The 1889 Jefferson Center for Population Health Study – Impact of Type 2 Diabetes on Healthcare Utilization in Rural and Urban Pennsylvania

The 1889 Jefferson Center for Population Health in Johnstown, Pennsylvania was founded as a collaborative research and resource center focused on population health and disease prevention to benefit the citizens living in Cambria and Somerset counties. The center is a first of its kind, a partnership between a rurally located philanthropic nonprofit (1889 Foundation) and a university (Thomas Jefferson University) to improve rural health.

The center’s Executive Director, Dr. Trina Thompson and Research Project Manager, Konstantinos Panitsas are using data from the Pennsylvania Health Care Cost Containment Council (PHC4) to study diabetes. In describing how PHC4 data was used in the analysis, Mr. Panitsas stated, “The center used PHC4 data to obtain a better understanding of diabetes prevalence in rural Pennsylvania, particularly in our footprint, Cambria and Somerset counties.”

Mr. Panitsas shared parts of the study with PHC4 staff, noting that the two key points of the analysis include: 1) focusing on diabetes-related hospitalizations with reliance on index (or initial) hospitalizations, rather than readmissions, so that a more homogeneous sample of charges related to diabetes is achieved, and 2) examining results at the census-tract level so that differences in prevalence and cost can be identified in geographic detail.

According to Mr. Panitsas, the analysis focused on patients hospitalized with diabetes in Pennsylvania during 2015-2016. Costs were analyzed by examining total and non-covered charges by sociodemographic and clinically-related factors. Patients were classified according to the number of comorbidities and other conditions each patient had. This approach provided a better understanding of how the cost of diabetes is distributed across patients with different sociodemographic characteristics and comorbidities.

In sharing results of the analysis, Mr. Panitsas noted that, “In rural areas, like Cambria and Somerset, the percentage of people who were hospitalized due to diabetes was on average slightly higher than the corresponding urban counties.” He added, “Important differences in the percentage of hospitalized patients who were diagnosed with diabetes were found not only in between-county comparisons, but also within them, at the census-tract level.”

Mr. Panitsas also outlined additional findings:

• Patients with a secondary diagnosis of diabetes had, on average, higher total expenditures when compared to patients without diabetes or to patients hospitalized specifically for diabetes (those patients whose principal diagnosis/reason for being hospitalized was diabetes)—a finding consistent at the state and county level and independent of stratification by age, gender, type of insurance, and race.
• For patients with a principal diagnosis of diabetes, those with Type 2 diabetes had, on average, higher expenditures than patients with Type 1 diabetes or other types of diabetes.
• For those patients whose principal diagnosis was diabetes, about 30% had more than 14 comorbidities. Mr. Panitsas noted that for those who had diabetes as their principal diagnosis, sepsis was the most common comorbidity not only in Pennsylvania, but also in Cambria and Somerset counties. Myocardial infarction, acute kidney failure, and pneumonia were the next most common comorbidities.
• In general, only 16% of the patients with diabetes had fewer than four comorbidities. The remaining 84% had from 5 to as many as 17 comorbidities. A higher number of comorbidities translated into higher total expenditures for patients suffering from diabetes.

Mr. Panitsas explained how the results of the study will be used to improve diabetes prevention and control. “Various data sources, including the PHC4 data, are being used to build a baseline description of Cambria and Somerset counties. As the 1889 Jefferson Center for Population Health partners with local organizations to implement diabetes prevention and care strategies, future data will be compared to assess the effectiveness of these interventions.” He further explained that based on the variation found within/between the counties studied, the center can prioritize and implement specific and more targeted interventions in areas with particular characteristics.

To improve the health of people in Cambria and Somerset counties, Dr. Thompson noted that the 1889 Jefferson Center for Population Health is seeking to identify a national expert with successful multi-modal strategies in diabetes care. Once selected, they will be partnered with local organizations to replicate those strategies in Cambria and Somerset counties. This three-year project is set to begin in 2019. The center will rigorously monitor, collect, analyze and publish the results of this initiative.

The center also provides community education surrounding the priority focus areas of diabetes, tobacco cessation, mental health, obesity and activity. According to Dr. Thompson, “Raising awareness, increasing knowledge, and changing the culture about health wellness is of priority. In the long term, coupled with a well-informed strategy for prevention and treatment of the disease, we hope to see a significant reduction in diabetes-related hospitalization costs in Cambria and Somerset.” The hope is a better informed community, with expectation that those with diabetes are able to avoid unnecessary hospitalizations and higher diabetes-related costs, particularly non-covered expenditures.

In the future, the center plans to generate additional analyses for mental health diagnoses. In describing PHC4 data, Mr. Panitsas stated, “We would recommend PHC4 data to other researchers as it is a complete dataset with an extensive list of diagnosis codes and a plethora of sociodemographic variables for a high number of patients hospitalized each year in Pennsylvania.”

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