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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.
OP attendance according to specialty
186,85744,640172,245
405,322809,064
Attendances
3.4 2.1 2.3
4.1 5.4
Attnd per patient
149,763SOP (All Specialties) ,excluding FM Clinic
54,559SOP (Others)21,147SOP (Orthopaedics)76,086SOP (Ophthalmology)
99,228SOP (Medicine)
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.
OP attendance according to specialty
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
149,763SOP (All Specialties) ,excluding FM Clinic
54,559SOP (Others)21,147SOP (Orthopaedics)76,086SOP (Ophthalmology)
32,409Endocrinology47,093General Medicine
5,030Nephrology12,401Geriatrics
Cardiology
99,228SOP (Medicine)
13,652
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.
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
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
Card Card O&T
Geri O&T Psy
Endo Endo Eye
Med Eye Med Eye
EyeMed Endo Others
For age group >15, excluded other clinic
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
Card Card O&T
Geri O&T Psy
Endo Endo Eye
Med Eye Med Eye
EyeMed Endo Others
For age group >15, excluded other clinic
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
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
Card Card O&T
Geri O&T Psy
Endo Endo Eye
Med Eye Med Eye
EyeMed Endo Others
For age group >15, excluded other clinic
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
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.
DP/IP Utilization by relationship to diabetes & complications
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
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.
DP/IP Utilization by relationship to diabetes & complications
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
19.961,482In-Patient:
11.3248
10.46,824
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.
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
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
UTIUTI UTI
pneum Gen IHD
CCF IHD Gen
CRFDMDM
DMCRF CRF DM
For age group >15, excluded other diagnosis
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
UTIUTI UTI
pneum Gen IHD
CCF IHD Gen
CRFDMDM
DMCRF CRF DM
For age group >15, excluded other diagnosis
1.6
2.1
2.6
3.1
3.6
4.1
SU MF SU+MF 3OAD ins+OAD ins
treatment
attn
per
pat
ient
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
UTIUTI UTI
pneum Gen IHD
CCF IHD Gen
CRFDMDM
DMCRF CRF DM
For age group >15, excluded other diagnosis
1.6
2.1
2.6
3.1
3.6
4.1
SU MF SU+MF 3OAD ins+OAD ins
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