The variation in preventable hospitalization in patients with type 2 diabetes in Kentucky before and after the Medicaid expansion-Reference-Cited by-同舟云学术

The variation in preventable hospitalization in patients with type 2 diabetes in Kentucky before and after the Medicaid expansion

Published:2024-03 Issue:2 Volume:44 Page:73-83
ISSN:0256-4947
Container-title:Annals of Saudi Medicine
language:en
Short-container-title:Ann Saudi Med

Author:

Arbaein Turky¹^ORCID,Little Bert²,Monshi Sarah¹,Al-Wathinani Ahmed M.³,Zaidan Amal⁴

Affiliation:

1. From the Department of Health Administration and Hospital, Umm Al-Qura University, Makkah, Saudi Arabia

2. From the Department of Health Management and System Sciences, University of Louisville, Kentucky, United States

3. From the Department of Emergency Medical Services, Prince Sultan bin Abdulaziz for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia

4. From the College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

Abstract

BACKGROUND: Hospitalizations are more resource intensive and expensive than outpatient care. Therefore, type 2 diabetes-related preventable hospitalization are a major topic of research efficiency in the healthcare system. OBJECTIVES: Analyze county level variation in type 2 diabetes-related preventable hospitalization rates in Kentucky before the Medicaid expansion (2010-2013) and after the Medicaid expansion (2014-2017). DESIGN: Geographic mapping and cluster analysis SETTING: Data for a state of the United States of America METHODS: We used the KID data to generate geographic mapping for type 2 diabetes-related preventable hospitalizations to visualize rates. We included all Kentucky discharges of age 18 years and older with the ICD9/10 principal diagnosis code for type 2 diabetes. Then, we conducted cluster analysis techniques to compare county-level variation in type 2 diabetes-related preventable hospitalization rates across Kentucky counties pre- and post-Medicaid expansion. MAIN OUTCOME AND MEASURES: County type 2 diabetes-related preventable hospitalization pre- and post-Medicaid expansion. RESULTS: From 2010-2017, type 2 diabetes-related preventable hospitalization discharge rates reduced significantly in the period of the post-Medicaid expansion ( P =.001). The spatial statistics analysis revealed a significant spatial clustering of counties with similar rates of type 2 diabetes-related preventable hospitalization in the south, east, and southeastern Kentucky pre- and post-Medicaid expansion (positive z-score and positive Moran's Index value ( P >.05). Also, there was a significant clustering of counties with low type 2 diabetes-related preventable hospitalization rates in the north, west, and central regions of the state pre-Medicaid expansion and post-Medicaid expansion (positive z-score and positive Moran's Index value ( P >.05). CONCLUSION: Kentucky counties in the southeast have experienced a significant clustering of highly avoidable hospitalization rates during both periods. Focusing on the vulnerable counties and the economic inequality in Kentucky could lead to efforts to lowering future type 2 diabetes-related preventable hospitalization rates. LIMITATIONS: We used de-identified data which does not provide insights into the frequency of hospitalizations per patient. An individual patient may be hospitalized several times and counted as several individuals.

Publisher

King Faisal Specialist Hospital and Research Centre

Reference20 articles.

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