New York City Department of Health and Mental Hygiene, New York, NY
New York City Department of Health and Mental Hygiene, New York, NY.
Diabetes Care. 2020 Apr;43(4):743-750. doi: 10.2337/dc19-0954. Epub 2020 Mar 4.
Self-management education and support are essential for improved diabetes control. A 1-year randomized telephonic diabetes self-management intervention (Bronx A1C) among a predominantly Latino and African American population in New York City was found effective in improving blood glucose control. To further those findings, this current study assessed the intervention's impact in reducing health care utilization and costs over 4 years.
We measured inpatient ( = 816) health care utilization for Bronx A1C participants using an administrative data set containing all hospital discharges for New York State from 2006 to 2014. Multilevel mixed modeling was used to assess changes in health care utilization and costs between the telephonic diabetes intervention (Tele/Pr) arm and print-only (PrO) control arm.
During follow-up, excess relative reductions in all-cause hospitalizations for the Tele/Pr arm compared with PrO arm were statistically significant for odds of hospital use (odds ratio [OR] 0.89; 95% CI 0.82, 0.97; < 0.01), number of hospital stays (rate ratio [RR] 0.90; 95% CI 0.81, 0.99; = 0.04), and hospital costs (RR 0.90; 95% CI 0.84, 0.98; = 0.01). Reductions in hospital use and costs were even stronger for diabetes-related hospitalizations. These outcomes were not significantly related to changes observed in hemoglobin A during individuals' participation in the 1-year intervention.
These results indicate that the impact of the Bronx A1C intervention was not just on short-term improvements in glycemic control but also on long-term health care utilization. This finding is important because it suggests the benefits of the intervention were long-lasting with the potential to not only reduce hospitalizations but also to lower hospital-associated costs.
自我管理教育和支持对于改善糖尿病控制至关重要。一项为期 1 年的针对纽约市以拉丁裔和非裔美国人为主的人群的电话糖尿病自我管理干预（Bronx A1C）研究发现，该干预措施可有效改善血糖控制。为了进一步证实这些发现，本研究评估了该干预措施在 4 年内对减少医疗保健利用和成本的影响。
我们使用包含 2006 年至 2014 年纽约州所有医院出院记录的行政数据集，对 Bronx A1C 参与者的住院（n=816）医疗保健利用情况进行了测量。采用多水平混合模型评估电话糖尿病干预（Tele/Pr）组与仅印刷（PrO）对照组之间医疗保健利用和成本的变化。
在随访期间，与 PrO 对照组相比，Tele/Pr 组的全因住院的超额相对减少在统计学上具有显著性，表现在住院使用的可能性（比值比 [OR] 0.89；95%CI 0.82,0.97； ＜0.01）、住院次数（比率比 [RR] 0.90；95%CI 0.81,0.99； = 0.04）和住院费用（RR 0.90；95%CI 0.84,0.98； = 0.01）。与糖尿病相关的住院治疗的住院使用和成本减少更为显著。这些结果与个体参与为期 1 年的干预措施期间观察到的血红蛋白 A 的变化没有显著关系。
这些结果表明，Bronx A1C 干预的影响不仅在于短期血糖控制的改善，还在于长期医疗保健的利用。这一发现很重要，因为它表明该干预措施的益处是持久的，不仅可以减少住院治疗，还可以降低与住院相关的成本。
