Preventable Hospitalization Among Elderly Medicare Beneficiaries With Type 2 Diabetes

Niefeld MR1, Braunstein JB2, Wu AW1, Saudek CD3, Weller WE1, Anderson GF1 

1 Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
2 Division of Cardiology and Robert Wood Johnson Clinical Scholars Program, Johns Hopkins Medical Institution, Baltimore, Maryland
3 Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland 

OBJECTIVE-To examine the impact of comorbid conditions on preventable hospitalizations among Medicare beneficiaries aged =65 years with type 2 diabetes.  

RESEARCH DESIGN AND METHODS-Data were drawn from the 1999 Medicare Standard Analytic Files, a 5% nationally representative random sample of Medicare beneficiaries. The analysis sample included 193,556 Medicare beneficiaries aged =65 years with type 2 diabetes (ICD-9-CM codes 250.xx) who were enrolled in fee-for-service Medicare. Preventable hospitalization was assessed by measuring ambulatory care-sensitive conditions, an accepted measure of hospitalizations that could have been prevented with appropriate outpatient care. Multivariable analyses controlled for demographics; mortality; renal, ophthalmic, or neurological manifestations of diabetes; type of physician providing the outpatient care; and per capita community-level indicators of income and hospital beds.  

RESULTS-Ninety-six percent of beneficiaries in the sample had a comorbidity, and 46% had five or more comorbidities. Among beneficiaries with type 2 diabetes, cardiovascular-related comorbidities were common and accounted for increased odds of preventable hospitalization, controlling for other factors. The likelihood of a preventable hospitalization increased in the presence of a claim for comorbid congestive heart failure, cardiomyopathy, coronary atherosclerosis, hypertension, or cardiac dysrythmias. Noncardiovascular comorbidities associated with a greater likelihood of preventable hospitalization included chronic obstructive pulmonary disease, asthma and lower respiratory disorders, Alzheimer's disease/dementia, personality/anxiety disorders, depression, and osteoporosis. Our data suggest that nearly 7% of all hospitalizations could be avoided.  

CONCLUSIONS-These findings support the need for improved outpatient care strategies to reduce the impact of comorbidity on unnecessary hospitalization in patients aged =65 years with type 2 diabetes. 


Niefeld MR, Braunstein JB, Wu AW, Saudek CD, Weller WE, Anderson GF. Preventable Hospitalization Among Elderly Medicare Beneficiaries With Type 2 Diabetes. Diabetes Care. 2003;26:1344-1349.


Last Modified: 2/22/2013