Development and validation of a diabetes mellitus severity index: A risk-adjustment tool for predicting health care resource use and costs

Vijay N. Joish, Daniel C Malone, Christopher S Wendel, JoLaine R. Draugalis, Martha J Mohler

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Study Objective. To develop and validate a diabetes mellitus-specific risk-adjustment tool-the diabetes severity index (DSI)-to assist in predicting health care costs and resources within populations of patients with diabetes. Design. Retrospective analysis of clinical and resource use for patients with a diagnosis of diabetes mellitus. Model estimation was conducted with half the sample, and validation analysis was conducted with the other half. Setting. Southern Arizona Veterans Affairs Health Care System. Patients. Seven hundred thirty-four patients with diabetes (710 men, 24 women; mean age 66 yrs). Measurements and Main Results. Clinical measures of diabetes severity (known as the DSI) were used to predict three health care resource outcomes: risk of hospitalization, and total and ambulatory health care costs. Validity of the DSI was assessed by comparing the DSI with the revised chronic disease score (CDS). The DSI weights ranged from -471.5-3081.2 for total health care costs, from -304.3-1582.1 for outpatient costs, and -0.19-0.93 for risk of hospitalization. The DSI explained 6-8% of the variance in total and ambulatory costs and performed significantly (p<0.05) better than demographics alone, but was similar to the CDS. When the DSI was used with the CDS, up to 8% of variability in costs and use were explained. Conclusion. The DSI was developed to stratify veterans with diabetes according to diabetes severity and comorbidity Since additional variance in medical care costs were explained by combining the DSI and CDS, the two indexes may explain different dimensions of a patient's severity of diabetes. However, the utility of such an index based on clinical measures to predict short-term use may be limited due to low yet significant variability explained in the outcomes.

Original languageEnglish (US)
Pages (from-to)676-684
Number of pages9
JournalPharmacotherapy
Volume25
Issue number5 I
DOIs
StatePublished - May 2005

Fingerprint

Risk Adjustment
Health Resources
Diabetes Mellitus
Health Care Costs
Delivery of Health Care
Costs and Cost Analysis
Chronic Disease
Hospitalization
Veterans Health
Veterans
Ambulatory Care
Comorbidity
Outpatients
Demography
Weights and Measures
Population

Keywords

  • Costs
  • Diabetes
  • Health care resources
  • Predictive models
  • Risk adjustment
  • Severity of illness

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology, Toxicology and Pharmaceutics(all)

Cite this

@article{20fdcb5c5ba54796950d3328511dbf13,
title = "Development and validation of a diabetes mellitus severity index: A risk-adjustment tool for predicting health care resource use and costs",
abstract = "Study Objective. To develop and validate a diabetes mellitus-specific risk-adjustment tool-the diabetes severity index (DSI)-to assist in predicting health care costs and resources within populations of patients with diabetes. Design. Retrospective analysis of clinical and resource use for patients with a diagnosis of diabetes mellitus. Model estimation was conducted with half the sample, and validation analysis was conducted with the other half. Setting. Southern Arizona Veterans Affairs Health Care System. Patients. Seven hundred thirty-four patients with diabetes (710 men, 24 women; mean age 66 yrs). Measurements and Main Results. Clinical measures of diabetes severity (known as the DSI) were used to predict three health care resource outcomes: risk of hospitalization, and total and ambulatory health care costs. Validity of the DSI was assessed by comparing the DSI with the revised chronic disease score (CDS). The DSI weights ranged from -471.5-3081.2 for total health care costs, from -304.3-1582.1 for outpatient costs, and -0.19-0.93 for risk of hospitalization. The DSI explained 6-8{\%} of the variance in total and ambulatory costs and performed significantly (p<0.05) better than demographics alone, but was similar to the CDS. When the DSI was used with the CDS, up to 8{\%} of variability in costs and use were explained. Conclusion. The DSI was developed to stratify veterans with diabetes according to diabetes severity and comorbidity Since additional variance in medical care costs were explained by combining the DSI and CDS, the two indexes may explain different dimensions of a patient's severity of diabetes. However, the utility of such an index based on clinical measures to predict short-term use may be limited due to low yet significant variability explained in the outcomes.",
keywords = "Costs, Diabetes, Health care resources, Predictive models, Risk adjustment, Severity of illness",
author = "Joish, {Vijay N.} and Malone, {Daniel C} and Wendel, {Christopher S} and Draugalis, {JoLaine R.} and Mohler, {Martha J}",
year = "2005",
month = "5",
doi = "10.1592/phco.25.5.676.63594",
language = "English (US)",
volume = "25",
pages = "676--684",
journal = "Pharmacotherapy",
issn = "0277-0008",
publisher = "Pharmacotherapy Publications Inc.",
number = "5 I",

}

TY - JOUR

T1 - Development and validation of a diabetes mellitus severity index

T2 - A risk-adjustment tool for predicting health care resource use and costs

AU - Joish, Vijay N.

AU - Malone, Daniel C

AU - Wendel, Christopher S

AU - Draugalis, JoLaine R.

AU - Mohler, Martha J

PY - 2005/5

Y1 - 2005/5

N2 - Study Objective. To develop and validate a diabetes mellitus-specific risk-adjustment tool-the diabetes severity index (DSI)-to assist in predicting health care costs and resources within populations of patients with diabetes. Design. Retrospective analysis of clinical and resource use for patients with a diagnosis of diabetes mellitus. Model estimation was conducted with half the sample, and validation analysis was conducted with the other half. Setting. Southern Arizona Veterans Affairs Health Care System. Patients. Seven hundred thirty-four patients with diabetes (710 men, 24 women; mean age 66 yrs). Measurements and Main Results. Clinical measures of diabetes severity (known as the DSI) were used to predict three health care resource outcomes: risk of hospitalization, and total and ambulatory health care costs. Validity of the DSI was assessed by comparing the DSI with the revised chronic disease score (CDS). The DSI weights ranged from -471.5-3081.2 for total health care costs, from -304.3-1582.1 for outpatient costs, and -0.19-0.93 for risk of hospitalization. The DSI explained 6-8% of the variance in total and ambulatory costs and performed significantly (p<0.05) better than demographics alone, but was similar to the CDS. When the DSI was used with the CDS, up to 8% of variability in costs and use were explained. Conclusion. The DSI was developed to stratify veterans with diabetes according to diabetes severity and comorbidity Since additional variance in medical care costs were explained by combining the DSI and CDS, the two indexes may explain different dimensions of a patient's severity of diabetes. However, the utility of such an index based on clinical measures to predict short-term use may be limited due to low yet significant variability explained in the outcomes.

AB - Study Objective. To develop and validate a diabetes mellitus-specific risk-adjustment tool-the diabetes severity index (DSI)-to assist in predicting health care costs and resources within populations of patients with diabetes. Design. Retrospective analysis of clinical and resource use for patients with a diagnosis of diabetes mellitus. Model estimation was conducted with half the sample, and validation analysis was conducted with the other half. Setting. Southern Arizona Veterans Affairs Health Care System. Patients. Seven hundred thirty-four patients with diabetes (710 men, 24 women; mean age 66 yrs). Measurements and Main Results. Clinical measures of diabetes severity (known as the DSI) were used to predict three health care resource outcomes: risk of hospitalization, and total and ambulatory health care costs. Validity of the DSI was assessed by comparing the DSI with the revised chronic disease score (CDS). The DSI weights ranged from -471.5-3081.2 for total health care costs, from -304.3-1582.1 for outpatient costs, and -0.19-0.93 for risk of hospitalization. The DSI explained 6-8% of the variance in total and ambulatory costs and performed significantly (p<0.05) better than demographics alone, but was similar to the CDS. When the DSI was used with the CDS, up to 8% of variability in costs and use were explained. Conclusion. The DSI was developed to stratify veterans with diabetes according to diabetes severity and comorbidity Since additional variance in medical care costs were explained by combining the DSI and CDS, the two indexes may explain different dimensions of a patient's severity of diabetes. However, the utility of such an index based on clinical measures to predict short-term use may be limited due to low yet significant variability explained in the outcomes.

KW - Costs

KW - Diabetes

KW - Health care resources

KW - Predictive models

KW - Risk adjustment

KW - Severity of illness

UR - http://www.scopus.com/inward/record.url?scp=18044380893&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=18044380893&partnerID=8YFLogxK

U2 - 10.1592/phco.25.5.676.63594

DO - 10.1592/phco.25.5.676.63594

M3 - Article

C2 - 15899729

AN - SCOPUS:18044380893

VL - 25

SP - 676

EP - 684

JO - Pharmacotherapy

JF - Pharmacotherapy

SN - 0277-0008

IS - 5 I

ER -