“For me, having diabetes means that I have a problem with the sugar in my blood. The Kids on the Block program on Diabetes was developed to educate children …
PARTNERSHIP FOR SOLUTIONS
Better Lives for People with Chronic Conditions
MAY 2002
Diabetes:
The Impact of Multiple Chronic Conditions
Diabetes is a chronic condition affecting 16 million Americansi,ii Most people with diabetes also have other serious health conditions, or co-morbidities, that complicate their care, treatment, and outcomes as illustrated by the data below
Hospital Use Increases With More Chronic Conditions
Many people with diabetes have ambulatory care sensitive conditions ACSCs ACSCs are conditions in which the risk of hospitalization can be reduced with adequate primary care that can either prevent the onset of the condition or effectively manage a chronic condition Patients with ACSCs who receive adequate, coordinated primary care experience fewer health problems and are hospitalized less often Admission to the hospital for treatment of an ACSC indicates poor access to appropriate quality care Co-morbidities increase the complexities of patient care, thus increasing the occurrence of ACSCs and complications As the data below show, having multiple chronic conditions significantly increases the risk of hospitalization to treat an ACSC Number of Chronic
Conditions in Addition to Diabetes 0 1 2 3 4 5
Source: Medicare Standard Analytic File, 1999
Most People With Diabetes Have Multiple Chronic Conditions
Over 81 percent of people with diabetes have one or more additional chronic conditions see Figure 1 Figure 1 Percent of People with Diabetes and Other Chronic Conditions
Number of Chronic Conditions in Addition to Diabetes
175
187
0 1 2 3 4
217 256 165
Hospitalizations for ACSC Admissions per 1,000 Patients Over Age 65 45 199 399 725 1107 2308
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 1996
The most common chronic health conditions that afflict people with diabetes are: Conditions Cardiovascular Diseases Including Hypertension Arthritis Eye Disorders Including Glaucoma Mental Illness Percent of Diabetes Patients Affected 572 214 199 135
Health Care Spending Increases With More Chronic Conditions
Co-morbidities in people with diabetes greatly increase health care expenses, which in Figure 2 include all spending for inpatient and outpatient care As Figure 2 shows, having just one additional condition almost doubles expenses, and having three co-morbidities more than triples annual per
capita expenditures
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 1996
PARTNERSHIP FOR SOLUTIONS
Better Lives for People with Chronic Conditions
Figure 2 Average Annual Per Capita Health Care Expenses
Number of Chronic Conditions in Addition to Diabetes
Figure 3 Average Annual Number of Physician Visits
25 5 4 3 2 1 0 0 10,498 10,041 7,248 4,716 2,433 5,000 10,000 15,000 20,000 14,540
Physician Visits
20 15 10 70 5 0 0 1 2 3 4 40 94 109 114
191
5
Number of Chronic Conditions in Addition to Diabetes
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 1996
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 1996
Certain chronic conditions are more common than others among people with diabetes The combination of these conditions and sometimes additional health concerns can greatly increase treatment costs, as shown below Conditions Per Capita Health Care Expenses 6,987 15,501
Re-organizing delivery and financing systems, Improving access to high-quality, affordable health care services, and Enhancing care coordination among multiple formal and informal providers
A growing body of research suggests that patients have better outcomes at lower cost when care is coordinated While we are seeing the benefits of specific disease management efforts, it is important to look more broadly to modify systems of care and financing to address the needs of people with diabetes who have multiple chronic conditions
Diabetes Eye Disorder Diabetes, Eye Disorder Arthritis
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 1996
Utilization Increases With More Chronic Conditions
People with diabetes and other chronic conditions use more health care services For example, people with diabetes who have other chronic conditions tend to visit physicians more often see Figure 3 Increased use of health care services and medications has substantial implications for coordination of care and patient outcomes Different drug and treatment regimens can result in harmful interactions if not well managed and coordinated
About Partnership for Solutions
Partnership for Solutions, led by Johns Hopkins University and The Robert Wood Johnson Foundation, is an initiative to improve the care and quality of life for the estimated 125 million
Americans with chronic health conditions The Partnership is engaged in three major activities: conducting original research and identifying existing research that clarifies the nature of the problem; communicating these research findings to policymakers, business leaders, health professionals, advocates, and others; and working with public and private programs to identify promising solutions to the problems faced by people with chronic conditions
i Diabetes includes all diabetes types I and II, with or without complications, as defined in the Agency for Healthcare Research and Qualitys Medical Expenditure Panel Survey, 1996 ii Prevalence data from the American Diabetes Association, 2001
Conclusion
As the population with diabetes and other chronic conditions continues to grow, we need to recognize that co-morbidities create extra challenges for patients, their families, and their health care providers To respond to these challenges, those who are looking to improve the health care system may want to consider:
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wwwpartnershipforsolutionsorg
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