Quality of Diabetes Care—Comparisons between Rzeszow, Podkarpacie, Poland and Waukesha, Wisconsin, U.S.

Abstract

Introduction: Poland spent 6.4% of its GDP on healthcare in 2013, while the United States (U.S.) spent 16.9%, despite similar life expectancies. Type 2 diabetes mellitus (DM) was estimated to have cost the U.S. $176 billion in 2012. This study compares the quality of DM care between Waukesha in Wisconsin, U.S. and Rzeszow in Podkarpacie region of Poland—cities comparable in population size, age, race, and income levels. Methods: DM quality data for the Polish cohort was abstracted from the charts of 144 DM patients attending a regional diabetes clinic in Rzeszow, Podkarpacie from 2013-2014. Podkarpacie DM cost data was attained from the Polish National Health Fund. One hundred and forty-four DM patients, matched for age, BMI, and sex, from a diabetes clinic in Waukesha, WI were chosen as comparators. DM quality data was obtained through the Clinical Research Data Warehouse at the Medical College of Wisconsin. Cost data for WI was inferred from a previously published cost estimate for WI. Results: The mean (SD) for glycosylated hemoglobin (HbA1C, %) in the Polish and U.S. cohorts was 7.4 (1.3) and 7.8 (1.9) respectively (p=0.04). Mean systolic/diastolic blood pressures (BP, mm Hg) in the Polish and U.S. cohorts were 148 (20)/81 (0.3) and 132 (16)/74 (11) (p <0.001, p<0.001) respectively. Insulin was prescribed in 38% of patients in Poland and 58% in U.S. The cost of hospitalizations, outpatient care, and medications per Polish patient with DM was $781 or 3.2% of the gross national income (GNI) per capita. In 2012, the direct medical cost was estimated at $8,926 per adult with DM in Wisconsin, or 15.9% GNI income per capita. Discussion: Based on our results, Polish cohort had a slightly better HbA1C. The U.S. cohort had much better BP control compared to the Polish cohort. The cost of care at Podkarpacie was ∼10-fold lower compared to Waukesha. While both countries operate under different political and economic conditions, each could benefit from a deeper understanding of the other’s quality practices and cost structures. Disclosure J. Idso: None. G. Telega: Research Support; Self; Kadmon Corporation. M. Dąbrowski: Other Relationship; Self; Ascensia Diabetes Care, AstraZeneca, Berlin-Chemie AG, Eli Lilly and Company, MSD K.K., Sanofi-Aventis, Servier. S. Kidambi: None.