As a certified Medicare Qualified Entity (QE), Blue Health Intelligence® (BHI®) produces a publicly available report assessing national quality measures using data from Medicare and Blue Cross Blue Shield commercial claims data. In this report, we examine the relationships between preventable diabetes and hypertension admission rates and socioeconomic status (SES) measures to inform the potential of improved access to preventive care to reduce avoidable hospitalization. This year, we incorporated multiple years of data (2017 – 2020), allowing us to evaluate trends across these measures prior to and during the COVID-19 pandemic. As expected, the findings continue to reinforce the impact of social determinants of health (SDOH) on health outcomes, including worsened disparities experienced during the COVID-19 pandemic. According to the CDC, the prevalence of chronic conditions, including diabetes and heart disease, continues to increase (CDC, 2022) [ST1] but with solid patient engagement with the healthcare system, these chronic conditions can be managed with appropriate screening and treatment. However, the COVID-19 pandemic disrupted this patient engagement, leading to delayed care. This has been further observed amongst those of lower socioeconomic status who are at greater risk of COVID-19 morbidity and mortality. [ST2]
BHI’s report reveals the results of analyzing five of the diabetes-related Agency for Healthcare Research and Quality Prevention Quality Indicators (PQIs) in relation to various SDOH and demographic factors, such as payer type, age, sex, and SES Index over a period of 4 years (2017 – 2020). Findings include:
- Preventable inpatient admission rates are indicative of the impact of COVID-19: Admission rates for short- and long-term diabetes complications, hypertension, and lower-extremity amputations generally increased between 2017 and 2019; however, the year 2020 revealed a marked decrease in PQIs relating to diabetes and hypertension.
- High acuity admissions remained relatively stable but when care could be deferred, lower acuity admissions decreased: Between 2019 and 2020 high acuity admissions, including short-term diabetes complications and lower extremity amputations, decreased by 3.1 per 100,000 and 2.5 per 100,000 respectively. Meanwhile, lower-acuity admissions, including long-term complications, hypertension, and uncontrolled diabetes admissions decreased by 23.8 per 100,000, 14.6 per 100,000, and 10.4 per 100,000 respectively.
- Disparate admission rates may reflect differences in access to preventive care: When stratifying by SES Index, lower SES levels showed disproportionately higher observed admission rates as compared to higher SES Index levels, which demonstrated consistently lower rates across all PQIs and analysis years. Particularly, admission rates among lower SES Index levels were substantially higher for diabetes long-term complications and hypertension.
BHI is among a few organizations that the Centers for Medicare & Medicaid Services (CMS) certified as a QE. The program requires assessments of national quality of care measures to be reported publicly. For this report, CMS granted BHI access to its Medicare fee-for-service claims data, which BHI combined with its own national commercial data set for analysis.
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[ST1]Centers for Disease Control and Prevention (CDC). (2022, September 30). Prevalence of Both Diagnosed and Undiagnosed Diabetes. Atlanta, GA: CDC. https://www.cdc.gov/diabetes/data/statistics-report/diagnosed-undiagnosed-diabetes.html
[ST2]Fisher, M. & Bubola, E. (2020, March 15). As Coronavirus deepens inequality, inequality worsens its spread. The New York Times. https://www.nytimes.com/2020/03/15/world/europe/coronavirus-inequality.html?smid=url-share