Regional Economic Conditions and Preventable Hospitalization Among Older Patients With Diabetes

Area of Science:

• Health Services Research
• Geriatric Medicine
• Public Health Policy

Background:

• Older adults with diabetes are a vulnerable population within the Veterans Health Administration (VHA) system.
• Regional economic conditions can influence healthcare access and demand for services.
• Assessing quality of care in safety-net systems requires understanding external economic factors.

Purpose of the Study:

• To investigate the association between regional economic changes and preventable hospitalizations or deaths in older diabetic VHA patients.
• To determine if economic downturns impact the quality of care metrics for diabetes patients in a safety-net setting.

Main Methods:

• Utilized county- and state-level economic data to characterize regional markets around VHA facilities.
• Employed discrete-time Cox proportional hazards models to analyze patient outcomes over 48 months.
• Linked patient data to regional market variables, including health insurance coverage and affluence.

Main Results:

• Changes in regional economic variables significantly correlated with preventable hospitalizations or deaths.
• A decrease in the regional demand index was associated with improved patient survival.
• Increased primary care capacity showed a stronger association with improved survival compared to economic factors alone.

Conclusions:

• Deteriorating regional economic conditions can elevate the risk of preventable adverse outcomes for older diabetic VHA patients.
• Safety-net healthcare systems like the VHA may face challenges in quality assessment due to increased demand during economic downturns.
• Policy considerations should account for economic influences on healthcare demand and quality metrics.