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Factors Influencing Hypoglycemia Care Utilization and Outcomes Among Adult Diabetic Patients Admitted to Hospitals: a Predictive Model

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Factors Influencing Hypoglycemia Care Utilization and Outcomes Among Adult Diabetic Patients Admitted to Hospitals: a Predictive Model University of Central Florida STARS Electronic Theses and Dissertations, 2004-2019 2017 Factors Influencing Hypoglycemia Care Utilization and Outcomes Among Adult Diabetic Patients Admitted to Hospitals: A Predictive Model Waleed Kattan University of Central Florida Part of the Health Services Research Commons, and the Public Affairs Commons Find similar works at: https://stars.library.ucf.edu/etd University of Central Florida Libraries http://library.ucf.edu This Doctoral Dissertation (Open Access) is brought to you for free and open access by STARS. It has been accepted for inclusion in Electronic Theses and Dissertations, 2004-2019 by an authorized administrator of STARS. For more information, please contact [email protected]. STARS Citation Kattan, Waleed, "Factors Influencing Hypoglycemia Care Utilization and Outcomes Among Adult Diabetic Patients Admitted to Hospitals: A Predictive Model" (2017). Electronic Theses and Dissertations, 2004-2019. 5416. https://stars.library.ucf.edu/etd/5416 FACTORS INFLUENCING HYPOGLYCEMIA CARE UTILIZATION AND OUTCOMES AMONG ADULT DIABETIC PATIENTS ADMITTED TO HOSPITALS: A PREDICTIVE MODEL by WALEED M KATTAN M.H.A. The George Washington University, 2010 MBBS, King Abdul-Aziz University, 2002 A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Public Affairs in the College of Health and Public Affairs at the University of Central Florida Orlando, Florida Spring Term 2017 Major Professor: Thomas T.H. Wan Waleed M. Kattan 2017 ii ABSTRACT Diabetes Miletus (DM) is one of the major health problems in the United States. Despite all efforts made to combat this disease, its incidence and prevalence are steadily increasing. One of the common and serious side effects of treatment among people with diabetes is hypoglycemia (HG), where the level of blood glucose falls below the optimum level. Episodes of HG vary in their severity. Nevertheless, many require medical assistance and are usually associated with higher utilization of healthcare resources such as frequent emergency department visits and physician visits. Additionally, patients who experience HG frequently have poor outcomes such as higher rates for morbidities and mortality. Although many studies have been conducted to explore the risk factors associated with HG as well as others that looked into the level of healthcare utilization and outcomes among patients with HG, most of these studies failed to establish a theoretical foundation and integrate a comprehensive list of personal risk factors. Therefore, this study aimed to employ Andersen’s health Behavior Model of health care utilization (BM) as a framework to examine the problems of HG. This holistic approach facilitates enumerating predictors and examining differential risks of the predisposing (P), enabling (E) and need-for-care (N) factors influencing HG and their effects on utilization (U) and outcomes (O). The population derived from the national inpatient sample of the Healthcare Cost and Utilization Project (HCUP) database and included all non-pregnant adult diabetic patients admitted to hospitals’ Emergency Departments (EDs) with a diagnosis of HG from 2012-2014. Based on the BM framework, different factors influencing HG utilization and outcome were grouped under the P, E, or N component. Utilization was measured by patients’ length of stay (LoS) in the hospital and the total charges incurred for the stay. Outcome was assessed based on iii the severity ranging from mortality (the worst), severe complications, mild complications, to no complications (the best). Structural Equation Modeling (SEM) followed by Decision Tree Regression (DTREG) were performed. SEM helped in testing multiple hypotheses developed in the study as well as exploring the direct and indirect impact of different risk factors on utilization and outcome. The results of the analysis show that N is the most influential component of predictors of U and O. This is parallel to what was repeatedly found in different studies that employed the BM. Regarding the other two components, P was found to have some effect on O, while E influences the total charge. Interaction effects of predictors were noted between some components, which indicate the indirect effect of these components on U and O. Subsequently, DTREG analysis was conducted to further explore the probability of the different predictor variables on LoS, total charge, and outcome. Results of this study revealed that the presence of renal disease and DM complications among HG patients play a key role in predicting U and O. Furthermore, age, socio-economic status (SES), and the geographical location of the patients were also found to be vital factors in determining the variability in U and O among HG patients. In conclusion, findings of this study lend support to the use of the BM approach to health services use and outcomes and provide some practical applications for healthcare providers in terms of using the predictive model for targeting patient subgroups (HG patients) for interventions among diabetic patients. Moreover, policy implications, particularly related to the Central Florida area, for decision makers regarding how to approach the growing problem of DM can be drawn from the study results. iv ACKNOWLEDGMENTS At the end of this long trip I would like to emphasize my deep appreciation to all who helped me in various aspects of my academic journey and made this dissertation possible. First and above all, I praise God, the almighty for providing me this opportunity and granting me the capability to proceed successfully. I thank Him for answering my prayers for giving me the strength and blessings to plod on during each and every phase of my life. There are many people who helped me during the journey of preparing this dissertation. So, I will attempt to give them their due here, and I sincerely apologize for any omissions. First and foremost, I am extremely grateful to my parents, the ones who can never ever be thanked enough, for the overwhelming love, prayers, care, wisdom, and sacrifices for educating and preparing me for my future. Without their support and proper guidance, it would have been impossible for me to complete my higher education. My special, profound and affectionate thanks, love, warm gratitude, and deep indebtedness are due to my wife, who has been struggling with me, hand by hand, to secure and shape brighter future. Her love, trust, understanding, sacrifices, prayers, support, commitment and looking after my children during my study all stand behind my achievements. I would also like to express my love and thanks to ‘the beats of my heart,’ my children for fulfilling my life with everlastingly joyful and happy moment, and it is their love and innocent smiles that have made the hardship of this task bearable. Also I express my deep thanks to my sisters, brothers, father in law and mother in law for their support, inspiration, and valuable prayers. I immensely thankful to the chair of my dissertation committee and my academic advisor, Dr. Thomas T. H. Wan for his perfect guidance, mentorship, patience and support throughout my v doctoral study. I also would like to thank all my dissertation committee members; Dr. Bernardo Ramirez, Dr. Robyne Stevenson, Dr. Varadraj Gurupur, and Dr. Richard Pratley for their invaluable comments and guidance. It was really honor to work under the guidance of these distinguished doctors. I would like to offer my sincere thanks to all of the professors who taught me during my graduate studies. They did not hesitate to share their knowledge with me and to inspire my interest of learning. I am also grateful to my all friends and classmates for making my study journey and campus life enjoyable. vi TABLE OF CONTENTS LIST OF FIGURES ..................................................................................................................... xiii LIST OF TABLES ........................................................................................................................ xv LIST OF ABBREVIATIONS ..................................................................................................... xvii CHAPTER 1 : INTRODUCTION .................................................................................................. 1 1.1 Organization of the chapters: .......................................................................................... 2 1.2 Background ..................................................................................................................... 4 1.2.1 Diabetes background:...................................................................................... 4 1.2.2 Hypoglycemia background ............................................................................. 5 1.2.3 The problem of hypoglycemia ........................................................................ 5 1.3 The Study problem .......................................................................................................... 7 1.4 The Study Purpose .......................................................................................................... 9 1.5 Significance of the Study ................................................................................................ 9 1.5.1 Policy Relevance ............................................................................................. 9 1.5.2 Practical Application ..................................................................................... 10 1.6 Theoretical
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