Fisher Monica A, Ma Zheng-qiang
Pennsylvania Department of Health, Bureau of Epidemiology, 625 Forster St, Harrisburg, PA 17120. E-mail:
Am J Manag Care. 2015 May 1;21(5):e312-9.
To evaluate the associations between potentially avoidable diabetes-related emergency/urgent hospital admissions and different health insurance status (ie, Medicaid, Medicare, uninsured, private), along with other characteristics including sociodemographic status (age, race/ethnicity, gender, region), hospitalization status (previous hospitalizations, weekend admissions), and health status (complications, comorbidities), among patients with type 2 diabetes mellitus (T2DM).
The 2011 data set of all inpatient discharge records with a primary diagnosis of T2DM from all hospitals in Pennsylvania were included in the analyses.
Multivariable logistic regression modeling with diabetes-related emergency/urgent hospitalizations as the dependent outcome variable and health insurance status as the main exposure independent variable, adjusting for age, race/ethnicity, gender, region, previous hospitalizations, weekend admissions, complications, and comorbidity. Hosmer and Lemeshow goodness-of-fit test was used for logistic model fit analysis.
Nearly 91% of 17,097 potentially avoidable diabetes-related hospitalizations were emergency/urgent admissions for T2DM patients in Pennsylvania during 2011. Uninsured and Medicaidinsured patients were 2.1 (adjusted odds ratio [AOR], 2.11; 95% CI, 1.23-3.61) and 1.8 (AOR, 1.78; 95% CI, 1.44-2.20) times more likely than privately insured patients, respectively, to be admitted through emergency/urgent admissions. There was no statistically significant difference in emergency/urgent admissions between Medicaid and uninsured (AOR, 0.85; 95% CI, 0.49-1.47).
Medicaid-insured T2DM patients, like the uninsured, are more likely to be hospitalized through emergency/urgent admissions. The presumption that insured individuals with diabetes are more likely than the uninsured to manage and control the progression of their condition, and receive care in the right setting, is not supported for those with Medicaid coverage.
评估2型糖尿病（T2DM）患者中潜在可避免的糖尿病相关急诊/紧急住院与不同健康保险状况（即医疗补助、医疗保险、未参保、私人保险）之间的关联，以及其他特征，包括社会人口统计学状况（年龄、种族/民族、性别、地区）、住院状况（既往住院史、周末入院）和健康状况（并发症、合并症）。
分析纳入了宾夕法尼亚州所有医院2011年所有主要诊断为T2DM的住院出院记录数据集。
以糖尿病相关急诊/紧急住院作为因变量，健康保险状况作为主要暴露自变量，进行多变量逻辑回归建模，并对年龄、种族/民族、性别、地区、既往住院史、周末入院、并发症和合并症进行调整。使用Hosmer和Lemeshow拟合优度检验进行逻辑模型拟合分析。
2011年宾夕法尼亚州17097例潜在可避免的糖尿病相关住院中，近91%是T2DM患者的急诊/紧急入院。未参保患者和医疗补助参保患者通过急诊/紧急入院的可能性分别是私人保险患者的2.1倍（调整优势比[AOR]，2.11；95%置信区间[CI]，1.23 - 3.61）和1.8倍（AOR，1.78；95% CI，1.44 - 2.20）。医疗补助参保患者和未参保患者在急诊/紧急入院方面无统计学显著差异（AOR，0.85；95% CI，0.49 - 1.47）。
医疗补助参保的T2DM患者与未参保患者一样，更有可能通过急诊/紧急入院。对于有医疗补助覆盖的糖尿病患者，认为参保个体比未参保个体更有可能管理和控制病情进展并在合适的环境中接受治疗的假设并不成立。
