National Healthcare Disparities Report - LDI Health Economist

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Effectiveness of Care Diabetes Importance Mortality Number of deaths (2007).....................................................................................70,905 (Kochanek, et al., 2011) Chapter 2 Diabetes Cause of death rank (2010)......................................................................................................7th (NHLBI, 2010) Prevalence Total number of people with diabetes (2010) ............................................................25.8 million (CDC, 2011d) Number of people with diagnosed diabetes (2010) ...................................................18.8 million (CDC, 2011d) Number of people with undiagnosed diabetes (2010).................................................7.0 million (CDC, 2011d) Incidence New cases (age 20 and over, 2010) ..............................................................................1.9 million (CDC, 2011d) Cost Total cost (2007) ………. ...........................................................................................$174 billion (CDC, 2011d) Direct medical costs (2007) ........................................................................................$116 billion (CDC, 2011d) Indirect costs (2007).....................................................................................................$58 million (CDC, 2011d) Measures Routine monitoring of blood glucose levels with hemoglobin A1c (HbA1c xiv ) tests and foot and dilated eye examinations have been shown to help prevent or mitigate complications of diabetes, such as diabetic neuropathy, retinopathy, and vascular and kidney disease. With more than half a million discharges in 2006, diabetes is one of the leading causes of hospitalization in the United States (CDC, 2009). However, with appropriate and timely ambulatory care, it may be possible to prevent many hospitalizations for diabetes and related complications. The measures reported in this section examine the extent to which individuals with diabetes receive care needed to prevent complications and the development of kidney failure, a serious complication of diabetes: n Receipt of four recommended diabetes services. n Hospitalization for short-term diabetes complications. n Development of kidney failure due to diabetes. xiv HbA1c, or glycosylated hemoglobin, is a measure of average levels of glucose in the blood. 70 National Healthcare Disparities Report, 2011
Effectiveness of Care NEW Findings Management: Receipt of Four Recommended Diabetes Services A composite measure is used to track the national rate of receipt of four recommended annual diabetes interventions: at least two HbA1c tests, a foot examination, an eye examination, and a flu shot. These are basic process measures that provide an assessment of the quality of diabetes management. This diabetes composite measure differs from the composite presented last year. To be more consistent with current recommendations, the required frequency of HbA1c testing has been increased to two per year and receipt of a flu shot has been added. Figure 2.15. Adults age 40 and over with diagnosed diabetes who reported receiving four recommended services for diabetes in the calendar year (2+ HbA1c tests, foot exam, dilated eye exam, and flu shot), by race/ethnicity, 2008 100 Total White Black Hispanic Chapter 2 Diabetes 75 Percent 50 25 0 2+ HbA1c Foot Exam Eye Exam Flu Shot All 4 Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2008. Denominator: Civilian noninstitutionalized population with diagnosed diabetes, age 40 and over. Note: Data include people with both type 1 and type 2 diabetes. Rates are age adjusted to the 2000 U.S. standard population. White and Black groups are non-Hispanic; Hispanic includes all races. n Among adults age 40 and over with diagnosed diabetes, report of receipt of recommended services ranged from 52% to 76%. However, only 21% of adults with diabetes received all four recommended services in 2008 (Figure 2.15). n Among adults with diabetes, Hispanics were less likely than non-Hispanic Whites to receive at least two HbA1c tests, a foot examination, and an eye examination while non-Hispanic Blacks were less likely than non-Hispanic Whites to receive a flu shot. There were no statistically significant differences between groups in rates of receipt of all four recommended services. Also, in the NHQR: n Adults with diabetes ages 40-59 were less likely than those age 60 and over to receive a foot examination, an eye examination, and a flu shot as well as the composite of four recommended services. National Healthcare Disparities Report, 2011 71
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U.S. Department of Health and Human
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