Regional Economic Conditions and Preventable Hospitalization Among Older Patients With Diabetes.

Abstract

The aim was to explore the relationship between changes in regional economic conditions and quality of care-preventable hospitalization or death among older patients with diabetes at Veterans Health Administration (VHA), safety-net system for veterans. VHA patients aged 65 years and older with a diabetes diagnosis between July 2012 and June 2014, who had at least 1 primary care visit in the past year. County-level and state-level public data were used to characterize regional health insurance coverage and affluence surrounding the VHA facilities. Each patient was associated with a VHA facility and its corresponding regional market variables, and followed up to 48 months or until they experienced diabetes-related Prevention Quality Indicators or death. Discrete-time Cox proportional hazards models estimated that changes in regional market variables characterizing regional health insurance coverage and affluence were significant factors associated with preventable hospitalization or death. All regional market variables were combined into a demand index, where 1 SD decrease in the demand index was associated with a 2.0-point increase in predicted survival for an average patient at an average VHA facility. For comparison, a 1 SD increase in primary care capacity was associated with 4.7-point increase. Downturns in regional economic conditions could increase demand for VHA care and raise the risk of diabetes-related preventable hospitalization or death among older VHA patients diagnosed with diabetes. Safety-net hospitals may be unfairly penalized for lower quality of care when experiencing higher demand for care because of an economic downturn.