Data-driven segmentation of type 2 diabetes mellitus patients: an observational study on health care utilisation prior to an emergency department visit in Germany

Mirjam Rupprecht^1*Alessandro Campione²Yves Noel Wu³Antje Fischer-Rosinský³Anna Slagman³Dorothee Riedlinger³Martin Möckel³Thomas Keil^4,5,6Lukas Reitzle⁷Cornelia Henschke^2,8

• ¹Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
• ²Department of Health Care Management, Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany
• ³Emergency and Acute Medicine (CVK, CCM), Charité - Universitätsmedizin Berlin, Berlin, Germany
• ⁴Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Baden-Württemberg, Germany
• ⁵Institute of Clinical Epidemiology and Biometry, Faculty of Medicine, University of Würzburg, Würzburg, Bavaria, Germany
• ⁶State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
• ⁷Department of Epidemiology and Health Monitoring, Robert Koch Institute (RKI), Berlin, Baden-Württemberg, Germany
• ⁸Institute of General Practice and Interprofessional Care, Faculty of Medicine, Eberhard Karls Universität Tübingen, Tübingen, Germany

Background Potentially avoidable hospital admissions (PAHs) due to type 2 diabetes mellitus (T2DM) occur more frequently in Germany than in the rest of Europe. Emergency departments (EDs) play an important role in understanding cross-sectoral health care utilisation resulting in inpatient admissions. Segmenting T2DM patients in homogenous groups according to their health care utilisation may help to understand the population’s needs and to allocate limited resources. The aim of this study was to describe ED use and subsequent inpatient admissions among T2DM patients, and to segment the study population into homogenous subgroups based on disease stage, health care utilisation and process quality of outpatient care prior to an ED visit.Methods This study was conducted as part of the INDEED project, comprising data on 56,821 ED visits in 2016 attributable to 40,561 patients with T2DM from 13 German EDs, as well as statutory health insurance claims data from 2014 to 2016 retrospectively linked per patient. Descriptive analyses included patient characteristics, ED admission diagnoses and discharge diagnoses in the case of inpatient admission of T2DM patients to the ED. Latent class analysis was conducted to identify different subgroups of T2DM patients based on disease stage, number of physician contacts and medical examinations prior to the ED visit. Results Almost half of the study population had severe comorbidities (44.3 %). In addition to T2DM, multiple cardiovascular diagnoses were among the most frequently documented admission and discharge diagnoses. The proportion of hospitalised ED visits for T2DM patients was higher (59%) than that for the INDEED population (42.8%). We identified three latent classes that were characterised as “early disease stage and high utilisation” (36.5% of the study population), “progressing disease stage and low utilisation” (26.1%) and “progressed disease stage and high utilisation” (37.4%).Conclusion A substantial share of T2DM patients had not received disease monitoring according to guideline recommendations prior to ED presentation. Improving guideline-adherence in the outpatient sector could help reduce potentially avoidable ED visits. Effective interventions that aim at improving continuity and quality of care as well as reducing the share of PAH need to be identified and evaluated per identified class.