Monitoring the prevalence of diabetes and the quality of care using electronic health data

Transcription

1 Monitoring the prevalence of diabetes and the quality of care using electronic health data Roberto Gnavi 1 Roberta Picariello 1, Graziella Bruno 2, Carlo Giorda 3, Giuseppe Costa 1,4 1 Epidemiology Unit ASL TO3, Piedmont Region; 2 Department of Internal Medicine, University of Torino; 3 Metabolism and Diabetes Unit, ASL TO5, Piedmont Region; 1,4 Department of Public Health, University of Torino, Italy EUROEPI 2010, Florence, 8 th November 2010

2 Background Worldwide prevalence of diabetes is estimated to be 2.8%, but in more developed societies has reached about 6% The number of people with diabetes is increasing: in the next 20 years the number of persons with diabetes will more than double (an epidemic) Mortality is up to three times greater than that of non-diabetic people To increase the survival of diabetic patients, changes in lifestyle, appropriate drug treatment, regular glycaemic control, and the continuous surveillance of health status are necessary Surveillance systems monitoring the occurrence of the disease over geographical areas and time and the quality of care received by persons with diabetes are needed to allow timely identification of critical cal points and rational planning of interventions

3 Objectives To report a selection of results from a population-based surveillance program, implemented in the city of Turin (900,000 inhabitants) Italy, based on administrative databases and aimed to monitor the occurrence of diabetes and the quality of care

4 Population with diabetes: data sources Exemption from payment: exemption from payment of drugs and laboratory tests because of a diagnosis of DM Regional Drug Prescriptions Database: All residents who had at least two prescriptions of antidiabetic drugs (ATC A10A and A10B) in 2003 Hospital Discharge Database: All residents discharged with a primary or secondary diagnosis of diabetes (ICD9 CM 250) from 1995 to 2002

5 Distribution of persons with diabetes by source of ascertainment 31 st July 2003 Exemption from payment for drugs Hospital discharges ( ) n = Drug Prescriptions Turin Population Register (at least two prescriptions in to 2003) include people alive and resident on 31 st July 2003 to determine individual educational level

6 Prevalence of diabetes in residents of Turin; 2003 Three sources Adjusted for undercount (capture recapture) n % n % difference (%) Gender Donne , ,66 78,6 Uomini , ,90 82,2 Age < , ,40 77, , ,60 81,5 > , ,31 83,4 ALL , ,77 80,4

7 Prevalence of diabetes by educational level in residents > 20 ys. old; Turin 2003 Men Women Prevalence (%) PRR* Prevalence (%) PRR* (95% CI) (95% C I) (95% C I) (95% C I) Educational level High ( ) ( ) Medium ( ) ( ) ( ) ( ) Low ( ) ( ) ( ) ( ) * Adjusted for age Nutr Metab Cardiovasc Dis 2008; 18:

8 To monitor the quality of the process of care of diabetes Regional Register Diabetes residents in (14%) (14%) Hospital discharges residents in Turin with diabetes (3%) Torino Population Register Drug Prescriptions to include people alive on 31st July 2003 to determine individual educational level to determine census tract median income 1 year Regional data base of ambulatory and outpatient care Drug prescriptions Hospital discharges therapy (insulin, oral drugs, diet only) circulatory disease

9 Laboratory test and outpatient consultations in persons with diabetes in Turin Test 1 year % 2 year % Glycosylated Hb Cholesterol Microalbuminuria Eye examination ECG Diabetologist GCI * * Guidelines Composite Indicator A1C + two among eye examination / cholesterol / microalbumiuria

10 Laboratory test and outpatient consultations in persons with diabetes in Turin Gender Eye A1C Cholesterol M.albuminuria Diabetologist examination ECG GCI PR PR PR PR PR PR PR women men 1,01 0,99 1,04 1,01 1,05 1,08 1,02 Age ,99 1,11 0,98 1,08 0,96 1,48 1, ,08 1,21 1,05 1,15 0,98 1,81 1, ,11 1,28 0,95 1,17 0,91 1,94 1,04 >=75 0,96 1,01 0,56 0,97 0,55 1,55 0,62 Educational level high medium 1,05 1,04 1,02 1,08 1,11 1,16 1,05 low 1,04 1,00 0,98 1,11 1,08 1,18 1,00 Treatment diet only oral drugs 1,74 1,35 1,97 1,83 1,84 1,36 1,98 insulin 1,84 1,35 2,18 1,98 2,11 1,42 2,21 Diabetes Care 2009;32:

11 Adherence to guidelines in persons with diabetes in Turin by health district of residence; Prevalence Ratios Prevalence Ratio

12 To monitor the outcomes of care of diabetes Regional Register Diabetes (14%) (14%) ,036 residents Hospital discharges residents with diabetes (1 st january 2002) (3%) Torino Population Register Drug Prescriptions to include people alive on 31st July 2003 to determine individual educational level to determine census tract median income 4 years f.u. MORTALITY All causes Chd Stroke Cancer AMPUTATIONS INCIDENCE Ami Stroke

13 Outcomes: Standard. Mortality/Incidence Ratio (ref. without diabetes) Men Women n SMR/SIR n SMR/SIR Mortality All Circulatory diseases CHD Cerebrovascular disease Cancer Incidence Ami Stroke Amputations

14 Outcomes: mortality/incidence by educational level in diabetic and non diabetic men Diabetics Non diabetics Educational level Medium Elementary Medium Elementary HR HR p for trend HR HR p for trend Mortality All <0.001 Circulatory diseases <0.001 Incidence AMI <0.001 stroke <0.001 Amputations

15 Outcomes: mortality/incidence by educational level in diabetic and non diabetic women Diabetics Non diabetics Educational level Medium Elementary Medium Elementary HR HR p for trend HR HR p for trend Mortality All <.0001 Circulatory diseases <.0001 Incidence AMI stroke <.0001 Amputations

16 Conclusions It is possible, with administrative data, to identify large cohorts of persons with known diabetes, to calculate the prevalence of the disease, and to monitor prospectively, at population level, several indicators that are used internationally to asses the quality of care This allows, in a simple way and at very low cost, to monitor the epidemiology of diabetes and to identify some strengths and weakness of the care system

17 Thank you for your attention