Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #113512

Marsha Regenstein, PhD¹, Jennifer Huang, MS¹, Dean Shillinger, MD², Daniel S. Lessler, MD³, Brendan M. Reilly, MD⁴, David H. Bor, MD⁵, Andrew B. Bindman, MD⁶, Myra Kleinpeter, MD, MPH⁷, David C. Ziemer, MD⁸, and Ira Glazer, MD⁹. (1) National Public Health and Hospital Institute, 1301 Pennsylvania Avenue, NW, Suite 950, Washington, DC 20004, 202-585-0135, mregenstein@naph.org, (2) SFGH Primary Care Research Center, UCSF Box 1364, San Francisco, CA 94143, (3) Harborview Medical Center, 325 9th Avenue, Seattle, WA 98104, (4) John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison Street, Chicago, IL 60612, (5) Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, (6) Division of General Internal Medicine, University of California, San Francisco, Box 1364, SFGH Bldg 90, Ward 9, University of California, San Francisco, San Francisco, CA 94143, (7) School of Medicine, Tulane University, 1430 Tulane Avenue, SL-16, New Orleans, LA 70112, (8) Division of Endocrinology, Emory University Department of Medicine, GMH/FEEBECK HALL, 96 Armstrong Street, Atlanta, GA 30303, (9) Department of Endocrinology, Memorial Healthcare System, 3501 Johnson Street, Hollywood, FL 33021

While public hospitals provide significant amounts of inpatient, outpatient, emergent, and supportive services to patients, little is known about the care of patients with diabetes across public hospitals, or the extent to which disparities in diabetes outcomes exist within these systems.

In 2002-3, the National Public Health and Hospital Institute assembled a quality improvement consortium involving 7 public hospital systems that provide care to over 125,000 patients with diabetes on an annual basis. We obtained demographic, clinical, and utilization data over a 3-year period on a random sample of 3,000 patients with diabetes from each system. Using patients' last HbA1c value, we measured the proportion of patients with poor glycemic control and explored whether glycemic control varied by race/ethnicity, insurance status, or use of outpatient services. Overall, 69% of patients were non-White minorities, and 42% were uninsured.

Overall, 26% of patients had poor glycemic control. Poor glycemic control was more common among Blacks (29%) and Hispanics (31%) than Whites (19%) or Asians (16%) (P<.001) and was greater among the uninsured (33%) than those with Medicaid (24%), commercial insurance (24%) or Medicare (17%) (P<.001). Adjusting for age, sex, race/ethnicity, insurance, and outpatient utilization, Blacks and Hispanics had worse glycemic control (8.3% and 8.2%) than Whites or Asians (7.8% and 7.9%), as did the uninsured (8.2%) compared to Medicaid (8.0%), commercially insured (7.9%) and Medicare (7.5%) (P<.001).

Despite limited resources and the challenges posed by caring for diverse and vulnerable populations, public hospital systems perform at a level comparable to other health systems with regard to glycemic control. Our results suggest that public hospital systems should target access for the uninsured, continuity of care for all patients, and quality of care for minority populations.

Learning Objectives:

• 1. Describe the extent of disparities in glycemic control demonstrated in seven public hospitals among individuals from different ethnic/racial and insured backgrounds (uninsured, Medicaid, Medicare, commercially insured).
• 2. Discuss the performance of Public Hospitals in promoting glycemic control in comparison to other health systems.
• 3. Identify means by which Public Hospitals can decrease and eliminate disparities in glycemic control among patients of different ethnic/racial and insured backgrounds.

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.