DefinitionAmbulatory care sensitive (ACS) conditions refer to those conditions for which hospitalizations could have been avoided, or conditions that could have been less serious, if they had been treated early and appropriately. Good outpatient management dramatically reduces the risk of hospitalization. For diabetes, an ACS condition refers to uncontrolled diabetes (type 1 and type 2), diabetes short-term and long-term complications, and amputations of lower extremities due to diabetes among adults aged 18 years and older.
As of November 2004, the IBIS diabetes information is based on four diabetes indicators (PQI 1, PQI 3, PQI 14, PQI 16) developed by the Agency for Healthcare Research and Quality Prevention Quality Indicators. National Healthcare Quality and Research provided the values for the national rate based on the National Inpatient Sample.
NumeratorNumber of hospitalizations among persons aged 18 years and older with diabetes complications as the principal or secondary diagnosis code. Maternal, newborn, and transfer cases are excluded.
DenominatorNumber of Utah residents aged 18 years and older.
Data Interpretation IssuesThe four Agency for Healthcare Research and Quality Prevention Quality Indicators for diabetes use both principal and secondary ICD-9-CM diagnosis codes for hospitalization, include all adults (aged 18 years and older), but exclude cases that may result in over counting of diabetes cases. Specifically maternal, newborn, and transfer cases are excluded from uncontrolled diabetes, diabetes long-term complications, and diabetes short-term complications. Diabetes lower extremity amputation also excludes trauma cases. The Utah diabetes rate is risk-adjusted by age and gender so that comparison with the national rate is more meaningful. 95% confidence intervals are the criterion for statistical significance, that is, they indicate whether differences are real or due to "noise" in the data.
Why Is This Important?Ambulatory care sensitive (ACS) conditions are conditions for which effective outpatient care can prevent hospitalizations. Diabetes is a disease for which regular physician visits can help to control blood sugar (glucose), fats (lipids), and blood pressure; screen for diabetes-related eye, foot, and kidney problems; and provide early treatment and patient education in self-management. Physician visits and early treatment can prevent otherwise avoidable hospitalizations and serious illness and injuries to patients. Diabetes complications include loss of consciousness, heart disease, stroke, circulation, kidney and nerve damage, impotence, blindness, amputation of extremities, and death.
Other ObjectivesSimilar to HP2020 Objective D-4: Reduce the rate of lower extremity amputations in persons with diagnosed diabetes.
How Are We Doing?From 2000 through 2012, the annual risk-adjusted rate of Utah residents aged 18 years and older hospitalized for diabetes with short-term complications has generally increased. However, in years 2004 and 2009, short-term rate decreases were reported. Only the decrease in 2009 was considered statistically significant, in comparison to the preceding year. On the contrary, the risk-adjusted rate has generally decreased from 2000 to 2012 for diabetes with long-term complications, uncontrolled diabetes, and amputation of lower extremities.
How Do We Compare With the U.S.?Based on four adult diabetes indicators (short-term complications, long-term complications, lower extremity amputations, and uncontrolled), the annual risk-adjusted rate for Utah residents aged 18 years and older hospitalized for diabetes from 2000 through 2011 (the most recent available national data), the was significantly lower than the national annual rate, which was obtained from the Agency for Healthcare Research and Quality/Healthcare Cost and Utilization Project (AHRQ/HCUP).
Utah rates for 2000 through 2012 are significantly lower than the annual national rates most years (except 2002 and 2003 for short-term complications), based on the Agency for Healthcare Research and Quality/Healthcare Cost and Utilization Project.
What Is Being Done?The Utah Diabetes Prevention and Control Program has been merged into the Healthy Living through Environment, Policy, and Improved Clinical Care (EPICC) Program. The EPICC Program places a high priority on diabetes self-management education and is working to increase the number of adults who have ever received it. However, EPICC funding no longer supports state-certification of Diabetes Self-Management Education Program and staff is assisting all state-certified programs obtain recognition from the American Diabetes Association or certification through the American Association of Diabetes Educators.
Evidence-based PracticesGlycemic control (average preprandial glucose for diabetics: 90-130 mg/dl, average normal: <110 mg/dl) results in significant reductions in the incidence and rate of progression of retinopathy, albuminuria, and clinical neuropathy.
A1c tests show a diabetic's average glycemia over the preceding 2-3 months. A1c tests should be performed at least twice per year in patients who are meeting treatment goals and at least quarterly in patients who are not meeting glycemic goals.
Diet and exercise have been shown to help diabetics with glycemic control.
Diabetics have increased risk of cardiovascular disease. Lowering risks, such as hypertension (diastolic >=90 mmHG or systolic >=140 mmHG) are especially important for diabetics. (http://care.diabetesjournals.org/content/25/1/213.full)
Health Program InformationA1c levels less than 7% indicate good glucose control. The Healthy Living through Environment, Policy, and Improved Clinical Care (EPICC) Program and the Office of Health Care Statistics collect HEDIS (Healthcare Effectiveness Data and Information Set) information on frequency of A1c exams for members of health plans throughout the state. The EPICC Program also conducts chart reviews to obtain A1c levels for a sample of health plan members.