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Feller DJ, Lor M, Zucker J, Yin MT, Olender S, Ferris DC, Elhadad N, Mamykina L. An investigation of the information technology needs associated with delivering chronic disease care to large clinical populations. Int J Med Inform 2020; 137:104099. [PMID: 32088558 DOI: 10.1016/j.ijmedinf.2020.104099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/08/2020] [Accepted: 02/12/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The growing number of individuals with complex medical and social needs has motivated the adoption of care management (CM) - programs wherein multidisciplinary teams coordinate and monitor the clinical and non-clinical aspects of care for patients with chronic disease. Despite claims that health information technology (IT) is essential to CM, there has been limited research focused on the IT needs of clinicians providing care management to large groups of patients with chronic disease. OBJECTIVE To assess clinicians' needs pertaining to CM and to identify inefficiencies and bottlenecks associated with the delivery of CM to large groups of patients with chronic disease. METHODS A qualitative study of two HIV care programs. Methods included observations of multidisciplinary care team meetings and semi-structured interviews with physicians, care managers, and social workers. Thematic analysis was conducted to analyze the data. RESULTS CM was perceived by staff as requiring the development of novel strategies including patient prioritization and patient monitoring, which was supported by patient registries but also required the creation of additional homegrown tools. Common challenges included: limited ability to identify pertinent patient information, specifically in regards to social and behavioral determinants of health, limited assistance in matching patients to appropriate interventions, and limited support for communication within multidisciplinary care teams. CONCLUSION Clinicians delivering care management to chronic disease patients are not adequately supported by electronic health records and patient registries. Tools that better enable population monitoring, facilitate communication between providers, and help address psychosocial barriers to treatment could enable more effective care.
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Affiliation(s)
- Daniel J Feller
- Department of Biomedical Informatics, Columbia University, New York, NY, United States.
| | - Maichou Lor
- School of Nursing, Columbia University, New York, NY, United States
| | - Jason Zucker
- Division of Infectious Disease, Department of Medicine, Columbia University, New York, NY, United States
| | - Michael T Yin
- Division of Infectious Disease, Department of Medicine, Columbia University, New York, NY, United States
| | - Susan Olender
- Division of Infectious Disease, Department of Medicine, Columbia University, New York, NY, United States
| | - David C Ferris
- Department of Population Health, BronxCare Health System, Bronx, NY, United States
| | - Noémie Elhadad
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
| | - Lena Mamykina
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
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Kolossváry E, Ferenci T, Kováts T. Potentials, challenges, and limitations of the analysis of administrative data on vascular limb amputations in health care. VASA 2019; 49:87-97. [PMID: 31638459 DOI: 10.1024/0301-1526/a000823] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although more and more data on lower limb amputations are becoming available by leveraging the widening access to health care administrative databases, the applicability of these data for public health decisions is still limited. Problems can be traced back to methodological issues, how data are generated and to conceptual issues, namely, how data are interpreted in a multidimensional environment. The present review summarised all of the steps from converting the claims data of administrative databases into the analytical data and reviewed the wide array of sources of potential biases in the analysis of such data. The origins of uncertainty of administrative data analysis include uncontrolled confounding due to a lack of clinical data, the left- and right-censored nature of data collection, the non-standardized diagnosis/procedure-based data extraction methods (i.e., numerator/denominator problems) and additional methodological problems associated with temporal and spatial analyses. The existence of these methodological challenges in the administrative data-based analysis should not deter the analysts from using these data as a powerful tool in the armamentarium of clinical research. However, it must be done with caution and a thorough understanding and respect of the methodological limitations. In addition to this requirement, there is a profound need for pursuing further research on methodology and widening the search for other indicators (structural, process or outcome) that allow a deeper insight how the quality of vascular care may be assessed. Effective research using administrative data is based on strong collaboration in three domains, namely expertise in claims data handling and processing, the clinical field, and statistical analysis. The final interpretations of results and the countermeasures on the level of vascular care ought to be grounded on the integrity of research, open discussions and institutionalized mechanisms of science arbitration and honest brokering.
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Affiliation(s)
- Endre Kolossváry
- St. Imre University Teaching Hospital, Department of Angiology, Budapest, Hungary
| | - Tamás Ferenci
- Óbuda University, Physiological Controls Research Center, Budapest, Hungary
| | - Tamás Kováts
- National Healthcare Service Center (ÁEEK), Directorate General of IT and Health System Analysis, Budapest, Hungary
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3
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Rodríguez-Sánchez B, Feenstra TL, Bilo HJG, Alessie RJM. Costs of people with diabetes in relation to average glucose control: an empirical approach controlling for year of onset cohorts. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:989-1000. [PMID: 31098887 DOI: 10.1007/s10198-019-01072-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 05/07/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To estimate the impact of glycaemic control and time since diabetes diagnosis on care costs incurred by people with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS Random-effects linear regression models were run to test the impact of average glucose control (HbA1c) and time since diabetes diagnosis on total care spending in people with T2DM, adjusting for year of onset and other covariates. Two datasets were linked, Vektis (healthcare costs reimbursed by the Dutch mandatory health insurance) and Zodiac (clinical and sociodemographic data). The sample includes 22,612 observations, grouped in 5653 individuals from the Northern part of the Netherlands, covering 4 years (2008-2011). RESULTS A 1% point increase in HbA1c is associated with a 2.2% higher total care costs. However, when treatment modality is included, the results are modified. A 1% point increase (11 mol/mol) in HbA1c is significantly associated with 3.4% higher total care costs for individuals without glucose-lowering treatment. Being treated with insulin is significantly associated with an increase in costs of 30-38% for every additional percentage point of HbA1c, depending on the covariates included. Without controlling for year of onset, an additional year of diabetes duration relates to 2.6% higher care costs, while this is 4.9% controlling for year of onset. The effect of HbA1c and diabetes duration differs between types of costs. CONCLUSION HbA1c, insulin treatment and diabetes duration are the main drivers of increasing care costs. The results signal the relevance of controlling for HbA1c together with treatment modality, diabetes duration and year of diagnosis effects.
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Affiliation(s)
- Beatriz Rodríguez-Sánchez
- Department of Economic Analysis and Finance, Faculty of Law and Social Sciences, University of Castilla la Mancha, Cobertizo de San Pedro Mártir s/n, 45071, Toledo, Spain.
| | - Talitha L Feenstra
- Department of Epidemiology, University Medical Centrum of Groningen, Groningen, The Netherlands
| | - Henk J G Bilo
- Department of Internal Medicine-Management, University Medical Centrum of Groningen, Groningen, The Netherlands
| | - Rob J M Alessie
- Department of Economics, Econometrics and Finance, University of Groningen, Groningen, The Netherlands
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Harris SB, Tompkins JW, TeHiwi B. Call to action: A new path for improving diabetes care for Indigenous peoples, a global review. Diabetes Res Clin Pract 2017; 123:120-133. [PMID: 28011411 DOI: 10.1016/j.diabres.2016.11.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 11/23/2016] [Accepted: 11/30/2016] [Indexed: 12/13/2022]
Abstract
Diabetes has reached epidemic proportions in Indigenous populations around the globe, and there is an urgent need to improve the health and health equity of Indigenous peoples with diabetes through timely and appropriate diabetes prevention and management strategies. This review describes the evolution of the diabetes epidemic in Indigenous populations and associated risk factors, highlighting gestational diabetes and intergenerational risk, lifestyle risk factors and social determinants as having particular importance and impact on Indigenous peoples. This review further describes the impact of chronic disease and diabetes on Indigenous peoples and communities, specifically diabetes-related comorbidities and complications. This review provides continued evidence that dramatic changes are necessary to reduce diabetes-related inequities in Indigenous populations, with a call to action to support programmatic primary healthcare transformation capable of empowering Indigenous peoples and communities and improving chronic disease prevention and management. Promising strategies for transforming health services and care for Indigenous peoples include quality improvement initiatives, facilitating diabetes and chronic disease registry and surveillance systems to identify care gaps, and prioritizing evaluation to build the evidence-base necessary to guide future health policy and planning locally and on a global scale.
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Affiliation(s)
- Stewart B Harris
- Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Jordan W Tompkins
- Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Braden TeHiwi
- School of Kinesiology, Lakehead University, Thunder Bay, Ontario, Canada.
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Borsari L, Malagoli C, Ballotari P, De Girolamo G, Bonora K, Violi F, Capelli O, Rodolfi R, Nicolini F, Vinceti M. Validity of hospital discharge records to identify pregestational diabetes in an Italian population. Diabetes Res Clin Pract 2017; 123:106-111. [PMID: 28002751 DOI: 10.1016/j.diabres.2016.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/20/2016] [Accepted: 11/29/2016] [Indexed: 12/30/2022]
Abstract
AIMS In recent years, the prevalence of pregestational diabetes (PGDM) and the concern about the possibility of adverse pregnancy outcomes in affected women have been increasing. Routinely collected health data represent a timely and cost-efficient approach in PGDM epidemiological research. This study aims to evaluate the reliability of hospital discharge (HD) coding to identify a population-based cohort of pregnant women with PGDM and to assess trends in prevalence in two provinces of Northern Italy. METHODS We selected all deliveries occurred in the period 1997-2010 with ICD-9-CM codes for PGDM in HD record and we matched up to 5 controls from mothers without diabetes. We used Diabetes Registers (DRs) as the gold standard for validation analysis. RESULTS We selected 3800 women, 653 with diabetes and 3147 without diabetes. The agreement between HD records and DRs was 90.7%, with K=0.58. We detected 350 false positives and only 1 false negative. Sensitivity was 99.3%, specificity 90.0%, positive predictive value 46.4% and negative predictive value 99.9%. Of the false positives, 48.6% had gestational diabetes and 2.3% impaired glucose tolerance. After the validation process, PGDM prevalence decreased from 4.4 to 2.0 per 1000 deliveries. CONCLUSIONS Our results show that HD facilitate detection of almost all PGDM cases, but they also include a large number of false positives, mainly due to gestational diabetes. This misclassification causes a large overestimation of PGMD prevalence. Our findings require accuracy evaluation of ICD-9-CM codes, before they can be widely applied to epidemiological research and public health surveillance related to PGDM.
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Affiliation(s)
- Lucia Borsari
- Sezione di Sanità Pubblica, Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy
| | - Carlotta Malagoli
- Sezione di Sanità Pubblica, Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy
| | - Paola Ballotari
- Azienda Unità Sanitaria Locale di Reggio Emilia, Reggio Emilia, Italy; Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | | | - Karin Bonora
- Azienda Unità Sanitaria Locale di Modena, Modena, Italy
| | - Federica Violi
- Sezione di Sanità Pubblica, Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy
| | | | - Rossella Rodolfi
- Azienda Unità Sanitaria Locale di Reggio Emilia, Reggio Emilia, Italy
| | - Fausto Nicolini
- Azienda Unità Sanitaria Locale di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Vinceti
- Sezione di Sanità Pubblica, Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy.
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Sreedharan J. The need to establish local Diabetes Mellitus registries. Nepal J Epidemiol 2016; 6:551-552. [PMID: 27774340 PMCID: PMC5073169 DOI: 10.3126/nje.v6i2.15155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 06/15/2016] [Accepted: 06/15/2016] [Indexed: 11/18/2022] Open
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Johnston GM, Lethbridge L, Talbot P, Dunbar M, Jewell L, Henderson D, D'Intino AF, McIntyre P. Identifying persons with diabetes who could benefit from a palliative approach to care. Can J Diabetes 2014; 39:29-35. [PMID: 25065477 DOI: 10.1016/j.jcjd.2014.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 01/22/2014] [Accepted: 01/23/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the need for diabetes mellitus palliative care, we identified persons with a diagnosis of diabetes who accessed palliative care programs and those who may have benefited from a palliative approach to care. METHODS This retrospective, descriptive research used 6 linked databases comprising 66 634 Nova Scotians from 3 health districts who died between 1995 and 2009, each with access to a palliative care program and diabetes centres. RESULTS The percentage of persons with diabetes enrolled in palliative care increased from 3.2% in 1995 to 34.3% in 2009; 31.5% were enrolled within their last 2 weeks of life. Most did not have their diabetes recorded in palliative data. Among the 5353 persons with a diagnosis of diabetes who died between 2005 and 2009, 61.0% were in the Diabetes Care Program of Nova Scotia registry. An additional 19.6% were identified in the Cardiovascular Health Nova Scotia registry, and a further 3.7% in palliative data. Applying the criteria of Rosenwax et al to the 5353, 65.8% to 97.9% may have benefitted from a palliative approach. CONCLUSIONS Rates of palliative enrollment for persons with diabetes are increasing. Diabetes care providers need to prepare patients and their families for changes in diabetes management that will be beneficial as end of life approaches. Collaboration among chronic disease programs, palliative care and primary care is advised to identify persons at end of life who have diabetes and to develop and implement care guidelines for this population.
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Affiliation(s)
- Grace M Johnston
- School of Health Administration, Dalhousie University, and Surveillance and Epidemiology Unit, Cancer Care Nova Scotia, Halifax, Nova Scotia.
| | - Lynn Lethbridge
- School of Health Administration, Dalhousie University, Halifax, Nova Scotia
| | - Pam Talbot
- Diabetes Care Program of Nova Scotia, Halifax, Nova Scotia
| | | | - Laura Jewell
- School of Health Administration, Dalhousie University, Halifax, Nova Scotia
| | - David Henderson
- Palliative Care Service, Colchester East Hants Health Authority, Truro, and Faculty of Medicine and Departments of Medicine and Family Medicine, Dalhousie University, Halifax, Nova Scotia
| | | | - Paul McIntyre
- Division of Palliative Medicine/Capital Health Integrated Palliative Care Service, Capital Health, and Departments of Medicine and Family Medicine, Dalhousie University, Halifax, Nova Scotia
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Gabbay RA, Añel-Tiangco RM, Dellasega C, Mauger DT, Adelman A, Van Horn DHA. Diabetes nurse case management and motivational interviewing for change (DYNAMIC): results of a 2-year randomized controlled pragmatic trial. J Diabetes 2013; 5:349-57. [PMID: 23368423 PMCID: PMC3679203 DOI: 10.1111/1753-0407.12030] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 01/21/2013] [Accepted: 01/29/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The aim of the present study was to determine whether the addition of nurse case managers (NCMs) trained in motivational interviewing (MI) to usual care would result in improved outcomes in high-risk type 2 diabetes patients. METHODS A 2-year randomized controlled pragmatic trial randomized 545 patients to usual care control (n=313) or those who received the intervention (n=232) with additional practice-embedded NCM care, including MI-guided behavior change counseling. The NCMs received intensive MI training with ongoing fidelity assessment. RESULTS Systolic blood pressure (SBP) was better in the intervention than usual care group (131 ± 15 vs. 135 ± 18 mmHg, respectively; P<0.05). Improvements were seen in both the control and intervention groups in terms of HbA1c (from 9.1% to 8.0% and from 8.8% to 7.8%, respectively), low-density lipoprotein (LDL; from 127 to 100 mg/dL and from 128 to 102 mg/dL, respectively), and diastolic blood pressure (from 78 to 74 mmHg and from 80 to 74 mmHg, respectively). Depression symptom scores were better in the intervention group. The reduction in diabetes-related distress approached statistical significance. CONCLUSIONS The NCMs and MI improved SBP and complications screening. The large decrease in HbA1C and LDL in the control group may have obscured any further intervention effect. Although nurses prompted providers for medication titration, strategies to reduce provider clinical inertia may also be needed.
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Abstract
A national effort to reform primary care, known as the Patient-Centered Medical Home (PCMH), requires fulfillment of six standards determined by the National Committee for Quality Assurance to (1) enhance access and continuity, (2) identify and manage patient populations, (3) plan and manage care, (4) provide self-care and community support, (5) track and coordinate care, and (6) measure and improve performance. Information technologies play a vital role in the support of most, if not all, of these standards. However, given the newness of the PCMH, little is known on how health information technologies (HITs) have been employed to accomplish these objectives. This article will review the role of HITs, including electronic health records, web-based patient portals, telemedicine, and patient registries, with a focus on diabetes care, and how these technologies have been engaged in the establishment of the PCMH. In addition, we will discuss the benefits and potential risks and barriers to employing these technologies, including privacy and security concerns, as well as describe next steps for future work in this important area.
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Affiliation(s)
- Jennifer L Kraschnewski
- The Pennsylvania State University College of Medicine, 500 University Dr., HO34, Hershey, PA 17033.
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Makam AN, Nguyen OK, Moore B, Ma Y, Amarasingham R. Identifying patients with diabetes and the earliest date of diagnosis in real time: an electronic health record case-finding algorithm. BMC Med Inform Decis Mak 2013; 13:81. [PMID: 23915139 PMCID: PMC3733983 DOI: 10.1186/1472-6947-13-81] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 07/26/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Effective population management of patients with diabetes requires timely recognition. Current case-finding algorithms can accurately detect patients with diabetes, but lack real-time identification. We sought to develop and validate an automated, real-time diabetes case-finding algorithm to identify patients with diabetes at the earliest possible date. METHODS The source population included 160,872 unique patients from a large public hospital system between January 2009 and April 2011. A diabetes case-finding algorithm was iteratively derived using chart review and subsequently validated (n = 343) in a stratified random sample of patients, using data extracted from the electronic health records (EHR). A point-based algorithm using encounter diagnoses, clinical history, pharmacy data, and laboratory results was used to identify diabetes cases. The date when accumulated points reached a specified threshold equated to the diagnosis date. Physician chart review served as the gold standard. RESULTS The electronic model had a sensitivity of 97%, specificity of 90%, positive predictive value of 90%, and negative predictive value of 96% for the identification of patients with diabetes. The kappa score for agreement between the model and physician for the diagnosis date allowing for a 3-month delay was 0.97, where 78.4% of cases had exact agreement on the precise date. CONCLUSIONS A diabetes case-finding algorithm using data exclusively extracted from a comprehensive EHR can accurately identify patients with diabetes at the earliest possible date within a healthcare system. The real-time capability may enable proactive disease management.
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Affiliation(s)
- Anil N Makam
- Division of General Internal Medicine, University of California San Francisco, Box 1211, Laurel Heights Campus, Room 383, 3333 California St., San Francisco, CA 94143, USA.
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Degli Esposti L, Saragoni S, Buda S, Sturani A, Degli Esposti E. Glycemic control and diabetes-related health care costs in type 2 diabetes; retrospective analysis based on clinical and administrative databases. CLINICOECONOMICS AND OUTCOMES RESEARCH 2013; 5:193-201. [PMID: 23696709 PMCID: PMC3658432 DOI: 10.2147/ceor.s41846] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Diabetes is one of the most prevalent chronic diseases, and its prevalence is predicted to increase in the next two decades. Diabetes imposes a staggering financial burden on the health care system, so information about the costs and experiences of collecting and reporting quality measures of data is vital for practices deciding whether to adopt quality improvements or monitor existing initiatives. The aim of this study was to quantify the association between health care costs and level of glycemic control in patients with type 2 diabetes using clinical and administrative databases. Methods A retrospective analysis using a large administrative database and a clinical registry containing laboratory results was performed. Patients were subdivided according to their glycated hemoglobin level. Multivariate analyses were used to control for differences in potential confounding factors, including age, gender, Charlson comorbidity index, presence of dyslipidemia, hypertension, or cardiovascular disease, and degree of adherence with antidiabetic drugs among the study groups. Results Of the total population of 700,000 subjects, 31,022 were identified as being diabetic (4.4% of the entire population). Of these, 21,586 met the study inclusion criteria. In total, 31.5% of patients had very poor glycemic control and 25.7% had excellent control. Over 2 years, the mean diabetes-related cost per person was: €1291.56 in patients with excellent control; €1545.99 in those with good control; €1584.07 in those with fair control; €1839.42 in those with poor control; and €1894.80 in those with very poor control. After adjustment, compared with the group having excellent control, the estimated excess cost per person associated with the groups with good control, fair control, poor control, and very poor control was €219.28, €264.65, €513.18, and €564.79, respectively. Conclusion Many patients showed suboptimal glycemic control. Lower levels of glycated hemoglobin were associated with lower diabetes-related health care costs. Integration of administrative databases and a laboratory database appears to be suitable for showing that appropriate management of diabetes can help to achieve better resource allocation.
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Molina-Ortiz EI, Vega AC, Calman NS. Patient registries in primary care: essential element for quality improvement. ACTA ACUST UNITED AC 2013; 79:475-80. [PMID: 22786736 DOI: 10.1002/msj.21328] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Primary care in the United States has been in the midst of a transformation from a system based solely on individual office interactions to one that includes managing health at a population level. The chronic care model provides a robust framework for health systems to transform and restructure their delivery of care to one that is committed to delivering multidisciplinary quality care with a proactive approach. Patient and disease registries are the essential tools necessary to inform all elements of the chronic care model and guide practices though this transformation. Nationally as well as internationally, when used as part of a robust continuous quality-improvement program, registries have demonstrated to improve patient outcomes and reduce healthcare costs. Despite challenges practices may confront when initially developing a patient registry, it is evident that population management is now an important and integral component of a successful primary-care practice whose aim is to improve quality of patient care.
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Nichols GA, Desai J, Elston Lafata J, Lawrence JM, O'Connor PJ, Pathak RD, Raebel MA, Reid RJ, Selby JV, Silverman BG, Steiner JF, Stewart WF, Vupputuri S, Waitzfelder B. Construction of a multisite DataLink using electronic health records for the identification, surveillance, prevention, and management of diabetes mellitus: the SUPREME-DM project. Prev Chronic Dis 2012; 9:E110. [PMID: 22677160 PMCID: PMC3457753 DOI: 10.5888/pcd9.110311] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Electronic health record (EHR) data enhance opportunities for conducting surveillance of diabetes. The objective of this study was to identify the number of people with diabetes from a diabetes DataLink developed as part of the SUPREME-DM (SUrveillance, PREvention, and ManagEment of Diabetes Mellitus) project, a consortium of 11 integrated health systems that use comprehensive EHR data for research. Methods We identified all members of 11 health care systems who had any enrollment from January 2005 through December 2009. For these members, we searched inpatient and outpatient diagnosis codes, laboratory test results, and pharmaceutical dispensings from January 2000 through December 2009 to create indicator variables that could potentially identify a person with diabetes. Using this information, we estimated the number of people with diabetes and among them, the number of incident cases, defined as indication of diabetes after at least 2 years of continuous health system enrollment. Results The 11 health systems contributed 15,765,529 unique members, of whom 1,085,947 (6.9%) met 1 or more study criteria for diabetes. The nonstandardized proportion meeting study criteria for diabetes ranged from 4.2% to 12.4% across sites. Most members with diabetes (88%) met multiple criteria. Of the members with diabetes, 428,349 (39.4%) were incident cases. Conclusion The SUPREME-DM DataLink is a unique resource that provides an opportunity to conduct comparative effectiveness research, epidemiologic surveillance including longitudinal analyses, and population-based care management studies of people with diabetes. It also provides a useful data source for pragmatic clinical trials of prevention or treatment interventions.
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Affiliation(s)
- Gregory A Nichols
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA.
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Bassett J, Adelman A, Gabbay R, Aňel-Tiangco RM. Relationship between Depression and Treatment Satisfaction among Patients with Type 2 Diabetes. ACTA ACUST UNITED AC 2012; 3. [PMID: 23243556 DOI: 10.4172/2155-6156.1000210] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND: Depression has been shown to adversely affect glycemic control. The purpose of this study is to examine the association between depression and treatment satisfaction in patients with diabetes. MATERIALS AND METHODS: Baseline data was collected on 545 patients with poorly controlled type 2 diabetes enrolled in a study that examined the effectiveness of diabetes nurse case managers. Depression was measured using the Center for Epidemiologic Studies Depression (CES-D) questionnaire, and treatment satisfaction, using the Diabetes Treatment Satisfaction Questionnaire (DTSQ). RESULTS: The majority of participants (59%) were female, with a high percentage (41%) of Hispanic/Latino participants with a mean HbA1C of 8.4%. The prevalence of depression in this population was 35.6%. High CES-D scores were associated with elevated levels of HbA1C and LDL cholesterol (p<0.001). The relationship between depression and treatment satisfaction was significant (p<0.001), indicating that as depression increases, treatment satisfaction decreases. DISCUSSION: We identified a significant relationship between depression and treatment satisfaction in this group of poorly controlled type 2 diabetes patients. Although causation cannot be determined, it is possible that patients who are depressed are less likely to be satisfied with their treatment. This could lead to decreased patient adherence, ultimately resulting in poor glycemic control.
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Affiliation(s)
- Jon Bassett
- University of Nebraska Medical Center and Ehrling Bergquist at Offutt AFB, USA
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Affiliation(s)
- Trajko Bojadzievski
- Division of Endocrinology, Diabetes and Metabolism, Penn State Institute for Diabetes and Obesity, Pennsylvania State College of Medicine, Hershey, Pennsylvania. USA
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Stuckey HL, Adelman AM, Gabbay RA. Improving care by delivering the Chronic Care Model for diabetes. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/dmt.10.9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Harris SB, Glazier RH, Tompkins JW, Wilton AS, Chevendra V, Stewart MA, Thind A. Investigating concordance in diabetes diagnosis between primary care charts (electronic medical records) and health administrative data: a retrospective cohort study. BMC Health Serv Res 2010; 10:347. [PMID: 21182790 PMCID: PMC3022877 DOI: 10.1186/1472-6963-10-347] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 12/23/2010] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Electronic medical records contain valuable clinical information not readily available elsewhere. Accordingly, they hold important potential for contributing to and enhancing chronic disease registries with the goal of improving chronic disease management; however a standard for diagnoses of conditions such as diabetes remains to be developed. The purpose of this study was to establish a validated electronic medical record definition for diabetes. METHODS We constructed a retrospective cohort using health administrative data from the Institute for Clinical Evaluative Sciences Ontario Diabetes Database linked with electronic medical records from the Deliver Primary Healthcare Information Project using data from 1 April 2006-31 March 2008 (N = 19,443). We systematically examined eight definitions for diabetes diagnosis, both established and proposed. RESULTS The definition that identified the highest number of patients with diabetes (N = 2,180) while limiting to those with the highest probability of having diabetes was: individuals with ≥2 abnormal plasma glucose tests, or diabetes on the problem list, or insulin prescription, or ≥2 oral anti-diabetic agents, or HbA1c ≥6.5%. Compared to the Ontario Diabetes Database, this definition identified 13% more patients while maintaining good sensitivity (75%) and specificity (98%). CONCLUSIONS This study establishes the feasibility of developing an electronic medical record standard definition of diabetes and validates an algorithm for use in this context. While the algorithm may need to be tailored to fit available data in different electronic medical records, it contributes to the establishment of validated disease registries with the goal of enhancing research, and enabling quality improvement in clinical care and patient self-management.
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Affiliation(s)
- Stewart B Harris
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Richard H Glazier
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Centre for Research on Inner City Health, in the Keenan Research Centre at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jordan W Tompkins
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Andrew S Wilton
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Vijaya Chevendra
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Moira A Stewart
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Amardeep Thind
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
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Doshi AM, Van Den Eeden SK, Morrill MY, Schembri M, Thom DH, Brown JS. Women with diabetes: understanding urinary incontinence and help seeking behavior. J Urol 2010; 184:1402-7. [PMID: 20727547 DOI: 10.1016/j.juro.2010.06.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE We examined the association of urinary incontinence with diabetes status and race, and evaluated beliefs about help seeking for incontinence in a population based cohort of women with vs without diabetes. MATERIALS AND METHODS We performed a cross-sectional analysis of 2,270 middle-aged and older racially/ethnically diverse women in the Diabetes Reproductive Risk factors for Incontinence Study at Kaiser. Incontinence, help seeking behavior and beliefs were assessed by self-report questionnaires and in-person interviews. We compared incontinence characteristics in women with and without diabetes using univariate analysis and multivariate models. RESULTS Women with diabetes reported weekly incontinence significantly more than women without diabetes (weekly 35.4% vs 25.7%, p <0.001). Race prevalence patterns were similar in women with and without diabetes with the most vs the least prevalence of incontinence in white and Latina vs black and Asian women. Of women with diabetes 42.2% discussed incontinence with a physician vs 55.5% without diabetes (p <0.003). Women with diabetes were more likely than those without diabetes to report the belief that incontinence is rare (17% vs 6%, p <0.001). CONCLUSIONS Incontinence is highly prevalent in women with diabetes. Race prevalence patterns are similar in those with and without diabetes. Understanding help seeking behavior is important to ensure appropriate patient care. Physicians should be alert for urinary incontinence since it is often unrecognized and, thus, under treated in women with diabetes.
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Affiliation(s)
- Ashmi M Doshi
- Women's Health Clinical Research Center, University of California-San Francisco School of Medicine, San Francisco, California 94115, USA.
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Tashko G, Gabbay RA. Evidence-based approach for managing hypertension in type 2 diabetes. Integr Blood Press Control 2010; 3:31-43. [PMID: 21949619 PMCID: PMC3172068 DOI: 10.2147/ibpc.s6984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Indexed: 01/13/2023] Open
Abstract
Blood pressure (BP) control is a critical part of managing patients with type 2 diabetes. Perhaps it is the single most important aspect of diabetes care, which unlike hyperglycemia and dyslipidemia can reduce both micro- and macrovascular complications. Hypertension is more prevalent in individuals with diabetes than general population, and in most cases its treatment requires two or more pharmacological agents (about 30% of individuals with diabetes need 3 or more medications to control BP). In this article we describe the key evidence that has contributed to our understanding that reduced BP translates into positive micro- and macrovascular outcomes. We review the data supporting current recommendation for BP target < 130/80 mmHg. Two studies suggest that a lower BP goal could be even more beneficial. We also present the comparative benefits of various antihypertensive drugs in reducing diabetes-related micro- and macrovascular complications. Finally we propose an evidence-based algorithm of how to initiate and titrate antihypertensive pharmacotherapy in affected individuals. Overall, achieving BP < 130/80 mmHg is more important than searching for the “best” antihypertensive agent in patients with diabetes.
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Affiliation(s)
- Gerti Tashko
- Division of Endocrinology, Diabetes, and Metabolism, Penn State College of Medicine, Hershey, PA, USA
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Current literature in diabetes. Diabetes Metab Res Rev 2009; 25:i-x. [PMID: 19790194 DOI: 10.1002/dmrr.1037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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