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Chehal PK, Uppal TS, Ng BP, Alva M, Ali MK. Trends and Race/Ethnic Disparities in Diabetes-Related Hospital Use in Medicaid Enrollees: Analyses of Serial Cross-sectional State Data, 2008-2017. J Gen Intern Med 2023; 38:2279-2288. [PMID: 36385411 PMCID: PMC10406763 DOI: 10.1007/s11606-022-07842-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Race/ethnic disparities in preventable diabetes-specific hospital care may exist among adults with diabetes who have Medicaid coverage. OBJECTIVE To examine race/ethnic disparities in utilization of preventable hospital care by adult Medicaid enrollees with diabetes across nine states over time. DESIGN Using serial cross-sectional state discharge records for emergency department (ED) visits and inpatient (IP) hospitalizations from the Healthcare Cost and Utilization Project, we quantified race/ethnicity-specific, state-year preventable diabetes-specific hospital utilization. PARTICIPANTS Non-Hispanic Black, non-Hispanic White, and Hispanic adult Medicaid enrollees aged 18-64 with a diabetes diagnosis (excluding gestational or secondary diabetes) who were discharged from hospital care in Arizona, Iowa, Kentucky, Florida, Maryland, New Jersey, New York, North Carolina, and Utah for the years 2008, 2011, 2014, and 2017. MAIN MEASURES Non-Hispanic Black-over-White and Hispanic-over-White rate ratios constructed using age- standardized state-year, race/ethnicity-specific ED, and IP diabetes-specific utilization rates. KEY RESULTS The ratio of Black-over-White ED utilization rates for preventable diabetes-specific hospital care increased across the 9 states in our sample from 1.4 (CI 95, 1.31-1.50) in 2008 to 1.73 (CI 95, 1.68-1.78) in 2017. The cross-year-state average non-Hispanic Black-over-White IP rate ratio was 1.46 (CI 95, 1.42-1.50), reflecting increases in some states and decreases in others. The across-state-year average Hispanic-over-White rate ratio for ED utilization was 0.67 (CI 95, 0.63-0.71). The across-state-year average Hispanic-over-White IP hospitalization rate ratio was 0.72 (CI 95, 0.69-0.75). CONCLUSIONS Hospital utilization by non-Hispanic Black Medicaid enrollees with diabetes was consistently greater and often increased relative to utilization by White enrollees within state programs between 2008 and 2017. Hispanic enrollee hospital utilization was either lower or indistinguishable relative to White enrollee hospital utilization in most states, but Hispanic utilization increased faster than White utilization in some states. Among broader patterns, there is heterogeneity in the magnitude of race/ethnic disparities in hospital utilization trends across states.
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Affiliation(s)
- Puneet Kaur Chehal
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA.
| | - Tegveer S Uppal
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Boon Peng Ng
- College of Nursing, University of Central Florida, Orlando, FL, USA
- Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, USA
| | - Maria Alva
- Massive Data Institute, McCourt School of Public Policy, Georgetown University, Washington, DC, USA
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
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Wang GX, Gauthier R, Gunter KE, Johnson L, Zhu M, Wan W, Tanumihardjo JP, Chin MH. Improving Diabetes Care Through Population Health Innovations and Payments: Lessons from Western Maryland. J Gen Intern Med 2023; 38:48-55. [PMID: 36864271 PMCID: PMC9980867 DOI: 10.1007/s11606-022-07918-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/31/2022] [Indexed: 03/04/2023]
Abstract
BACKGROUND Global budgets might incentivize healthcare systems to develop population health programs to prevent costly hospitalizations. In response to Maryland's all-payer global budget financing system, University of Pittsburgh Medical Center (UPMC) Western Maryland developed an outpatient care management center called the Center for Clinical Resources (CCR) to support high-risk patients with chronic disease. OBJECTIVE Evaluate the impact of the CCR on patient-reported, clinical, and resource utilization outcomes for high-risk rural patients with diabetes. DESIGN Observational cohort study. PARTICIPANTS One hundred forty-one adult patients with uncontrolled diabetes (HbA1c > 7%) and one or more social needs who were enrolled between 2018 and 2021. INTERVENTIONS Team-based interventions that provided interdisciplinary care coordination (e.g., diabetes care coordinators), social needs support (e.g., food delivery, benefits assistance), and patient education (e.g., nutritional counseling, peer support). MAIN MEASURES Patient-reported (e.g., quality of life, self-efficacy), clinical (e.g., HbA1c), and utilization outcomes (e.g., emergency department visits, hospitalizations). KEY RESULTS Patient-reported outcomes improved significantly at 12 months, including confidence in self-management, quality of life, and patient experience (56% response rate). No significant demographic differences were detected between patients with or without the 12-month survey response. Baseline mean HbA1c was 10.0% and decreased on average by 1.2 percentage points at 6 months, 1.4 points at 12 months, 1.5 points at 18 months, and 0.9 points at 24 and 30 months (P<0.001 at all timepoints). No significant changes were observed in blood pressure, low-density lipoprotein cholesterol, or weight. The annual all-cause hospitalization rate decreased by 11 percentage points (34 to 23%, P=0.01) and diabetes-related emergency department visits also decreased by 11 percentage points (14 to 3%, P=0.002) at 12 months. CONCLUSIONS CCR participation was associated with improved patient-reported outcomes, glycemic control, and hospital utilization for high-risk patients with diabetes. Payment arrangements like global budgets can support the development and sustainability of innovative diabetes care models.
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Affiliation(s)
- Gary X Wang
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
| | - Richard Gauthier
- University of Chicago Section of General Internal Medicine, Chicago, IL, USA
| | - Kathryn E Gunter
- University of Chicago Section of General Internal Medicine, Chicago, IL, USA
| | | | - Mengqi Zhu
- University of Chicago Section of General Internal Medicine, Chicago, IL, USA
| | - Wen Wan
- University of Chicago Section of General Internal Medicine, Chicago, IL, USA
| | | | - Marshall H Chin
- University of Chicago Section of General Internal Medicine, Chicago, IL, USA
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Sukkarieh O, Egede LE, Bassil M. Relationship between social determinants of health and quality of life in low income adults with diabetes in Lebanon. Postgrad Med 2023; 135:169-178. [PMID: 36714928 DOI: 10.1080/00325481.2023.2172283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND & OBJECTIVE Global rates of type 2 diabetes (T2DM) are increasing, with the Middle East and North Africa (MENA) region having the second highest prevalence in the world. Populations from the MENA region, including Lebanon, are also witnessing massive waves of immigration to the western hemisphere. Limited data exist about how social determinants of health (SDOH) impact outcomes for T2DM in this population. Thus, the aim of this study was to assess the relationship between SDOH and quality of life (QoL) in Lebanese adults with T2DM. METHODS Adults with T2DM (n = 300) were recruited from primary healthcare centers in Lebanon. Demographic characteristics and WHO QoL domains (physical health, psychological wellbeing, social relationships, and environment) were assessed. SDOH included socioeconomic, neighborhood/built environment, and psychosocial variables. Partially and fully adjusted regression models were used to test for associations between SDOH and QoL domains. RESULTS Mean age of the participants was 60.3 years, 48% were women, 73% were married, and 64% had less than high-school education. Results from the fully adjusted regression models showed that psychosocial (i.e. adverse childhood experiences and depression), socioeconomic (i.e. employment, income, family size, insurance, financial status, and financial independence), and neighborhood/built environment (i.e. transportation, number of rooms in the household, and certain household items) variables were independent correlates of different QoL domains. CONCLUSIONS This study shows that psychosocial, socioeconomic, and neighborhood/built environment variables are differentially associated with different QoL domains, suggesting that SDOH factors are strongly associated with quality of life in low-income adults with T2DM in Lebanon.
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Affiliation(s)
- Ola Sukkarieh
- Alice Ramez Chagoury School of Nursing, Lebanese American University, Byblos, Lebanon
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Maya Bassil
- Department of Human Nutrition, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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Hatipoglu BA. Rekindling Hope for Remission: Current Impact of Diabetes for Our World's Future Health and Economy. Endocrinol Metab Clin North Am 2023; 52:1-12. [PMID: 36754486 DOI: 10.1016/j.ecl.2022.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The individual and societal burdens of living with a chronic disease are a global issue. Diabetes directly increases health care costs to manage the disease and the associated complications and indirectly increases the economic burden through long-term complications that hinder the productivity of humans worldwide. Thus, it is crucial to have accurate information on diabetes-related costs and the geographic and global economic impact when planning interventions and future strategies. Health care systems must work with government agencies to plan national-level pre diabetes and diabetes strategies and policies. Public health services must focus on diabetes screening prevention and remission.
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Affiliation(s)
- Betul A Hatipoglu
- Case Western Reserve University, School of Medicine, Department of Medicine University Hospitals Cleveland Medical Center, Department of Medicine, Adult Endocrinology, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
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Chehal PK, Selvin E, DeVoe JE, Mangione CM, Ali MK. Diabetes And The Fragmented State Of US Health Care And Policy. Health Aff (Millwood) 2022; 41:939-946. [PMID: 35759725 PMCID: PMC10420383 DOI: 10.1377/hlthaff.2022.00299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Progress in the prevention and treatment of type 2 diabetes-the dominant form of diabetes-appears to have stalled in the US over the past decade, and diabetes-related morbidity has increased nationally. The most geographically and socioeconomically disadvantaged segments of the population have been especially hard hit, and interventions that reduce the risk for diabetes have not reached these populations. In this overview article we lay out how fragmentation in health policy and governance, payers and reimbursement design, and service delivery in the US has contributed to low accountability and coordination, and thus stagnation and persistent inequities. We also review the evidence regarding past, ongoing, and new reforms that may help address fragmentation, lower diabetes burdens, and narrow disparities.
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Affiliation(s)
| | | | - Jennifer E DeVoe
- Jennifer E. DeVoe, Oregon Health & Science University, Portland, Oregon
| | - Carol M Mangione
- Carol M. Mangione, University of California Los Angeles, Los Angeles, California
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Davis J, Fischl AH, Beck J, Browning L, Carter A, Condon JE, Dennison M, Francis T, Hughes PJ, Jaime S, Lau KHK, McArthur T, McAvoy K, Magee M, Newby O, Ponder SW, Quraishi U, Rawlings K, Socke J, Stancil M, Uelmen S, Villalobos S. 2022 National Standards for Diabetes Self-Management Education and Support. Diabetes Care 2022; 45:484-494. [PMID: 35050365 DOI: 10.2337/dc21-2396] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 02/03/2023]
Affiliation(s)
| | | | - Joni Beck
- The University of Oklahoma Health Science Center, Oklahoma City, OK
| | | | | | - Jo Ellen Condon
- Anne Arundel Medical Center, Annapolis, MD
- Diabetes Alliance Network, Naples, FL
| | | | | | | | | | | | | | | | - Michelle Magee
- 15MedStar Diabetes and Research Institutes, Georgetown University School of Medicine, Washington, D.C
| | - Olivia Newby
- 16The Healthy Living Center Diabetes Education Program, Norfolk, VA
| | | | | | | | | | | | - Sacha Uelmen
- 22Association of Diabetes Care & Education Specialists, Chicago, IL
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Davis J, Fischl AH, Beck J, Browning L, Carter A, Condon JE, Dennison M, Francis T, Hughes PJ, Jaime S, Lau KHK, McArthur T, McAvoy K, Magee M, Newby O, Ponder SW, Quraishi U, Rawlings K, Socke J, Stancil M, Uelmen S, Villalobos S. 2022 National Standards for Diabetes Self-Management Education and Support. Sci Diabetes Self Manag Care 2022; 48:44-59. [PMID: 35049403 DOI: 10.1177/26350106211072203] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The National Standards for Diabetes Self-Management Education and Support (DSMES) provide guidance and evidence-based, quality practice for all DSMES services. Due to the dynamic nature of health care and diabetes research, the National Standards are reviewed and revised approximately every 5 years by key stakeholders and experts within the diabetes care and education community. For each revision, the Task Force is charged with reviewing the current National Standards for appropriateness, relevance, and scientific basis and making updates based on current evidence and expert consensus. In 2021, the group was tasked with reducing administrative burden related to DSMES implementation across diverse care settings. CONCLUSION The evidence supporting the 2022 National Standards clearly identifies the need to provide person-centered services that embrace cultural differences, social determinants of health, and the ever-increasing technological engagement platforms and systems. Payers are invited to review the National Standards as a tool to inform and modernize DSMES reimbursement requirements and to align with the evolving needs of people with diabetes (PWD) and physicians/other qualified health care professionals. The American Diabetes Association and the Association of Diabetes Care & Education Specialists strongly advocate for health equity to ensure all PWD have access to this critical service proven to improve outcomes both related to and beyond diabetes. The 2022 National Standards update is meant to be a universal document that is easy to understand and can be implemented by the entire health care community. DSMES teams in collaboration with primary care have been shown to be the most effective approach to overcome therapeutic inertia.
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Affiliation(s)
| | | | - Joni Beck
- The University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | | | | | - Jo Ellen Condon
- Anne Arundel Medical Center, Annapolis, Maryland, and Diabetes Alliance Network, Naples, Florida
| | | | | | | | - Stephen Jaime
- El Centro Regional Medical Center, El Centro, California
| | | | | | - Karen McAvoy
- Yale New Haven Health System, New Haven, Connecticut
| | - Michelle Magee
- MedStar Diabetes and Research Institutes, Georgetown University School of Medicine, Washington, DC
| | - Olivia Newby
- The Healthy Living Center Diabetes Education Program, Norfolk, Virginia
| | | | | | | | | | | | - Sacha Uelmen
- Association of Diabetes Care & Education Specialists, Chicago, Illinois
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Davis J, Fischl AH, Beck J, Browning L, Carter A, Condon JE, Dennison M, Francis T, Hughes PJ, Jaime S, Lau KHK, McArthur T, McAvoy K, Magee M, Newby O, Ponder SW, Quraishi U, Rawlings K, Socke J, Stancil M, Uelmen S, Villalobos S. 2022 National Standards for Diabetes Self-Management Education and Support. Diabetes Spectr 2022; 35:137-149. [PMID: 35668879 PMCID: PMC9160547 DOI: 10.2337/ds22-ps02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | - Joni Beck
- The University of Oklahoma Health Science Center, Oklahoma City, OK
| | | | | | - Jo Ellen Condon
- Anne Arundel Medical Center, Annapolis, MD
- Diabetes Alliance Network, Naples, FL
| | | | | | | | | | | | | | | | - Michelle Magee
- MedStar Diabetes and Research Institutes, Georgetown University School of Medicine, Washington, DC
| | - Olivia Newby
- The Healthy Living Center Diabetes Education Program, Norfolk, VA
| | | | | | | | | | | | - Sacha Uelmen
- Association of Diabetes Care & Education Specialists, Chicago, IL
- Corresponding author: Sacha Uelmen,
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Martinez-Cardoso A, Jang W, Baig AA. Moving Diabetes Upstream: the Social Determinants of Diabetes Management and Control Among Immigrants in the US. Curr Diab Rep 2020; 20:48. [PMID: 32857197 PMCID: PMC9328159 DOI: 10.1007/s11892-020-01332-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Relative to the US-born population, immigrants are less likely to successfully manage and control their diabetes, leading to a host of diabetes-related complications. This review draws on the social determinants of health framework (SDoH) to summarize the multilevel factors that shape diabetes care and management among immigrants in the USA. RECENT FINDINGS While the diabetes literature is replete with research on individual-level risk factors and health behaviors, empirical literature linking the SDoH to diabetes management among immigrants is limited. However, housing precarity, food insecurity, poverty, uninsurance and underinsurance, and limited support for immigrants in healthcare systems are consistently shown to deter diabetes management and care. Immigrants with diabetes face a multitude of structural constraints to managing their diabetes. More research that theorizes the role of SDoH in diabetes management along with empirical qualitative and quantitative studies are needed. Interventions to address diabetes also require a more upstream approach in order to mitigate the drivers of diabetes disparities among immigrants.
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Affiliation(s)
- Aresha Martinez-Cardoso
- Department of Public Health Sciences, University of Chicago, 5841 South Maryland Ave, MC 2000, Chicago, IL, 60637, USA.
| | - Woorin Jang
- The College, University of Chicago, Chicago, IL, USA
| | - Arshiya A Baig
- Department of Medicine, University of Chicago, Chicago, IL, USA
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