Diabetes Hospital Discharge and Emergency Department Data, Montana Dorota Carpenedo, MPH Epidemiologist

Outline 1.Data Reporting 2.Hospital Discharge Data – Rates overtime – Montana compared to the Nation 3.Hospital Discharge and Emergency Department Data – Comorbidities – By age group 4.Hospital Discharge, Diabetes Manifestations 5.Emergency Department Visits, Diabetes Manifestations 6.Conclusion 2

Data Reporting Office of Epidemiology and Scientific Support, DPHHS. 3

Data Reporting Hospital Discharge Data: Person admitted to the hospital for at least one night and is discharged from the hospital. Years of data: Emergency Department Data: Person visits and is discharged from Emergency Department. – Years of data: Annual data with no individual identifiers. 4

Data Reporting Primary diagnosis, 8 secondary diagnosis, 5 secondary procedure codes, 3 External Causes of Injury and Poisoning (E-codes). Coded using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). 5

6 Diabetes Hospital Discharge Data - Rates overtime - Montana compared to the Nation

7 Data Source: Montana Hospital Association; limited to reporting Montana hospitals Primary or Secondary Diagnosis

8 Rates for Diabetes Prevention Quality Indicators, Montana Compared to the Nation, 18 years and older, Diabetes short-term complications ages 6-17yrs. MT: 51% US: 28% Data Source: Montana Hospital Association; limited to reporting Montana hospitals, Agency for Health Research and Quality. Information extracted from the Montana Prevention Quality Indicators , March 2011.

9 Hospital Discharge and Emergency Department Data - Comorbidities - By age group

Diabetes Top 3 Comorbidities, Hospitalizations and Emergency Department Visits, Montana Residents, Hospital Discharge Emergency Department Comorbidities% Symptoms involving respiratory system and other chest symptoms (786.00) 10 Diabetes Type II (250.00)10 Other symptoms involving abdomen and pelvis (789) 5 10 Comorbidities% Diabetes Type II (250.00)9 Osteoarthrosis and allied disorders (715.00) 5 Heart failure (428.00)4 Primary or Secondary Diagnosis. Data Source: Montana Hospital Association; limited to reporting Montana hospitals

11 Diabetes Hospitalizations and Emergency Department Visits by Age Groups, Montana Residents, Primary or Secondary Diagnosis. Data Source: Montana Hospital Association; limited to reporting Montana hospitals 0-17 years years

12 Diabetes Hospitalizations and Emergency Department Visits by Age Groups, Montana Residents, Primary or Secondary Diagnosis. Data Source: Montana Hospital Association; limited to reporting Montana hospitals years 65+ years

13 Hospitalizations0-17 yrs yrs yrs.65+ yrs. Diabetes without mention of complications (250.0) 12.0%2.4%0.5%0.2% Diabetes with ketoacidosis (250.1)60.0%21.4%3.2%0.5% Emergency Department Visits Diabetes without mention of complications (250.0) 77.9%86.2%88.7%90.3% Diabetes with ketoacidosis (250.1)12.0%2.4%0.5%0.2% Diabetes Manifestations Hospital Discharge and Emergency Department Visits, Montana Residents, Primary or Secondary Diagnosis. Data Source: Montana Hospital Association; limited to reporting Montana hospitals

14 Primary or Secondary Diagnosis. Data Source: Montana Hospital Association; limited to reporting Montana hospitals

Diabetes Hospital Discharge and Emergency Department Visits, Montana Residents, Hospital Discharge Type II (250.00,.02) Type I (250.01,.03) Age, average67 yrs.38 yrs. Female50%54% Payer: Commercial27%38% Medicare57%24% Medicaid6%17% Emergency Department Type II (250.00,.02) Type I (250.01,.03) Age, average61 yrs.38 yrs. Female53%54% Payer: Commercial31%43% Medicare45%20% Medicaid10%19% 15 Primary or Secondary Diagnosis. Data Source: Montana Hospital Association; limited to reporting Montana hospitals

Diabetes Hospital Discharge and Emergency Department Visits, Montana Residents, Hospital Discharge Type I + ketoacidosis (250.11,.13) Type II + hyperosmolarity (250.20,.22) Age, average30 yrs.61 yrs. Female56%38% Payer: Commercial39%22% Medicare13%44% Medicaid21%19% Emergency Department Type I + ketoacidosis (250.11,.13) Type II + hyperosmolarity (250.20,.22) Age, average29 yrs.52 yrs. Female61%45% Payer: Commercial41%19% Medicare13%39% Medicaid24%13% 16 Primary or Secondary Diagnosis. Data Source: Montana Hospital Association; limited to reporting Montana hospitals

17 Hospital Discharge Data, Diabetes Manifestations

Diabetes Hospital Stay, Montana Residents, Average Length of Stay: – 4.0 days for Type II (250.00,.02) – 3.6 days for Type I (250.01,.03) – 3.0 days for Type I with ketoacidosis (250.11,.13) – 4.3 days Type II with hyperosmolarity (250.20,.22) Primary or Secondary Diagnosis. Data Source: Montana Hospital Association; limited to reporting Montana hospitals

19 Diabetes Hospitalizations Source of Admission*, Montana Residents, July, December, 2012 *Effective July 1, 2010, admission source changed to point of origin. Primary or Secondary Diagnosis. Data Source: Montana Hospital Association; limited to reporting Montana hospitals

20 Diabetes Hospitalizations Discharge Status, Montana Residents, Primary or Secondary Diagnosis. Data Source: Montana Hospital Association; limited to reporting Montana hospitals

21 Emergency Department Data, Diabetes Manifestations

22 Diabetes Emergency Department Visits Source of Admission*, Montana Residents, July, 2010-December, 2012 *Effective July 1, 2010, admission source changed to point of origin. Primary or Secondary Diagnosis. Data Source: Montana Hospital Association; limited to reporting Montana hospitals

23 Diabetes Emergency Department Visits Discharge Status, Montana Residents, Primary or Secondary Diagnosis. Data Source: Montana Hospital Association; limited to reporting Montana hospitals

24

25 Conclusions: Since 2000, Montana’s diabetes hospitalization rates have increased. The prevalence of short-term complications of diabetes for children is double the national rate. From research we know that individuals with diabetes have higher rates of hospitalization and hospital care compared with persons without diabetes. 1 Preventing the complications related to diabetes that result in hospitalization will improve the quality of life and could have a great impact on the resources of a health care system. 1. Ronald E. Aubert, Linda S. Geiss, “Diabetes-Related Hospitalization and Hospital Utilization”

Thank you! Dorota Carpenedo, MPH Epidemiologist