Dossier n. 264/2018 [Abstract] Clinical pathways and costs of diabetes management in Emilia-Romagna. Empirical analysis through administrative data. 2010-2016

Diabetes management is a major health problem, both for the epidemiological and clinical aspects related to the spread of the disease and the importance of its complications, and for the impact on services in terms of quality of care pathways and dedicated resources. The use of administrative information sources is a valid tool to monitor diabetes epidemiology and quality of care. In recent years the Emilia-Romagna Region has developed a patient traceability system based on the integration of different data sources, which allows to map the process, outcomes and resources used for health care over the years.

The objective of this report is to describe the impact of diabetic disease in the adult population of Emilia-Romagna from 2010 to 2016, through the integration of hospital admissions databases, pharmaceutical prescriptions, outpatient specialist services, exemptions for pathology and mortality registry.

Over the years a slight increase in the standardized prevalence rate of diabetic subjects has been registered, as well as a reduction in mortality, diabetic coma, heart ischemic disease, stroke, eye complications, peripheral revascularization interventions, amputation and dialysis procedures. The standardized hospitalization rate for any cause has decreased and the execution rates of some outpatient services have increased such as glycated haemoglobin, microalbuminuria and complete urinalysis. The overall average expenditure per patient has decreased, in particular that for hospital care, while per user expenditure has slightly increased, ie for patients who actually receive assistance in terms of drugs, specialist visits and admissions. In absolute terms, the total health expenditure for drugs and outpatient assistance has increased, while the expenditure for hospital admissions has decreased.

The regional guidelines for the management of diabetes mellitus issued from 2003, the implementation of the integrated care management model, the process monitoring have contributed to achieve significant improvements in the outcomes of diabetic patients without substantial expenditure increases. At the same time, some areas still need to be improved, such as adherence to the execution of some recommended follow-up examinations and the reduction of variability among Local Health Authorities. The ongoing reorganization process of primary care and the development of community health centres and community hospitals will certainly increase the volume and the quality of care to patients with diabetes.