Online Program

333870
Differences in maintenance vs. acute care between a rural and urban Mississippi Medicare Advantage population with diabetes; a cross-sectional analysis


Wednesday, November 4, 2015 : 12:50 p.m. - 1:10 p.m.

Kayleigh Majercak, MS, Population Health Analytics, Humana, Louisville, KY
Priya John, MPH, Population Health Analytics, Humana, Louisville, KY
Christine Hettel, MPH, CPH, CPA, Population Health Analytics, Humana, Louisville, KY
Erik Eaker, MHA, Project Leap Frog, Humana, Louisville, KY
Andrew Renda, MD, MPH, Office of the Chief Medical Officer, Humana Inc., Louisville, KY
Diana Cusano, MPH, Population Health Analytics, Humana, Louisville, KY
Vipin Gopal, Ph.D, MBA, Clinical Analytics, Humana, Louisville, KY
Objectives: To describe compliance with diabetes care screenings and health care resource utilization (HCRU) among rural and urban residents of Mississippi across the continuum of diabetes severity.

Methods: People insured by a Medicare Advantage health plan in Mississippi identified as having diabetes based on a combination of ICD-9 codes, lab results, and pharmacy claims were included.  Severity (low, medium, high) was based on the Diabetes Complication Severity Index.  Rural-Urban Commuting Area Codes determined geography status. Compliance with annual proteinuria screens, low density lipoprotein (LDL) tests, and hemoglobin A1C as well as all-cause physician office visits (PO visits) and ER visits per 1,000 was reported.  Statistical significance was examined using t-tests and chi-square tests with a priori level of 0.05.

Results: In the sample population (n=13,040), nearly 2 in 5 lived in rural areas (39.7%), and 71.9% of the sample had low severity diabetes. Among those with low severity, the rural cohort had significantly lower compliance with screenings than those in urban areas (p<0.01): proteinuria 45% vs. 51%, LDL 64% vs. 69%, and A1C 70% vs. 75%, respectively. The low severity, rural cohort trended towards fewer PO visits (7,605 vs. 7,912, p<0.28), and more ER visits (515 vs. 471, p<0.01) per 1,000 than their urban counterparts. The observed trends in the low severity group were generally similar in the medium and high severity groups; PO and ER visits were higher as severity increased.

Conclusions: Diabetes-specific population health strategies should address disparities in maintenance vs. acute HCRU among rural and urban residents.

Learning Areas:

Chronic disease management and prevention
Provision of health care to the public
Public health or related research

Learning Objectives:
Identify the differential in health care resource utilization and compliance with diabetes care screenings among people with diabetes in Mississippi based on where they reside (rural vs urban setting).

Keyword(s): Diabetes, Rural Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal or co-princial of many studies focusing on diabetes.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Humana Diabetes Employment (includes retainer)

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 5168.0: Rural and frontier health