The Diabetes Integrated Care Initiative (DICI) has tested whether hospital admissions and total amounts paid for inpatient care have declined through closer (integrated) working between primary, secondary and community diabetes services in Cambridgeshire.
Poisson regression models were used to compare the percentage change in hospital admissions, and tariff paid, before and after each of 43 months (April 2007 – November 2010). East Cambridgeshire and Fenland (ECF) practices were divided into those fully (n = 10) and less (n = 7) “engaged” with the intervention defined by the extent of their uptake of intervention components between July 2009 and June 2010. Other parts of the county were “controls”.
Among patients with diabetes in the fully engaged ECF practices, the monthly average hospital admission rate was 19.0% (13.9, 24.2) higher (7.7 hospital admissions per 1000 patients) and the monthly tariff paid was 28.8% (28.7, 28.9) higher (£19.60 per patient per month), at the time of introducing the DICI versus the pre-implementation period (April 2007 to June 2009). These differences, had dropped to 8.7% (1.9, 15.6) and 13.4% (13.2, 13.5) (£9.92 per patient per month) higher 12 months after introduction. Comparable reductions in the rate of increase were not seen among those without diabetes or in control areas.
During the DICI, patients with diabetes from “fully engaged” practices experienced increased hospitalization and amount paid for in-patient care, the extent of which trended downwards by 12 months. Further time is needed to monitor whether this trend is sustained.
在每个月前后都使用Poisson回归模型来比较住院以及住院费用的百分比变化，共43个月（2007年4月–2010年11月）。在2009年7月至2010年6月之间，根据其采取干预的程度将东剑桥郡与芬兰德的医疗机构划分为完全（n = 10）与不完全（n = 7）干预组。其他的郡为“对照组”。