Pattern of Hospitalizations and SOPD attendance of ... · Pattern of Hospitalizations and SOPD attendance of diabetic patients under care of Hospital Authority Central Coordinating

Pattern of Hospitalizations and SOPD attendance of diabetic

patients under care of Hospital Authority

Central Coordinating Committee on Diabetes

HA Convention 2006

Diabetes Mellitus: the silent killer

DiabetesDiabetesBlindness*

Renal failure*

Amputation*

Life expectancy↓5 to 10 yr

Cardiovasculardisease ↑ 2X to 4X

*Diabetes is the no. 1 cause of renal failure, new cases of blindness, and nontraumatic amputations

Nerve damage in 60% to 70% of patients

6th leading cause of death

Diabetes Statistics. October 1995 (updated 1997). NIDDK publication NIH 96-3926. Harris MI. In: Diabetes in America. 2nd ed. 1995:1-13.

Method• Targeted patients

– Patients ever dispensed with anti-diabetic drugs in 2004/05

• Laboratory results– Latest results of targeted patients from selected laboratory tests

• Hospitalizations (DP/IP) & specialty outpatient attendance (OP)– All DP/IP and OP records of targeted patients from quarterly

frozen datasets – Classification of principal diagnosis:

• DM related: acute & chronic complications• DM unrelated

Clinical characteristics

36.3:38.6:25.152.8:31.7:15.562.6:26.5:10.993.3:6.7:0% of NA:MI:MA

9.830.560.898.890+

42.552.833.00.660-89

36.612.23.6030-59

6.92.11.0015-29

4.22.41.60<15

% of patients according to eGFR(ml/min/1.73m2)*

7.6±1.67.9±1.78.1±1.99.2±2.2HbA1c(%)

1.44[1.04,2.02]1.49[1.03,2.18]1.50[0.96,2.34]0.91[0.65,1.23]TG(mmol/L)

Age group

4.9±1.05.0±1.15.0±1.14.6±1.1TC(mmol/L)

110,93877,02813,293261number

65+45-6415-44<15

Results are displayed in mean (SD) or median [IQR]*Based on abbreviated MDRD equation** NA: normoalbuminuria, MI: microalbuminuria, MA: macroalbuminuria

Mean age 64.6±12.9, male 46.3%

OP attendance according to specialty

809,064

Attendances

5.4

Attnd per patient

149,763SOP (All Specialties) ,excluding FM Clinic

Headcount @

@ It refers to the number of patient contributing the attendances. Patient headcount are counted separatelyunder each category. It may not add up to total due to multiple counting.

# Data are calculated based on GOP case with drug dispensed. Subject to under reporting error.


186,85744,640172,245

405,322809,064

Attendances

3.4 2.1 2.3

4.1 5.4

Attnd per patient


54,559SOP (Others)21,147SOP (Orthopaedics)76,086SOP (Ophthalmology)

99,228SOP (Medicine)

Headcount @




186,85744,640172,245

30,11139,75144,652

102,108152,736

405,322809,064

Attendances

3.4 2.1 2.3 6.0 3.2 3.3 3.2 3.2 4.1 5.4

Attnd per patient


54,559SOP (Others)21,147SOP (Orthopaedics)76,086SOP (Ophthalmology)

32,409Endocrinology47,093General Medicine

5,030Nephrology12,401Geriatrics

Cardiology

99,228SOP (Medicine)

13,652

Headcount @



OP attendance categorized by age and treatment

5

5.2

5.4

5.6

5.8

6

6.2

<15 15-44 45-64 65+age group

attn

per

pat

ient

For age group >15, excluded other clinic


5

5.2

5.4

5.6

5.8

6

6.2

<15 15-44 45-64 65+age group

attn

per

pat

ient

Card Card O&T

Geri O&T Psy

Endo Endo Eye

Med Eye Med Eye

EyeMed Endo Others



5

5.2

5.4

5.6

5.8

6

6.2

<15 15-44 45-64 65+age group

attn

per

pat

ient

Card Card O&T

Geri O&T Psy

Endo Endo Eye

Med Eye Med Eye

EyeMed Endo Others


4.5

5

5.5

6

6.5

7

7.5

8

SU MF SU+MF 3OAD ins+OAD ins

treatment

attn

per

pat

ient


5

5.2

5.4

5.6

5.8

6

6.2

<15 15-44 45-64 65+age group

attn

per

pat

ient

Card Card O&T

Geri O&T Psy

Endo Endo Eye

Med Eye Med Eye

EyeMed Endo Others


4.5

5

5.5

6

6.5

7

7.5

8


treatment

attn

per

pat

ient

O&T

Psy

Endo

Eye

Med

O&T

Psy

Endo

Med

Eye

SurgO&TGeriCard

MedRenalCardSurg

RenalMedEyeGeri

EyeEyeEndoMed

EndoEndoMedEyeCrude estimate of cost for OP attendance

~HKD 676 million

DP/IP Utilization by relationship to diabetes & complications

1,222,959Bed Days

159,717Episodes

2.6

Episode per patient

19.961,482In-Patient:

Bed days per patientHeadcount@

# Include also Chronic Cx cases without DM diagnosis mentioned@ It refers to the number of patient contributing the episodes. Patient headcount are counted separately

under each category. It may not add up to total due to multiple counting.


623,538

599,4311,222,959Bed Days

75,155

84,562159,717

Episodes

2.0

2.22.6

Episode per patient

15.638,501 DM related:

16.438,101DM unrelated






623,53847,743

478,17470,713

2,801599,431

1,222,959Bed Days

75,1558,479

67,6518,146

28684,562159,717

Episodes

2.01.32.3

1.2

1.2

2.22.6

Episode per patient

15.638,501 DM related:

7.16,758Cx not mentioned 16.229,599Chronic Cx only#

Acute and Chronic Cx

Acute Cx only

16.438,101DM unrelated


11.3248

10.46,824




DP/IP utilization categorized by age and treatment

2.2

2.4

2.6

2.8

3

3.2

<15 15-44 45-64 65+age group

attn

per

pat

ient

For age group >15, excluded other diagnosis


2.2

2.4

2.6

2.8

3

3.2

<15 15-44 45-64 65+age group

attn

per

pat

ient

UTIUTI UTI

pneum Gen IHD

CCF IHD Gen

CRFDMDM

DMCRF CRF DM



2.2

2.4

2.6

2.8

3

3.2

<15 15-44 45-64 65+age group

attn

per

pat

ient

UTIUTI UTI

pneum Gen IHD

CCF IHD Gen

CRFDMDM

DMCRF CRF DM


1.6

2.1

2.6

3.1

3.6

4.1


treatment

attn

per

pat

ient


2.2

2.4

2.6

2.8

3

3.2

<15 15-44 45-64 65+age group

attn

per

pat

ient

UTIUTI UTI

pneum Gen IHD

CCF IHD Gen

CRFDMDM

DMCRF CRF DM


1.6

2.1

2.6

3.1

3.6

4.1


treatment

attn

per

pat

ient

IHD

cata

Resp

Gen

DM

UTI

IHD

Gen

cata

DM

UTIUTIGenpneum

pneumpneumcata Gen

CCFCCF CCFCCF

DMCRF IHDDM

CRFDM DMCRFCrude estimate of cost for IP ~ HKD 3500 million

limitations• Patients selection

– Patients without anti-diabetic drugs dispensing records in 04-05 were not included

– Ward issued drugs were not included• Laboratory results

– Laboratory results from certain pathology laboratories were not included

• IP/DP discharges and SOP attendances– Frozen datasets were used and some records may be missed– Principal diagnosis coding variable

• GOPC attendances– Analysis on GOPC attendance were not performed as only

~43% of GOPC had attendance records available in OPAS

Summary

• Clinical characteristics, OP attendance and hospitalization pattern are associated with age and treatment regimen

• ~50% of patients had evidence of chronic kidney disease by eGFR

• Chronic complications constitute the major cause of both OP and DP/IP service utilization

Crude estimate of cost of care (HK $Million)

381.900.0031.2559.522390.26111.9510918265+ 242.621.1058.3613.97596.3398.567459445-6450.210.3739.012.0299.3225.091327615-441.210.309.891.132580-14SOPMHPsy IPConv bedAcute IPDPnAge Group

3.550.024.030.62698SU+MF+PPAR17.761.270.4933.232.773562SU+MF+alpha

237.320.3739.2312.37610.1551.1781827SU+MF 73.620.3720.388.11165.9315.6626467MF

159.670.7335.8918.50731.8560.2953968SU116.0621.7523.511037.8046.4119341INS+OAD61.520.309.1512.20492.7858.3310271INSSOPMHPsy IPConv bedAcute IPDPnType of Prescription

83810041417103931386614Estimated unit cost

Hospital admissions

0.79 adm/patient or 2.59adm/patient (n=60,228)

155,759total

others

Respiratory or other chest symptoms

COPD

IHD

Cataract

Other disorders of urethra and urinary tract

Pneumonia

General symptoms

CCF

DM

CRF

Diagnosis

94,192

2,763786

2,930496

3,334414

3,490366

4,492599

4,536486

4,618780

5,298428

14,404250

15,702585

Number of adm

ICD 9 code

2.600.96104,35540,161109,18265+

2.520.5641,83516,59774,59445-64

2.740.699,1363,32913,27615-44

3.101.67431139258<14

Adjusted adm/patie

nt

No. of adm/patie

nt

No. of adm

Pateintswith adm

Total no. of

patients

Age group

1.770.42295167698SU+MF+PPAR

2.040.521,8639153,562SU+MF+alpha

1.920.4435,99318,70981,827SU+MF

1.870.4010,6445,68926,467MF

2.510.7339,57215,75453,968SU

3.282.0840,27812,27719,341Ins+OAD

4.152.5326,0006,25910,271Ins

Adjusted adm/patie

nt

No. of adm/patie

nt

No. of adm

Pateintswith adm

Total no. of

patients

Type of prescription

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Pattern of Hospitalizations and SOPD attendance of ... · Pattern of Hospitalizations and SOPD attendance of diabetic patients under care of Hospital Authority Central Coordinating