OBJECTIVE Self-management education and support are essential for improved diabetes control. A 1-year randomized telephonic diabetes self-management intervention (Bronx A1C) among a predominantly Latino and African American population in New York City was found effective in improving blood glucose control. To further those findings, this current study assessed the intervention’s impact in reducing health care utilization and costs over 4 years. RESEARCH DESIGN AND METHODS We measured inpatient ( n = 816) health care utilization for Bronx A1C participants using an administrative data set containing all hospital discharges for New York State from 2006 to 2014. Multilevel mixed modeling was used to assess changes in health care utilization and costs between the telephonic diabetes intervention (Tele/Pr) arm and print-only (PrO) control arm. RESULTS During follow-up, excess relative reductions in all-cause hospitalizations for the Tele/Pr arm compared with PrO arm were statistically significant for odds of hospital use (odds ratio [OR] 0.89; 95% CI 0.82, 0.97; P < 0.01), number of hospital stays (rate ratio [RR] 0.90; 95% CI 0.81, 0.99; P = 0.04), and hospital costs (RR 0.90; 95% CI 0.84, 0.98; P = 0.01). Reductions in hospital use and costs were even stronger for diabetes-related hospitalizations. These outcomes were not significantly related to changes observed in hemoglobin A1c during individuals’ participation in the 1-year intervention. CONCLUSIONS These results indicate that the impact of the Bronx A1C intervention was not just on short-term improvements in glycemic control but also on long-term health care utilization. This finding is important because it suggests the benefits of the intervention were long-lasting with the potential to not only reduce hospitalizations but also to lower hospital-associated costs.

中文翻译：

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电话干预改善糖尿病控制对纽约州南布朗克斯市成年人医疗保健利用和成本的影响。

目的自我管理教育和支持对于改善糖尿病控制至关重要。发现在纽约市主要是拉丁美洲人和非裔美国人的人群中进行了为期1年的随机电话糖尿病自我管理干预（Bronx A1C），可有效改善血糖控制。为了进一步阐明这些发现，本项研究评估了该干预措施在4年内降低医疗保健利用率和成本的影响。研究设计与方法我们使用包含2006年至2014年纽约州所有出院情况的行政数据集，对布朗克斯A1C参与者的住院患者（n = 816）卫生保健利用率进行了测量。多级混合模型用于评估卫生保健利用率和电话糖尿病干预（Tele / Pr）组和仅打印（PrO）控制组之间的费用。结果在随访期间，与使用PrO臂相比，Tele / Pr臂的全因住院率的相对减少率在统计学上具有统计学意义（赔率[OR] 0.89； 95％CI 0.82，0.97； P <0.01 ），住院天数（比率[RR] 0.90； 95％CI 0.81，0.99； P = 0.04）和住院费用（RR 0.90； 95％CI 0.84，0.98； P = 0.01）。对于糖尿病相关的住院治疗，医院使用的减少和费用的减少甚至更大。这些结果与个体参与1年干预期间血红蛋白A1c的变化没有显着相关。结论这些结果表明，布朗克斯A1C干预的影响不仅对血糖控制的短期改善，而且对长期医疗保健的利用也有影响。