Health Indicator Report of Diabetes Hospitalizations
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, MyCD (chronic disease self-management programs), diabetes self-management education, and other community-based prevention programs.
NotesDiseases 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. US rates for 2010 and later are currently not available, due to a redesign of the national hospital discharge sample. US rates will be available after 2016.
- Hospital Inpatient Discharge Data, New Mexico Department of Health.
- Population Estimates: University of New Mexico, Geospatial and Population Studies (GPS) Program, http://gps.unm.edu/.
Data Interpretation IssuesThe International Classification of Diseases (ICD) is a coding system that provides the rules for coding and classifying diseases and conditions. The ICD is developed collaboratively between the World Health Organization (WHO) and 10 international centers, such as the U.S. National Center for Health Statistics. These data are about discharges of New Mexico residents from non-federal NM hospitals only. A discharge occurs when a patient is admitted to a hospital and stays overnight or when a hospital patient dies on the day of admission to the hospital. NM non-federal hospitals submit these data to the New Mexico Department of Health, which maintains these data in the Hospital Inpatient Discharge Database (HIDD). Data have been directly age-adjusted to the U.S. 2000 standard population. These data do not include hospital discharges from federal hospitals, that is, Department of Veterans Affairs and Indian Health Service hospitals. Thus, the data presented in this report under-estimate hospitalization rates, especially for the New Mexico American Indian population and military veterans. Until federal hospitals can be included in the data, these results should not be used to make population inferences for New Mexico's American Indian populations. These data also do not include information about New Mexico residents who were hospitalized outside New Mexico or about out-of-state residents who were hospitalized in New Mexico. The accuracy of the original data is the responsibility of the submitting hospital, and the New Mexico Department of Health assumes no responsibility for any use made of or conclusions drawn from these data.
- as Primary (First-Listed) Diagnosis, by Age Group and Year, 2000 to 2014
- as Primary (First-Listed) Diagnosis, by Age Group and Sex, 2012-2014
- as Any-Listed Diagnosis, by Age Group, 2000 to 2014
- as Primary (First-Listed) Diagnosis, by NM Health Regions, Age-adjusted 2008 to 2014
- as Any-Listed Diagnosis, by NM Health Regions, Age-adjusted 2008 to 2014
- as Primary Diagnosis, by NM County, 2012-2016
- as Any-Listed Diagnosis, by NM County, 3-Year Rolling Age-adjusted Averages, 2007-2014
DefinitionThe number of hospital inpatient discharges per 10,000 persons for diabetes, ICD9-CM code 250 and, after October 1, 2015, ICD10-CM codes E10-E14.
NumeratorNumber of diabetes-related hospital discharges within a given year. Discharges are grouped as "any-listed" and "first-listed". "Any-listed" discharges are all discharges in which diabetes was one of the nine possible diagnoses listed for the hospitalizations. "First-listed" (or primary) discharges include only the discharges in which diabetes was the first diagnosis listed (coded) for the hospitalizations. Numerator data are from the NM Hospital Inpatient Discharge Database of the NM Department of Health.
DenominatorNumber of NM residents in a given year who belong within the specified geographic or age group.
Healthy People Objective: D-5.1, Reduce the proportion of the diabetic population with an A1c value greater than 9percentU.S. Target: 14.6 percent
Other ObjectivesThere are 16 Healthy People 2020 (HP 2020) diabetes objectives. The only HP 2020 objective directly related to hospitalization is Objective D-4: Reduce the rate of lower extremity amputations in persons with diagnosed diabetes. Other HP 2020 diabetes objectives include: D-5: Improve glycemic control among the population with diagnosed diabetes; D-7: Increase the proportion of the population with diagnosed diabetes whose blood pressure is under control; and Objective D-13: Increase the proportion of adults with diabetes who perform self-blood glucose monitoring at least once daily. While these three do not refer directly to hospitalization, good glycemic and blood pressure control (which are also part of self-management) and daily glucose monitoring can impact hospitalization rates. New Mexico Community Health Status Indicator (CHSI)
How Are We Doing?The first chart shows diabetes discharge rates for the first-listed (primary) diagnosis and for any-listed diagnosis for NM and the US, and give a general view of diabetes hospitalization. NM rates for diabetes as a primary diagnosis were, except for two years, generally stable from 2000 to 2008. An upward trend from 2009 to 2013 is not clearly evident in this graph, due to the scale of the vertical axis. However, this latter period had higher rates than the earlier 2000-2008 period. The 14-year trend for diabetes as any-listed diagnosis shows an overall rising trend. The later rates, from 2008 to 2013, were statistically higher than the earlier 2000-2007 rates. At 127 to 138 diabetes hospitalizations per 10,000 persons, these later rates are a distinct break from the earlier rates of 111 to 119 diabetes hospitalizations per 10,000 persons. During 2008 to 2013 in NM, a total of 157,979 diabetes-related hospitalizations occurred. Of this total, 17, 670 (10%) were discharges in which diabetes was the primary diagnosis and 157,979 (90%) were discharges in which diabetes was a contributing diagnosis. Annually, an average of 2,945 diabetes discharges were those in which diabetes was a primary diagnosis, and an average of 26,330 discharges were those in which diabetes was a contributing diagnosis. RATES by AGE: Two graphs show trends of diabetes hospitalization for age groups 15-44, 45-64, and 65+. One graph shows the trend for diabetes as primary diagnosis; the second graph shows the trend for diabetes as any-listed diagnosis. As age increases, diabetes hospitalization rates increase; the rates for the 65+ age group are highest while the rates for the 15-44 age group are lowest. Rates for the 15 to 44 age group show increasing trends, for the primary diagnosis discharges and the any-listed diagnoses discharges. These trends are statistically significant. The percent change from 2000 to 2013 was 100% for the first-listed diagnosis (7.6 to 15.2) and 70% for the any-listed diagnosis (29.6 to 50.3). These percent increases for the 15-44 group were by far the largest of the three age groups. The average number of diabetes discharges per year, among primary diagnosis discharges, was 848 discharges for ages 15 to 44; 923 discharges for ages 45 to 64; and, 695 discharges for ages 65 and older. Among the any-listed diagnoses discharges, the average number of diabetes discharges per year were 3,315 for ages 15 to 44; 9,051 for ages 45 to 64; and, 12,574 for ages 65 and older. 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. Five years of regional rates are shown. The 2013 Northwest Region rate for diabetes as primary diagnosis was higher than the rates for the previous three years (2010 through 2012). The 2013 Metro Region rate was higher than the 2009 rate, but statistically similar to the 2010 through 2012 rates. There was been an apparent upward (though not borne out statistically) creep each year since 2009; it has been only the fifth year, 2013, that the Metro rate is statistically higher than the first year, 2009. Among the rates for diabetes as any-listed diagnosis, the 2013 Northwest rate was higher than the 2009 and 2010 rates, but similar to the 2011 and 2012 rates. The 2013 Metro rate was higher than rates of the previous four years (2009 to 2012). The 2011 to 2013 Southwest rates were lower than the 2009 rate.
How Do We Compare With the U.S.?Making area-to-area comparisons of hospital rates is not straightforward. Many factors drive the variation in hospitalization rates across states and within a state. There are area-to-area differences in medical practice, in reasons or algorithms for admitting or not admitting into a hospital, and in the resources and effectiveness of local medical and social systems in diabetes treatment and management. Lastly, US rates are from the National Hospital Discharge Survey and are based on a sample of short-stay, nonfederal hospitals in the US and are based on diabetes as any of seven diagnoses examined (rather than the nine diagnoses used in NM rates). One should keep these caveats in mind in when reading the comparisons below. US rates were higher than NM rates for primary and for any-listed diabetes hospitalizations. From 2000 to 2009 (the last year of data for the US), US any-listed rates fluctuated between 157 and 176 diabetes-related hospitalizations per 10,000 persons, compared to NM rates that were between 111 and 119. For primary diagnosis rates, the 2009 US rate was 60% higher than the corresponding NM rate. For any-listed rates, the 2009 US rate was 30% higher than the 2009 NM rate. At this time, there are no 2010 or later US rates available. The national survey of hospital discharges has been redesigned; the survey had been conducted annually from 1965-2010. US rates will be published again in late 2016 or 2017, according to personal communication from the National Center for Health Statistics, Ambulatory and Hospital Care Statistics Branch.
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.
Available Services-Professional development opportunities, including online trainings with continuing education credits on Diabetes & Depression, Smoking & Diabetes, and Prediabetes -Technical assistance to clinics and primary care providers to support system changes that improve health outcomes (e.g. AIC, blood pressure, LDL cholesterol and smoking cessation) -Support for community-based prevention and management initiatives such as the National Diabetes Prevention Program, Kitchen Creations cooking schools for people with diabetes and development of walking trails -Technical assistance with data, surveillance, and epidemiology All are free of charge. For more information on any programs or services provided by the NM Department of Health, Diabetes Prevention and Control Program, go to http://archive.diabetesnm.org/ or call 1-888-523-2966.
Page Content Updated On 09/09/2017, Published on 02/12/2018