Preprint Article Version 1 This version is not peer-reviewed

The Impact of a Continuous Care Intervention for Treatment of Type 2 Diabetes on Health Care Utilization

Version 1 : Received: 26 January 2019 / Approved: 31 January 2019 / Online: 31 January 2019 (08:56:46 CET)

How to cite: Wagner, Z.; Bhanpuri, N.H.; McCarter, J.P.; Sood, N. The Impact of a Continuous Care Intervention for Treatment of Type 2 Diabetes on Health Care Utilization. Preprints 2019, 2019010324 (doi: 10.20944/preprints201901.0324.v1). Wagner, Z.; Bhanpuri, N.H.; McCarter, J.P.; Sood, N. The Impact of a Continuous Care Intervention for Treatment of Type 2 Diabetes on Health Care Utilization. Preprints 2019, 2019010324 (doi: 10.20944/preprints201901.0324.v1).

Abstract

Introduction: Type 2 diabetes (T2D) is a major driver of health care costs, thus treatments enabling T2D reversal may reduce expenditures. We examined the impact of a T2D continuous care intervention (CCI) on health care utilization. Previous research documented that CCI, including individualized nutrition supported by remote care, simultaneously reduced hemoglobin A1c and medication use and improved cardiovascular status after two years; however, the impact on utilization is unknown. Methods: This study used four years of data (two years pre-intervention, two years post-intervention) from the Indiana Network for Patient Care (INPC) health record. Two methods estimated the impact of CCI on utilization. First, an interrupted time series (ITS) including only CCI participants (n=193) compared post-intervention utilization to expected utilization had the pre-intervention trend persisted. Deviation from the trend was estimated non-parametrically for each 6-month interval after the implementation of CCI . Second, a 1:3 matched comparator group (n=579) was constructed and used for a difference-in-differences (DiD) analysis. The primary outcome was annualized outpatient encounters. Secondary outcomes included emergency encounters and hospitalizations. Results: In two years prior to intervention, CCI participants had a mean of 5.77 annualized encounters (5.62 outpatient, 0.04 hospitalizations, 0.11 emergency). The CCI group showed a reduction in outpatient utilization after intervention. In ITS analysis, 1.6 to 1.9 fewer annualized outpatient encounters occurred in each 6-month interval post-intervention relative to expected utilization based on pre-intervention trends (p<0.01 each 6-month period; 28-33% reduction). The DiD analysis suggested a larger reduction; 5 fewer annualized outpatient encounters in the quarter after intervention, diminishing to 2.5 fewer after 2 years (p<0.01 each quarter). The study was underpowered to draw conclusions about hospitalization and emergency encounters due to the limited number of CCI patients and the rarity of encounters. Conclusions: Outpatient encounters were significantly reduced for a T2D patient population up to 2 years after receiving an individualized intervention supporting nutrition and behavior change through remote care.

Subject Areas

Type 2 diabetes, health care utilization

Comments (0)

We encourage comments and feedback from a broad range of readers. See criteria for comments and our diversity statement.

Leave a public comment
Send a private comment to the author(s)
Views 0
Downloads 0
Comments 0
Metrics 0


×
Alerts
Notify me about updates to this article or when a peer-reviewed version is published.