Preventable Hospitalizations for Diabetes

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, hospitalizations that evidence suggests may have been avoided through access to quality outpatient care.

Why is the Diabetes Hospitalization Rate Important?#

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 PQIs Condition PQIs are part of a broader collection that includes Acute Condition PQIs and Chronic Condition PQIs.

Which Counties may Have Greater Unmet Diabetes Outpatient Needs?#

The Diabetes Composite indicator (PQI #93) includes any hospitalizations identified under one of the four individual indicators.  Counties with a higher hospitalization rate are distinguished from those with a lower hospitalization rate, indicating a potential unmet outpatient care need.

Note: The risk-adjusted rates are age, sex, and poverty adjusted and are calculated per 100,000 state or county population. The PQI software calculates the rates regardless of the number of cases available. Rates based on only a few cases should be interpreted with caution.

How do Individual Diabetes Indicators Compare Among Counties?#

The individual diabetes indicators allow county-to-county comparisons for each of the indicators.  This level of granularity can help determine the type of diabetes intervention(s) needed in each county.

Note: The risk-adjusted rates are age, sex, and poverty adjusted and are calculated per 100,000 state or county population. The PQI software calculates the rates regardless of the number of cases available. Rates based on only a few cases should be interpreted with caution.

How Have Individual Counties’ Diabetes Hospitalizations Changed Over Time?#

This visualization shows differences in the diabetes composite hospitalization rates from year to year, which can be used to assess whether the rate is increasing or decreasing. The changes in rates may be due to the implementation of or lack of programmatic and policy interventions. 

Note: The risk-adjusted rates are age, sex, and poverty adjusted and are calculated per 100,000 state or county population. The PQI software calculates the rates regardless of the number of cases available. Rates based on only a few cases should be interpreted with caution.

Which Diabetes PQI Measures are Included in this Analysis?#

The suite of five 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.

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 2019, HCAI received price increase reports for 41 diabetes drugs² and these drugs had a median 3-year percent Wholesale Acquisition Cost (WAC) increase of 25.70%.
• In 2020, HCAI received price increase reports for 95 diabetes drugs² and these drugs had a median 3-year percent WAC increase of 21.35%.

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. Wholesale Acquisition Cost 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.

Additional Information#

Topic: Healthcare Quality
Temporal Coverage: 2016-2020
Spatial/Geographic Coverage: Statewide
Frequency: Annual
Source Link: Rates of Preventable Hospitalizations for Selected Medical Conditions by County (LGHC Indicator)
Citation: HCAI Patient Discharge Data; Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators, SAS Software,  Version v2021 (2016-2020, ICD-10-CM).