Total and excess bed occupancy by age, specialty and insulin use for nearly one million diabetes patients discharged from all English Acute Hospitals
Introduction
Up to 10% of unselected inpatient populations have diabetes and most inpatients with diabetes are admitted because of medical or surgical conditions, rather than the acute or long term complications of diabetes [1], [2], [3], [4], [5], [6]. Populations with diabetes have higher hospital admission rates and inpatients with diabetes stay in hospital longer than age-matched controls without diabetes [1], [2], [3], [4], [5], [6]. The USA National discharge data described an excess mean inpatient length of stay (LOS) of 2.0 days in middle-aged diabetes inpatient populations [1], [2] and there are equivalent data from local populations in the UK and Europe [4], [5], [6], [7], [8], [9]. Although the causes for this excess length of stay are unknown, there is increasing evidence from the USA and UK that enhanced diabetes services for inpatients can reduce this excess diabetes bed occupancy [4], [10], [11], [12], [13]. The UK Diabetes National Service Framework (NSF) and the UK Long Term Conditions–Public Service Agreement (LTC–PSA) suggest ambitious targets for improving inpatient diabetes care and reducing chronic disease bed occupancy [14], [15]. There are no data on overall or excess diabetes related bed occupancy in a national UK or European population, certainly nothing to compare with the national hospital survey data in the USA [1], [2] and little on the contribution of excess LOS to overall national diabetes bed occupancy. The aim of this study was to provide an accurate descriptive analysis of total and excess diabetes bed occupancy due to prolonged length of stay in all English Acute Hospitals by age-band, specialty and insulin dependency in the main medical and surgical specialties and for key cardiac and surgical conditions.
Section snippets
Hospital episode statistics (HES) database
The UK Department of Health HES database contains discharge activity records for each financial year (1st April–31st March) for all National Health Service (NHS) providers in England. The HES dataset is created from nearly 300 NHS Hospitals. The presentation of these data are summarized elsewhere [16]. The diabetes population of England (2001) was estimated as 2,168,000 with an overall diabetes prevalence of 4.41% [17].
Diagnostic codes in HES
Diagnosis codes are taken from the established International Classification
Distribution of total diabetes discharges and associated occupied bed days (Table 1)
There were 943,613 discharges with a diagnosis of diabetes and 6,508,668 associated bed days in this 4 year period. The distribution of these discharges and bed days are shown by age-band and diabetes discharge code (E10 or E11) (Table 1). There were 222,694 (23.6%) discharges coded as E10 (‘insulin-dependent’) and 720,919 (76.4%) coded as E11 (‘non-insulin-dependent’). Of the E10 (‘insulin-dependent’) coded discharges, 104,949 (47.1%) were aged 18–60 years old compared to 72,303 (32.5%) and
Discussion
This analysis provides data on the distribution of nearly one million diabetes inpatient discharges by age-band, specialty and diabetes discharge code from the main medical and surgical specialties in all English Hospitals over 4 years. The main observations are that prolonged LOS in diabetes populations is relatively modest (rarely >1.0 days) and concentrated in younger age groups. This pattern also occurs in key cardiac and surgical conditions in diabetes inpatient populations. Finally, total
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