Rupprecht Mirjam, Campione Alessandro, Wu Yves Noel, Fischer-Rosinský Antje, Slagman Anna, Riedlinger Dorothee, Möckel Martin, Keil Thomas, Reitzle Lukas, Henschke Cornelia
Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
Department of Health Care Management, Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany.
Front Med (Lausanne). 2025 May 16;12:1509220. doi: 10.3389/fmed.2025.1509220. eCollection 2025.
Potentially avoidable hospital admissions (PAHs) due to type 2 diabetes mellitus (T2DM) occur more frequently in Germany than in the rest of Europe. Emergency departments (EDs) play an important role in understanding cross-sectoral health care utilisation resulting in inpatient admissions. Segmenting T2DM patients in homogenous groups according to their health care utilisation may help to understand the population's needs and to allocate limited resources. The aim of this study was to describe ED use and subsequent inpatient admissions among T2DM patients, and to segment the study population into homogenous subgroups based on disease stage, health care utilisation and process quality of outpatient care prior to an ED visit.
This study was conducted as part of the INDEED project, comprising data on 56,821 ED visits in 2016 attributable to 40,561 patients with T2DM from 13 German EDs, as well as statutory health insurance claims data from 2014 to 2016 retrospectively linked per patient. Descriptive analyses included patient characteristics, ED admission diagnoses and discharge diagnoses in the case of inpatient admission of T2DM patients to the ED. Latent class analysis was conducted to identify different subgroups of T2DM patients based on disease stage, number of physician contacts and medical examinations prior to the ED visit.
Almost half of the study population had severe comorbidities (44.3%). In addition to T2DM, multiple cardiovascular diagnoses were among the most frequently documented admission and discharge diagnoses. The proportion of hospitalised ED visits for T2DM patients was higher (59%) than that for the INDEED population (42.8%). We identified three latent classes that were characterised as " (36.5% of the study population), " (26.1%) and (37.4%).
A substantial share of T2DM patients had not received disease monitoring according to guideline recommendations prior to ED presentation. Improving guideline-adherence in the outpatient sector could help reduce potentially avoidable ED visits. Effective interventions that aim at improving continuity and quality of care as well as reducing the share of PAH need to be identified and evaluated per identified class.
在德国，2型糖尿病（T2DM）导致的潜在可避免住院（PAHs）比欧洲其他地区更为频繁。急诊科（EDs）在理解导致住院的跨部门医疗保健利用方面发挥着重要作用。根据医疗保健利用情况将T2DM患者分为同质组，可能有助于了解人群需求并分配有限资源。本研究的目的是描述T2DM患者的急诊科使用情况及随后的住院情况，并根据疾病阶段、医疗保健利用情况以及急诊科就诊前门诊护理的过程质量，将研究人群分为同质亚组。
本研究作为INDEED项目的一部分进行，包括2016年来自德国13个急诊科的40561例T2DM患者的56821次急诊科就诊数据，以及2014年至2016年每位患者的法定医疗保险理赔数据的回顾性关联。描述性分析包括患者特征、急诊科入院诊断以及T2DM患者在急诊科住院时的出院诊断。进行潜在类别分析以根据疾病阶段、急诊科就诊前的医生接触次数和医学检查确定T2DM患者的不同亚组。
几乎一半的研究人群患有严重合并症（44.3%）。除了T2DM，多种心血管诊断是最常记录的入院和出院诊断之一。T2DM患者的住院急诊科就诊比例（59%）高于INDEED人群（42.8%）。我们确定了三个潜在类别，分别为“（占研究人群的36.5%）”、“（26.1%）”和“（37.4%）”。
相当一部分T2DM患者在急诊科就诊前未按照指南建议接受疾病监测。提高门诊部门对指南的依从性有助于减少潜在可避免的急诊科就诊。需要针对每个确定的类别确定并评估旨在改善护理连续性和质量以及减少PAH比例的有效干预措施。
