Ewald D, Patel M, Hall G
National Centre for Epidemiology of Population Health, Australian National University, Canberra.
Aust J Rural Health. 2001 Dec;9(6):275-9. doi: 10.1046/j.1038-5282.2001.00371.x.
The aim of this study was to guide service provision for prevention of diabetic foot complications through the analysis of hospital separation data for those with diabetes in central Australia. We reviewed the hospital separation data for central Australia from 1992 to 1997 for adults known to be diabetic and those with diabetic foot complications. Foot complications were identified from International Classification of Diseases-9th Revision (ICD-9) codes. Additionally, we assessed the proportion of cases with diabetic foot, identified by ICD-9 coding and confirmed by record review, that were identified by Australian National-Diagnostic Related Group-Version 3 (AN-DRG-3) coding. Separations with diabetes doubled from 352 in 1992 to 796 in 1997. This represents an increase from 1232 to 2521 separations per 100,000 people over 15 years of age. Separations with foot complications increased threefold from 28 in 1992 to 90 in 1997, a rate increase from 98 to 285 per 100,000 people over 15 years of age. The proportion of diabetes separations that had foot complications remained around 10% during the 6 year period. Aboriginal people made up 89% of the individuals with foot complications and 91% of separations for diabetic foot. Foot complications were predominantly of the more acute type (90%), amenable to early intervention. The AN-DRG-3 code for diabetic foot identified only 59% (37/63 in 1997) of the separations identified by the ICD-9 codes, and admitted primarily for foot complications in Alice Springs Hospital. The known burden of hospital care for diabetes and diabetic foot complications has increased markedly in recent years. A combination of changes in prevalence, primary care utilisation, detection, hospital access or re-admission rates may underlie the observed increases. As it is very unlikely that diabetes or diabetic foot complications are being over diagnosed, or that the hospitals are over utilised, this analysis shows there is an increasingly apparent need for improved prevention of diabetic foot complications. Therefore primary health care systems should ensure that they implement evidence-based care for preventing foot complications among people with diabetes.
本研究的目的是通过分析澳大利亚中部糖尿病患者的医院出院数据，为预防糖尿病足并发症的服务提供指导。我们回顾了1992年至1997年澳大利亚中部已知患有糖尿病及患有糖尿病足并发症的成年人的医院出院数据。通过国际疾病分类第九版（ICD - 9）编码识别足部并发症。此外，我们评估了通过ICD - 9编码识别并经记录审查确认的糖尿病足病例中，由澳大利亚国家诊断相关组第三版（AN - DRG - 3）编码识别出的病例比例。糖尿病患者的出院人数从1992年的352例增加了一倍，到1997年达到796例。这相当于15岁以上人群每10万人的出院人数从1232例增加到2521例。足部并发症患者的出院人数从1992年的28例增加了两倍，到1997年达到90例，15岁以上人群每10万人的发病率从98例增加到285例。在这6年期间，患有足部并发症的糖尿病出院患者比例保持在10%左右。原住民占足部并发症患者的89%，糖尿病足出院患者的91%。足部并发症主要为更急性的类型（90%），适合早期干预。糖尿病足的AN - DRG - 3编码仅识别出ICD - 9编码识别出的出院病例的59%（1997年为37/63），且主要是爱丽丝泉医院因足部并发症收治的病例。近年来，已知的糖尿病和糖尿病足并发症的住院治疗负担显著增加。患病率、初级保健利用率、检测、医院就医或再入院率的变化综合起来可能是观察到的增加的原因。由于糖尿病或糖尿病足并发症被过度诊断或医院被过度使用的可能性极小，该分析表明，预防糖尿病足并发症的需求日益明显。因此，初级卫生保健系统应确保对糖尿病患者实施基于证据的预防足部并发症的护理。
