clinical, community, or web-based setting), the Diabetes Self-Management Education Program or DSMEP (provided in a community or web-based setting), and Diabetes Self-Management Education and Support programs or DSME/S (usually provided in a clinical setting). Improving the quality of clinical care for people with and at risk for diabetes is also an evidence-based practice. The following DPCP activities are in alignment with these accepted programs and practices: 1. Increase use of the NDPP to prevent or delay onset of type 2 diabetes among people at high risk by raising awareness about prediabetes and the NDPP, increasing delivery sites, facilitating the screening and referral process, and working to obtain health insurance coverage (including Medicaid) for the program. 2. Increase access to sustainable self-management education and support services (DSMEP and DSME/S) to improve control of A1C, blood pressure, and cholesterol, and to promote tobacco cessation, by increasing delivery sites, facilitating the referral process, and working to obtain health insurance coverage (including Medicaid) for the programs. 3. Implement evidence-based worksite programs and policies that help people prevent or manage diabetes and related chronic conditions, promote tobacco cessation, and help employees improve control of their A1C, blood pressure, and cholesterol. 4. Improve health outcomes for people with and at risk for diabetes by supporting health care organizations to improve quality of care through use of the Planned Care Model, Patient Centered Medical Home, and Electronic Health Record. Within these organizations, support policy and protocol implementation that institutionalize and help sustain quality care improvements. 5. Promote the sustainability of Community Health Workers (CHWs) involved in providing diabetes prevention and management services.
Relevant Population Characteristics:
- New Mexico Population - Age 65+
- New Mexico Population - Poverty Among All Persons
- New Mexico Population - Race/Ethnicity
- Obesity - Adult Prevalence
- Obesity - Adolescent Prevalence
- Physical Activity - Adult Prevalence
- Physical Activity - Adolescent Prevalence
- Tobacco Use - Adult Smoking Prevalence
- Tobacco Use - Youth Smoking Prevalence
Health Care System Factors:
- Health Care Access - Unable to Get Care Because of Cost
- Health Care Access - Primary Care Physicians Compared to Population Size
- Health Care Access - Primary Medical Provider
- Health Insurance Coverage - BRFSS Survey Estimates
- Medicaid Enrollment
- Cardiovascular Disease - Adult Ever Told Blood Pressure Was High
- Obesity - Adult Prevalence
- Physical Activity - Adult Prevalence
- Tobacco Use - Adult Smoking Prevalence
Health Status Outcomes:
NoteDiseases listed on hospital discharge records are assigned specific ICD codes. Under the ICD, the primary condition/ disease leading to the hospitalization is listed first. There may also be up to eight additional conditions which contributed to the hospitalization, for a total of nine possible conditions. These data are based on the ICD codes listed on the hospital discharge records, and thus are about the number of discharges, not the number of persons hospitalized, over the course of the year. This means a person admitted to a hospital multiple times over the year will be counted each time as a separate discharge from the hospital. Except for age-specific rates, rates are age-adjusted to the 2000 US Standard Populations.
Data SourcesHospital Inpatient Discharge Data, New Mexico Department of Health. Population Estimates: University of New Mexico, Geospatial and Population Studies (GPS) Program, http://gps.unm.edu/.
Measure Description for Diabetes Hospitalizations
Definition: The number of hospital inpatient discharges for diabetes per 10,000 population, ICD9-CM code 250 and, after October 1, 2015, ICD10-CM codes E10-E14.
Numerator: Number of diabetes-related hospital discharges within a given year. Discharges are grouped as Primary and Any diagnosis. Primary discharges include only the discharges in which diabetes was the first diagnosis listed (coded) for the hospitalizations. "Any" discharges are all discharges in which diabetes was one of the nine possible diagnoses listed for the hospitalizations. Numerator data are from the NM Hospital Inpatient Discharge Database of the NM Department of Health.
Denominator: Number of NM residents in a given year who belong within the specified geographic or age group.