Diabetes mellitus in managed care: complications and resource utilization

Am J Manag Care. 2001 May;7(5):501-8.

Abstract

Objectives: To implement a diabetes mellitus surveillance system designed to use administrative data and to demonstrate how it can be used by managed care organizations (MCOs) with different administrative data systems to estimate the prevalence of diabetic complications and describe utilization of services in persons with and without complications and comorbidities.

Study design, patients, and methods: We identified individuals with diabetes mellitus in 3 MCOs in 1993 using 4 sources of computerized data records: inpatient, pharmacy, outpatient, and laboratory. The presence of diabetes mellitus complications and cardiovascular comorbidities were determined using diagnostic and procedural codes. Use of healthcare resources by persons with and without complications and comorbidities was determined from computerized administrative data.

Results: The most prevalent complication or comorbidity was cardiovascular disease (45%-53%), followed by eye disease (20%-34%), lower extremity disease (8%-20%), and renal disease (3%-6%). The presence of multiple complications was common and ranged from 14% to 34% in the 3 MCO populations. Compared with persons with none, persons with 2 or more complications or comorbidities used moderately more primary care services (1.3-1.9 times more) and markedly more specialty care services (5.8-6.3 times more), emergency department visits (3.3-5.5 times more), and hospitals stays (3.3-11.9 times more).

Conclusions: Diabetic complications were common and had a large impact on patients' use of healthcare services. Within MCOs, administrative databases are useful tools for estimating and monitoring the prevalence of diabetic complications and the use of healthcare resources associated with these complications.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Comorbidity
  • Diabetes Complications*
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / therapy
  • Disease Management
  • Health Resources / statistics & numerical data*
  • Health Services Needs and Demand
  • Humans
  • Managed Care Programs / statistics & numerical data*
  • Population Surveillance
  • Prevalence
  • United States / epidemiology
  • Utilization Review*