| Use of the emergency department for less-urgent care among type 2 diabetics under a disease management program. | |
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MedLine Citation:
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PMID: 19968871 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: This study analyzed the likelihood of less-urgent emergency department (ED) visits among type 2 diabetic patients receiving care under a diabetes disease management (DM) program offered by the Louisiana State University Health Care Services Division (LSU HCSD). METHODS: All ED and outpatient clinic visits made by 6,412 type 2 diabetic patients from 1999 to 2006 were extracted from the LSU HCSD Disease Management (DM) Evaluation Database. Patient ED visits were classified as either urgent or less-urgent, and the likelihood of a less-urgent ED visit was compared with outpatient clinic visits using the Generalized Estimating Equation methodology for binary response to time-dependent variables. RESULTS: Patients who adhered to regular clinic visit schedules dictated by the DM program were less likely to use the ED for less urgent care with odds ratio of 0.1585. Insured patients had 1.13 to 1.70 greater odds of a less-urgent ED visit than those who were uninsured. Patients with better-managed glycated hemoglobin (A1c or HbA1c) levels were 82 times less likely to use less-urgent ED visits. Furthermore, being older, Caucasian, or a longer participant in the DM program had a modestly lower likelihood of less-urgent ED visits. The patient's Charlson Comorbidity Index (CCI), gender, prior hospitalization, and the admitting facility showed no effect. CONCLUSION: Patients adhering to the DM visit guidelines were less likely to use the ED for less-urgent problems. Maintaining normal A1c levels for their diabetes also has the positive impact to reduce less-urgent ED usages. It suggests that successful DM programs may reduce inappropriate ED use. In contrast to expectations, uninsured patients were less likely to use the ED for less-urgent care. Patients in the DM program with Medicaid coverage were 1.3 times more likely to seek care in the ED for non-emergencies while commercially insured patients were nearly 1.7 times more likely to do so. Further research to understand inappropriate ED use among insured patients is needed. We suggest providing visit reminders, a call centre, or case managers to reduce the likelihood of less-urgent ED visit use among DM patients. By reducing the likelihood of unnecessary ED visits, successful DM programs can improve patient care. |
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Authors:
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Shang-Jyh Chiou; Claudia Campbell; Ronald Horswell; Leann Myers; Richard Culbertson |
Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't Date: 2009-12-07 |
Journal Detail:
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Title: BMC health services research Volume: 9 ISSN: 1472-6963 ISO Abbreviation: BMC Health Serv Res Publication Date: 2009 |
Date Detail:
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Created Date: 2009-12-18 Completed Date: 2010-03-10 Revised Date: 2010-09-27 |
Medline Journal Info:
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Nlm Unique ID: 101088677 Medline TA: BMC Health Serv Res Country: England |
Other Details:
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Languages: eng Pagination: 223 Citation Subset: IM |
Affiliation:
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Department of Health Care Administration, College of Health Science, Asia University, 500, Lioufeng Road, Wufeng, Taichung County 41354, Taiwan. chiouatg2@gmail.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Age Factors Ambulatory Care / utilization Diabetes Mellitus, Type 2 / therapy* Disease Management* Emergency Service, Hospital / utilization* Female Hemoglobin A, Glycosylated Humans Insurance, Health Louisiana Male Middle Aged Multivariate Analysis Risk Factors |
| Chemical | |
Reg. No./Substance:
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0/Hemoglobin A, Glycosylated |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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