Effect of a chronic disease management service for patients with diabetes on hospitalisation and acute care costs.

OBJECTIVE: To evaluate the effect of a diabetes-management program for patients with type 2 diabetes and related comorbidities on acute healthcare utilisation and costs. METHODS: This was a retrospective administrative dataset analysis using data for patients enrolled from 2007 to 2008. Inpatient admissions for diabetes-related conditions were compared before, during and following enrolment. Costs per episode were estimated from Weighted Inlier Equivalent Separations (WIES) funding. A cost model was then developed based on admission rates per 100 patients. RESULTS: Data were retrieved for 357 patients; 49% males, mean age 62 years. The mean per-patient cost of the program was AU$524 (s.d. $213). The mean cost of an inpatient admission was $4357(95% CI 2743-5971) pre-enrolment and $4396 (95% CI 2888-5904) post-enrolment. Following program completion the annual costs (per 100 patients) for managing 'diabetes with multiple complications' and hypoglycaemia decreased from $10181 to $1710 and $9947 to $7800. In contrast, the annual cost of cardiovascular disorders increased from $14485 to $40071 per 100 patients. CONCLUSIONS: In the short-term diabetes-management programs for patients with comorbid vascular disease may reduce hospital utilisation for diabetes but not for cardiovascular disease. Longer-term follow-up is needed to determine whether intensive management of vascular complications can reduce costs.

Determinants of instrumented sedentary and physical activity behavior in geriatric rehabilitation inpatients: RESORT.

BACKGROUND: Physical inactivity in hospitalized older adults is highly prevalent and associated with detrimental health outcomes. Understanding its determinants is important for prognosis and tailoring interventions in geriatric rehabilitation inpatients. METHODS: Within the REStORing health of acutely unwell adulTs (RESORT) observational, longitudinal cohort, geriatric rehabilitation inpatients wore an inertial sensor (ActivPAL4) for one week to objectively assess instrumented sedentary behavior (i-SB) and physical activity (i-PA). Determinants were grouped in five geriatric domains: morbidity, cognition/psychology, physical performance, functional performance, and nutritional status. Their association with i-SB (mean sitting, lying, non-upright time) and i-PA (mean number of steps, sit-to-stand transitions and upright time) quintiles were examined using multivariate ordinal logistic regression analyses with Bonferroni correction (p < 0.006). RESULTS: A total of 145 inpatients were included (mean age 83.0, SD 7.7 years; 55.9% females). More comorbidities were associated with a lower daily number of steps (OR:0.91, 95%CI: 0.86-0.96) and lower upright time (OR:0.93, 95%CI: 0.88-0.98). Depressive symptoms (higher Hospital Anxiety and Depression Scale score) were associated with higher non-upright time (OR: 1.12, 95%CI: 1.03-1.21) and lower upright time (OR: 0.89, 95%CI: 0.83-0.96). Better physical performance (higher Functional Ambulation Classification, gait speed, and Short Physical Performance Battery score) was associated with lower i-SB measures (OR range: 0.07-0.78, p < 0.0005) and higher i-PA measures (OR range: 1.35-19.50, p < 0.0005). Higher functional performance (Katz index of Activities of Daily Living score) was associated with lower i-SB measures (OR range: 0.61-0.69, p ≤ 0.003) and higher i-PA measures (OR range: 1.60-3.64, p < 0.0005). Being malnourished was associated with lower i-PA measures (OR range: 0.29-0.32, p ≤ 0.004). CONCLUSIONS: Worse morbidity, depressive symptoms, worse physical and functional performance, and worse nutritional status were associated with higher i-SB and lower i-PA. These determinants should be taken into account while designing and promoting multidisciplinary physical activity interventions.