Unexpected hospital admissions among patients with diabetes mellitus.

In a search for a new way to recognize the patients who are at higher risk of unexpected hospitalizations, the characteristics of patients with diabetes mellitus were examined after their last office visit prior to hospitalization. Six characteristics contributed significantly in distinguishing 256 patients who were subsequently hospitalized from 512 patients who were not. The six characteristics included the following: frequent emergency room visits, low serum albumin level, cardiomegaly, anemia, hypotension, and hyperglycemia. The sensitivity of prediction was 43.2%, specificity was 77.4%, and the relative risk by odds ratio was 2.60:1. The intensity of care, as estimated by the level of the provider, and the intended intensity of care, as measured by the scheduled return-visit interval, were not clinically consistent with the magnitude of risk. The characteristics of patients at higher risk of unexpected hospitalizations were identified and provide a direction for increased intensity of ambulatory care.