Author(s): Chiou, SJ (Chiou, Shang-Jyh); Campbell, C (Campbell, Claudia); Horswell, R (Horswell, Ronald); Myers, L (Myers, Leann); Culbertson, R (Culbertson, Richard)
Title: Use of the emergency department for less-urgent care among type 2 diabetics under a disease management program
Source: BMC HEALTH SERVICES RESEARCH, 9: Art. No. 223 DEC 7 2009 Language: English
Document Type: Article
KeyWords Plus: HEALTH-SERVICE; ASSOCIATION; ADHERENCE; DESIGN Abstract: Background: This study analyzed the likelihood of less-urgent emergency
department (ED) visits among type 2 diabetic patients receiving care under a diabetes disease management (DM) program offered by the Louisiana State University Health Care Services Division (LSU HCSD).
Methods: All ED and outpatient clinic visits made by 6,412 type 2 diabetic patients from 1999 to 2006 were extracted from the LSU HCSD Disease Management (DM) Evaluation Database.
Patient ED visits were classified as either urgent or less-urgent, and the likelihood of a less- urgent ED visit was compared with outpatient clinic visits using the Generalized Estimating Equation methodology for binary response to time-dependent variables.
Results: Patients who adhered to regular clinic visit schedules dictated by the DM program were less likely to use the ED for less urgent care with odds ratio of 0.1585. Insured patients had 1.13 to 1.70 greater odds of a less-urgent ED visit than those who were uninsured.
Patients with better-managed glycated hemoglobin (A1c or HbA1c) levels were 82 times less likely to use less-urgent ED visits. Furthermore, being older, Caucasian, or a longer participant in the DM program had a modestly lower likelihood of less-urgent ED visits. The patient's Charlson Comorbidity Index (CCI), gender, prior hospitalization, and the admitting facility showed no effect.
Conclusion: Patients adhering to the DM visit guidelines were less likely to use the ED for less-urgent problems. Maintaining normal A1c levels for their diabetes also has the positive impact to reduce less-urgent ED usages. It suggests that successful DM programs may reduce inappropriate ED use. In contrast to expectations, uninsured patients were less likely to use the ED for less-urgent care. Patients in the DM program with Medicaid coverage were 1.3 times more likely to seek care in the ED for non-emergencies while commercially insured patients were nearly 1.7 times more likely to do so. Further research to understand inappropriate ED use among insured patients is needed. We suggest providing visit
reminders, a call centre, or case managers to reduce the likelihood of less-urgent ED visit use among DM patients. By reducing the likelihood of unnecessary ED visits, successful DM programs can improve patient care.
Addresses: [Chiou, Shang-Jyh] Asia Univ, Coll Hlth Sci, Dept Hlth Care Adm, Wufeng 41354,
Taichung County, Taiwan; [Campbell, Claudia; Culbertson, Richard] Tulane Univ, Sch Publ Hlth & Trop Med, Dept Hlth Syst Management, New Orleans, LA 70112 USA; [Myers, Leann]
Tulane Univ, Sch Publ Hlth & Trop Med, Dept Biostat, New Orleans, LA 70112 USA;
[Horswell, Ronald] Louisiana State Univ, Hlth Sci Ctr, Div Hlth Care Serv, Baton Rouge, LA 70821 USA
Reprint Address: Chiou, SJ, Asia Univ, Coll Hlth Sci, Dept Hlth Care Adm, 500 Lioufeng Rd, Wufeng 41354, Taichung County, Taiwan.
E-mail Address: chiouatg2@gmail.com; ccampbel@tulane.edu; RHorsw@lsuhsc.edu;
myersl@tulane.edu; rculber@tulane.edu Funding Acknowledgement:
Funding Agency Grant Number
LSUHSC HCSD
The study was supported by LSUHSC HCSD, which provided the original data. We are indebted to Dr. Gene Beyt who provided the background to start this research and also wish to acknowledge the assistance of Dr. Jolene Johnson and Dr. Ke Xiao, which was essential for finishing this study. The authors thank Donna Kulawiak, MPH, of Tulane University's Department of Health Systems Management for her contributions. In addition, we thank Miss Hsiu Mei Wei, Miss Fei Yun Yu and Chi-Jeng Hsieh for their excellent assistance in ICD-9 classification and data programs.
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Publisher: BIOMED CENTRAL LTD
Publisher Address: 236 GRAYS INN RD, FLOOR 6, LONDON WC1X 8HL, ENGLAND ISSN: 1472-6963
Article Number: 223
DOI: 10.1186/1472-6963-9-223
29-char Source Abbrev.: BMC HEALTH SERV RES ISO Source Abbrev.: BMC Health Serv. Res.
Source Item Page Count: 6
Subject Category: Health Care Sciences & Services ISI Document Delivery No.: 535XD
