Pogach L M, Hawley G, Weinstock R, Sawin C, Schiebe H, Cutler F, Zieve F, Bates M, Repke D
Medical Service, East Orange Veterans Administration Medical Center, New Jersey 07019, USA.
Diabetes Care. 1998 Mar;21(3):368-73. doi: 10.2337/diacare.21.3.368.
To develop a diabetes registry from an outpatient pharmacy database to systematically analyze the prevalence of diabetes, patterns of glycemic medication and glucose monitoring, pharmacy costs, and hospital use related to diabetes care in the Veterans Health Administration (VHA) in fiscal year (FY) 1994.
Veterans with diabetes were identified using a software program that extracted the social security number (SSN) of patients receiving insulin, sulfonylurea agents, or glucose-monitoring supplies. The cumulative FY94 cost for a drug was calculated by multiplying the units dispensed times the unit cost for each fill, using the actual drug cost that was in effect at the time of dispensing. Admission data were obtained by crossmatching the SSN registry with the VHA Austin Mainframe Patient Treatment Files to retrieve associated diagnosis-related groups (DRG), Physicians' Current Procedural Terminology (CPT), and International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes.
From among 1,180,260 unique patients, 139,646 veterans with diabetes receiving insulin, oral agents, or glucose-monitoring strips were identified, accounting for a prevalence of 11.83% from 62 Veterans Administration medical centers. There were 63,078 individuals (52%) who received oral agents, of whom 26.3% also received blood glucose-monitoring supplies; 46,664 individuals (39%) received insulin, of whom 53.2% received blood glucose-monitoring supplies; and 9,440 individuals (8%) received both oral agents and insulin during FY94, with 64.4% receiving blood glucose-monitoring supplies. Only 1,482 (1.2%) individuals received monitoring supplies alone, and 129 patients (0.1%) were provided with an insulin pump. Using an adjusted data set, 12% of veterans accounted for 24% of all outpatient pharmacy costs, with an average expenditure of $622 for veterans with diabetes compared with $276 for veterans without diabetes. There was $454 (73%) for non-diabetes-specific prescriptions and $168 (27%) for prescriptions related to glycemic control. Of pharmacy expenditures for glycemic control, $101 (60.1%) was attributed to insulin, oral agents, and supplies, while $67 (39.9%) was attributable to glucose monitoring. Veterans with diabetes were admitted 1.6 times as frequently as veterans without diabetes.
This study demonstrates the feasibility of using a pharmacy-based electronic diabetes database in a payor system that can track both claims and individual classes of medication based on a unique identifier number. While the prevalence of diabetes in the VHA is high relative to other health care systems and the general population, patterns of medication usage, pharmacy costs, and relative admission frequency are comparable to results from the private sector.
利用门诊药房数据库建立糖尿病登记系统，以系统分析1994财年退伍军人健康管理局（VHA）中糖尿病的患病率、降糖药物使用模式及血糖监测情况、药房成本以及与糖尿病护理相关的医院利用情况。
使用一个软件程序来识别患有糖尿病的退伍军人，该程序提取接受胰岛素、磺脲类药物或血糖监测用品的患者的社会安全号码（SSN）。通过将每次配药的单位数量乘以单位成本，利用配药时有效的实际药品成本，计算出1994财年某种药物的累计成本。通过将SSN登记系统与VHA奥斯汀主机患者治疗档案进行交叉匹配，获取入院数据，以检索相关的诊断相关分组（DRG）、医师当前操作术语（CPT）和国际疾病分类第九版临床修订本（ICD-9-CM）编码。
在1,180,260名不同患者中，识别出139,646名接受胰岛素、口服药物或血糖监测试纸的糖尿病退伍军人，占62个退伍军人管理局医疗中心患者总数的11.83%。有63,078人（52%）接受口服药物治疗，其中26.3%的人还接受血糖监测用品；46,664人（39%）接受胰岛素治疗，其中53.2%的人接受血糖监测用品；在1994财年，有9,440人（8%）同时接受口服药物和胰岛素治疗，其中64.4%的人接受血糖监测用品。仅1,482人（1.2%）仅接受监测用品，129名患者（0.1%）配备了胰岛素泵。使用经过调整的数据集，12%的退伍军人占所有门诊药房成本的24%，糖尿病退伍军人的平均支出为622美元，而无糖尿病退伍军人的平均支出为276美元。非糖尿病特定处方费用为454美元（73%），与血糖控制相关的处方费用为168美元（27%）。在血糖控制的药房支出中，101美元（60.1%）归因于胰岛素、口服药物和用品，而67美元（39.9%）归因于血糖监测。糖尿病退伍军人的入院频率是无糖尿病退伍军人的1.6倍。
本研究证明了在一个支付系统中使用基于药房的电子糖尿病数据库的可行性，该数据库可以根据唯一标识符号码跟踪索赔和各类药物。虽然VHA中糖尿病的患病率相对于其他医疗保健系统和普通人群较高，但药物使用模式、药房成本和相对入院频率与私营部门的结果相当。
