Educational visits linked to less hospitalization and lower costs for diabetic patients

Last Updated: 2008-04-30 14:19:52 -0400 (Reuters Health)

NEW YORK (Reuters Health) – Diabetes classes or nutritionist visits for people with diabetes are associated with lower hospitalization rates and charges, according to findings published in the April issue of Diabetes Care.

"Self-management is the cornerstone of modern diabetes care, and providing patients with the information, skills, and support they need to manage the disease is a critical issue for health care providers and systems," write Dr. Jessica M. Robbins, of the Philadelphia Department of Public Health, and colleagues with the Urban Diabetes Study. "Self-management education can be provided in a variety of settings to patients with diabetes using any of a variety of models and methods."

The researchers examined the association of different types of educational visits for diabetic patients in relation to hospital admission rates and charges. The team linked primary care data for 18,404 diabetic patients in the Philadelphia Health Care Centers with hospital discharge data from the Pennsylvania Health Care Cost Containment Council.

The patients were followed-up for a mean of 4.7 years. Records showed that 1054 of the patients (5.7%) had at least one diabetes class visit, 1683 (9.1%) had at least one nutritionist visit, and 332 (1.8%) had a health education visit. Overall, 2465 (13.4%) subjects had at least one of any of these educational visits.

The authors report that there were 31,653 hospitalizations for the study population, for a rate of 36.4 hospitalizations per 100 person-years.

"The hospitalization rate for patients who had no educational visits during follow-up was 38.1 per 100 person-years," Dr. Robbins and colleagues found. "For patients who had at least one educational visit, the hospitalization rate was 34% lower at 25.0 per 100 person-years."

Having had any type of educational visit was associated with $11,571 less in hospital charges per person, after adjustment for demographic factors, baseline comorbid conditions, hospitalizations prior to diabetes diagnosis, and number of other primary care visits.

Nutritionist visits were associated with the greatest reductions in hospitalizations and hospital charges, according to the investigators, "suggesting that providing these services in the primary care setting may be highly cost-effective for the health care system."

Diabetes Care 2008;31:655-660.