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Hospital resource consumption in patients with diabetes and multivessel coronary disease undergoing revascularization

S D Culler1, W S Weintraub, L J Shaw

  • 1Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. sculler@sph.emory.edu

The American Journal of Managed Care
|September 8, 2000
PubMed

Insights

For diabetic patients undergoing heart procedures, higher creatinine levels significantly increase hospital costs and length of stay. This highlights the need for risk adjustment in healthcare reimbursement for these complex cases.

Area of Science:

  • Cardiology
  • Diabetology
  • Health Services Research

Background:

  • Diabetes mellitus is a significant risk factor for coronary artery disease.
  • Revascularization procedures like angioplasty and bypass surgery are common treatments for coronary artery disease in diabetic patients.
  • Variations in hospital costs and length of stay for these procedures necessitate identification of contributing factors.

Purpose of the Study:

  • To identify factors influencing hospital costs and length of stay in diabetic patients undergoing coronary angioplasty or bypass surgery.
  • To determine if diabetes-specific characteristics independently affect hospital resource utilization during revascularization.

Main Methods:

  • Retrospective study of 1809 diabetic patients with multivessel coronary artery disease.
  • Analysis of patients undergoing initial coronary angioplasty or coronary bypass surgery between 1988 and 1996.
  • Sequential modeling to assess the independent association of diabetic characteristics with resource utilization, controlling for coronary artery disease severity.

Main Results:

  • For diabetic patients undergoing coronary angioplasty, baseline creatinine levels ≥ 2.0 mg/dL were linked to higher costs and longer stays.
  • For diabetic patients undergoing coronary bypass surgery, baseline creatinine levels ≥ 2.5 mg/dL were associated with increased costs and longer hospital stays.
  • These associations remained significant after controlling for coronary risk factors.

Conclusions:

  • Specific diabetes-related factors, such as elevated creatinine, are independently associated with increased hospital resource utilization in patients undergoing revascularization.
  • Current risk adjustment models for hospital reimbursement may not adequately account for the increased resource needs of diabetic patients with cardiovascular disease.
  • Recommendations for revised reimbursement policies are suggested to ensure equitable access to necessary revascularization procedures for diabetic patients.
Abstract

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