Evaluation of diabetes primary care and effects on health care charges in elderly patients with diabeties

Background. This study assessed diabetes out-patient care at a single institution in Medicare patients with significant health care expenditures and correlated the control of these patients with hospital admission rates and charges. Methods: A retrospective review was performed at a university health sciences center's clinics and affiliated hospital. Medicare patients with Type 2 diabetes, >65 years, and hospitalized >1 in the past year with annual incurred Medicare charges of >$6,000 were included in the study. Data collected over a year period included: hospitalization and emergency department use and charges, and key out-patient diabetes-related quality of care outcomes. These outcomes were compared with national benchmark National Health and Nutrition Examination Survey (NHANES) data. Results: Ninety-three patients were identified (median age of 72). More patients were at goal hemoglobin A1c, low-density lipoprotein cholesterol, and blood pressure than benchmark National Health and Nutrition Examination Survey data. There was a significant correlation between HbA1c and diabetes-related and all cause hospitalizations and ER visits per patient (P < 0.025) and diabetes-related charges (P = 0.0291). There were no differences between an endocrinologist and general practitioners in the quality of care except for documented microalbuminuria and aspirin use. Conclusions: Diabetes care at this institution was better than national benchmark data. HbA1c correlated with diabetes-related hospitalizations, all-cause combined hospitalizations and emergency department visits and charges. There were no major differences in the care of patients between the endocrinologist and general practitioners.