Preventable Hospitalizations for Diabetes
In 2023, nearly 25% of the 270,647 preventable hospitalizations in adults occurred for a diabetes-related condition. With access to high-quality outpatient care, many of the 68,194 hospitalizations may have been prevented.
Why Is the Diabetes Hospitalization Rate Important?
The Agency for Healthcare Research and Quality’s (AHRQ’s) Prevention Quality Indicators (PQIs) are a set of measures of adult hospitalizations for ambulatory care-sensitive conditions that evidence suggests may have been avoided through access to quality outpatient care. The PQIs are calculated as Risk-Adjusted Rates (RAR) and counties with lower rates have a lower relative burden of hospitalizations for the given disease-related issues.
Diabetes is a serious, but manageable, disease. Keeping blood sugar levels within normal ranges can help prevent diabetes complications, such as damage to nerves, eyes, kidneys, and other organs. Diabetes hospitalizations can potentially be avoided if quality outpatient services are available and prescribed treatment plans are followed.
The diabetes hospitalization rates are important for measuring where we are today and measuring improvements or declines in access to care and are a first step in informing the discussion.
These diabetes-related PQIs are part of a broader collection that includes Acute Condition PQIs and Chronic Condition PQIs.
Key Findings – 2019 to 2023
- The percentage change of the Statewide RAR for Diabetes Composite Index increased by 7% (219.1 to 234.4). Over this period there was an annual average percent change of 1.7% for the Statewide RAR for Diabetes Composite.
- The percentage change of the Statewide RAR for Long Term Complications increased by 6.4%, Short Term Complications increased by 13.7%, Lower Extremity Amputations increased by 24.3% and Uncontrolled Diabetes decreased by 15.9%.
- The Statewide RAR for every diabetes-related PQI increased except for Uncontrolled Diabetes which had a decrease. In 2023, the Statewide RAR for Diabetes Composite conditions was 234.4, with component rates of 114.9 for long-term complications, 72.3 for short-term complications, 37.8 for lower-extremity amputations and 29.6 for uncontrolled conditions.
- The largest three percentage increases in RARs for Diabetes Composite conditions are seen in the Del Norte (110.8%), Imperial (56.0%) and Colusa (45.0%) counties.
- The largest three percentage decreases in RARs for Diabetes Composite conditions are seen in the Alpine (100.0%), Modoc (75.1%) and Sierra (66.0%) counties.
- In 2023, HCAI received price increase reports for 11 diabetes drugs, and these drugs had a median 3-year percent Wholesale Acquisition Cost (WAC) increase of 19.1%.
Which Counties May Have Greater Unmet Diabetes Outpatient Needs?
The Map & County Rankings dashboard shows RARs for a selected PQI and year. Greater access to care is generally reflected by lower hospitalization rates. In this visualization, counties with higher hospitalization rates are distinguished from those with lower hospitalization rates using the California statewide rate as a baseline. Counties with higher hospitalization rates are an indicator for potential unmet outpatient care. The ranking chart shows the counties with the lowest RARs for a chosen PQI and year.
The Statewide & Regional Comparison tab provides two views of RARs. The All Counties dashboard allows for a graphical view of RARs ordered lowest to highest for a chosen PQI and year. The Regions dashboard allows for a narrower county view of RARs by selecting a California Region.
Note: Rankings are not an indicator of which counties have the best outpatient care but simply list the lowest to highest RAR. Counties that saw 0 hospitalization or a very low number of observations are often listed near the top and should be interpreted with caution.
How Have Individual Counties’ Diabetes Hospitalizations Changed Over Time?
The County-Level Trends dashboard looks at RARs over 2019 to 2023 for a singular indicator or all selected PQIs. This allows a view of hospitalization rates over time, which can be used to assess the year-to-year hospitalization rate change and compare county trends to the California statewide rate.
From 2019 to 2023, there were substantial changes in hospitalization rates with a 7% increase in the Statewide RAR for Diabetes Composite Index. The most common trend seen during this timeframe was an overall decrease in hospitalization rates in 2020 and 2021. The impact of COVID may have been the primary reason for the decreases in these rates. Changes in rates may also be due to the implementation of programmatic and policy interventions, or a lack of such interventions.
Have Diabetes Drug Prices Changed Over Time?
Prescription drug costs are a significant factor in the treatment and management of chronic conditions, including diabetes, but prescription drug pricing is often complicated and obscure. In an effort to increase prescription drug cost transparency, California requires prescription drug manufacturers to report drug price increases when certain thresholds are met or exceeded1.
- In 2022, HCAI received price increase reports for 9 diabetes drugs2 and these drugs had a median 3-year percent WAC increase of 20.2%.
- In 2023, HCAI received price increase reports for 11 diabetes drugs2 and these drugs had a median 3-year percent WAC increase of 19.1%.
1 California Law stipulates that drug manufacturers are to report prescription drug price increases when the WAC of a prescription drug is increased 16 percent or more over the course of three years and the WAC is $40.00 or more for a course of therapy. WAC is defined in the U.S. Code as “…the manufacturer’s list price for [a] drug or biological to wholesalers or direct purchasers in the United States, not including prompt pay or other discounts, rebates or reductions in price…”
2The diabetes drugs included in this analysis are based on the Nevada Department of Health and Human Services’ Essential Diabetes and Asthma Drug List.
See the Cost Transparency: Prescription Drugs (CTRx) website for additional information.
See the list of diabetes drugs wholesale acquisition costs HCAI used in its analysis.
How HCAI Created This Product
Composite Indicators combine all hospitalizations across multiple related PQIs into one comprehensive indicator group. This measure allows for a view of broader conditions rather than a specific PQI.
The five individual diabetes-related PQIs can help inform the discussion about whether access to quality outpatient diabetes treatment in a community is adequate:
- Diabetes Short-term Complications (PQI #1) – Diabetes with ketoacidosis, hyperosmolarity, or coma.
- Diabetes Long-term Complications (PQI #3) – Diabetes with renal, eye, neurological, circulatory, or complications not otherwise specified.
- Uncontrolled Diabetes (PQI #14) – Diabetes without mention of short-term or long-term complications.
- Lower-Extremity Amputation among Patients with Diabetes (PQI #16) – Diabetes with a procedure of lower-extremity amputation (except toe, e.g., removal of leg or foot).
- Diabetes Composite (PQI #93) – Includes any conditions mentioned above.
About the Risk-Adjusted Rate (RAR): The RAR provides a comparative metric for understanding how specific disease-related hospitalizations vary across California counties.
- The RAR variable is calculated by adjusting for Age and Assigned Sex at Birth and is calculated per 100,000 state or county population.
- Counties with lower RARs have a lower relative burden of hospitalizations for the given disease-related issues.
Note: The RARs are adjusted for Age and Assigned Sex at Birth and are calculated per 100,000 state or county population. The PQI software program calculates RARs regardless of the number of cases available. However, PQI rates based on only a few cases should be interpreted with caution.
Additional Information
Topic: Healthcare Quality
Source Link: Rates of Preventable Hospitalizations for Selected Medical Conditions by County (LGHC Indicator)
Citation: HCAI – Patient Discharge Data – Preventable Hospitalizations for Acute Conditions; Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators, SAS Software, PQI Version v2023 (2019-2022, ICD-10-CM) and PQI Version v2024 (2023, ICD-10-CM).
Temporal Coverage: 2019–2023
Spatial/Geographic Coverage: Statewide, County
Frequency: Annually