An algorithm to identify patients with treated type 2 diabetes using medico-administrative data

<p>Abstract</p> <p>Background</p> <p>National authorities have to follow the evolution of diabetes to implement public health policies. An algorithm was developed to identify patients with treated type 2 diabetes and estimate its annual prevalence in Luxembourg using health insurance claims when no diagnosis code is available.</p> <p>Methods</p> <p>The DIABECOLUX algorithm was based on patients' age as well as type and number of hypoglycemic agents reimbursed between 1995 and 2006. Algorithm validation was performed using the results of a national study based on medical data. Sensitivity, specificity and predictive values were estimated.</p> <p>Results</p> <p>The sensitivity of the DIABECOLUX algorithm was found superior to 98.2%. Between 2000 and 2006, 22,178 patients were treated for diabetes in Luxembourg, among whom 21,068 for type 2 diabetes (95%). The prevalence was estimated at 3.79% in 2006 and followed an increasing linear trend during the period. In 2005, the prevalence was low for young age classes and increased rapidly from 40 to 70 for male and 80 for female, reaching a peak of, respectively 17.0% and 14.3% before decreasing.</p> <p>Conclusions</p> <p>The DIABECOLUX algorithm is relevant to identify treated type 2 diabetes patients. It is reproducible and should be transferable to every country using medico-administrative databases not including diagnosis codes. Although undiagnosed patients and others with lifestyle recommendations only were not considered in this study, this algorithm is a cheap and easy-to-use tool to inform health authorities. Further studies will use this tool with the aim of improving the quality of health care dedicated to diabetic patients in Luxembourg.</p

Valorisation des bases médico-administratives de l'assurance maladie pour identifier et suivre la progression d'une pathologie, en étudier la prise en charge et estimer l'impact de l'implémentation d'une politique de santé grâce à leur utilisation dans un modèle médico-économique (Application au diabète de type 2 au Luxembourg)

Le diabète de type 2 (DT2) est une maladie chronique associée à de graves et coûteuses complications. Dans un contexte de restriction budgétaire, il est nécessaire de pouvoir estimer les ressources à affecter à la prise en charge des maladies chroniques et donc de suivre l évolution épidémiologique et économique d une telle maladie. Une base de données a été construite à partir des données médico-administratives de l assurance maladie luxembourgeoise. Elle comprenait les consommations de soins, associées au diabète et ses complications, des patients diabétiques de type 2 traités entre 2000 et 2006. L objectif était d étudier les champs d utilisation de ces données et leurs applications possibles pour les décisions en santé publique. Cette thèse en donne quelques exemples. En 2006, la prévalence du DT2 au Luxembourg était de 3,79% (N= 17 070). Un algorithme a permis d identifier trois stades de la néphropathie diabétique (3,77% des cas de DT2 en 2006). L analyse de l adhérence aux recommandations européennes de bonnes pratiques médicales a mis en évidence une situation critique associée à certains facteurs (médecin traitant, type de traitement, région de résidence ). Les dépenses moyennes d un patient en hémodialyse a été estimé à 116 647EUR/patient en 2006. Enfin, une analyse médico-économique a montré la dominance coût-efficace d une stratégie d implémentation de la dialyse péritonéale sur la situation actuelle. Malgré les difficultés à évaluer leur qualité, les données médico-administratives offrent une source d informations précieuses pour les décideurs publics et les professionnels de la santé, dans le but d améliorer la prise en charge des patients.Type 2 diabetes (T2D) is a chronic disease associated with many severe and costly complications. In a context of budgetary constraint, it is necessary to obtain an estimate the amount of resources to allocate to the management of chronic diseases. This includes monitoring the epidemiologic and economic evolutions. A database was built from medico-administrative databases of the national health insurance of Luxembourg. It included the healthcare consumptions associated with diabetes and its complications, of all type 2 diabetic patients treated in Luxembourg between 2000 and 2006. The objectives were to study the fields of use of this database and the possible applications for public health decision-making. This thesis gives some examples. In 2006, T2D prevalence in Luxembourg was 3.79% (N= 17070). An algorithm was built and permitted to identify three stages of diabetic nephropathy (3.77% of T2D cases in 2006). The analysis of the adherence to European follow-up guidelines showed a critical situation associated to several factors (treating physician, type of treatment, living region ). The mean costs associated with patients in dialysis were estimated at 116 647EUR/patient in 2006. Finally, a health-economic evaluation showed the dominance of a strategy promoting peritoneal dialysis in Luxembourg over the present situation.PARIS5-Bibliotheque electronique (751069902) / SudocSudocFranceF

Nouvelles formes de tarification : quels effets sur la qualité et l’efficience ?

Blum-Boisgard Claudine, Rochaix Lise, Contandriopoulos André-Pierre, Francoeur Danièle. Nouvelles formes de tarification : quels effets sur la qualité et l’efficience ?. In: Santé, Société et Solidarité, n°2, 2007. Maîtrise des dépenses de santé ou qualité : faut-il choisir ? pp. 79-82

Nouvelles formes de tarification : quels effets sur la qualité et l’efficience ?

Blum-Boisgard Claudine, Rochaix Lise, Contandriopoulos André-Pierre, Francoeur Danièle. Nouvelles formes de tarification : quels effets sur la qualité et l’efficience ?. In: Santé, Société et Solidarité, n°2, 2007. Maîtrise des dépenses de santé ou qualité : faut-il choisir ? pp. 79-82

Adherence to international follow-up guidelines in type 2 diabetes: a longitudinal cohort study in Luxembourg.

INTRODUCTION: Type 2 diabetes is associated with severe micro- and macro-vascular complications. Physicians' and patients' adherence to follow-up guidelines permits postponing or reducing these complications. The objectives were to assess the level of adherence to fundamental follow-up guidelines and determine patients' characteristics associated with this level of adherence in the context of Luxembourg, where no guidelines were implemented. STUDY POPULATION: The exhaustive residing population treated for type 2 diabetes in Luxembourg during the 2000-2006 period (N = 21,068). METHODS: Seven fundamental criteria were extracted from international guidelines (consultation with the treating physician, HbA1c tests, electrocardiogram, retinal, dental, lipid and renal check-ups). The factors associated with the level of adherence to those criteria were identified using a partial proportional odds model. RESULTS: In 2006, despite 90% of the patients consulted at least 4 times their treating physician, only 0.6% completed all criteria; 55.0% had no HbA1c test (-8.6 points since 2000) and 31.1% had a renal check-up (+21.6 points). The sex (OR(male): 0.87 [95%CI, 0.83-0.92]), the nationality (OR(NonEU): 0.64 [0.52-0.78]), the type of antidiabetic treatment (ORoral: 1.48 [1.35-1.63], OR(mixed): 1.35 [1.20-1.52]) and the type of treating physician (ORG-ID: 0.47 [0.42-0.53]) were the main factors associated with the level of adherence in 2006 (3 or more criteria). CONCLUSION: A large percentage of patients were not provided with a systematic annual follow-up between 2000 and 2006. This study highlighted the necessity to promote guidelines in Luxembourg, education for physicians and to launch a national discussion on a disease management program for diabetic patients

Odds ratios [95%CI] from cumulative odds models of adherence to guidelines (from 0: any adherence to 6: full adherence) between 2000 and 2006.

a<p>A10 treatment duration; ^b Number of visits to the Treating Physician (TP); ^c D: At least a diabetologist; I-D: At least an internist but no diabetologist; G-ID: At least a GP but no diabetologist, nor internist; O-GID: A physician but no GP, nor diabetologist, nor internist; ^d European Union 15 countries (except Luxembourg) and European Free Trade Association countries; NA: Not available.</p

Level of adherence according to the number of criteria achieved each year (% of patients).

<p>Level of adherence according to the number of criteria achieved each year (% of patients).</p

Descriptive statistics of the study population.

<p>Descriptive statistics of the study population.</p