The future of population registers: linking routine health datasets to assess a population's current glycaemic status for quality improvement.

OBJECTIVES: To determine the diabetes screening levels and known glycaemic status of all individuals by age, gender and ethnicity within a defined geographic location in a timely and consistent way to potentially facilitate systematic disease prevention and management. DESIGN: Retrospective observational study. SETTING: Auckland region of New Zealand. PARTICIPANTS: 1 475 347 people who had utilised publicly funded health service in New Zealand and domicile in the Auckland region of New Zealand in 2010. The health service utilisation population was individually linked to a comprehensive regional laboratory repository dating back to 2004. OUTCOME MEASURES: The two outcomes measures were glycaemia-related blood testing coverage (glycated haemoglobin (HbA1c), fasting and random glucose and glucose tolerance tests), and the proportions and number of people with known dysglycaemia in 2010 using modified American Diabetes Association (ADA) and WHO criteria. RESULTS: Within the health service utilisation population, 792 560 people had had at least one glucose or HbA1c blood test in the previous 5.5 years. Overall, 81% of males (n=198 086) and 87% of females (n=128 982) in the recommended age groups for diabetes screening had a blood test to assess their glycaemic status. The estimated age-standardised prevalence of dysglycaemia was highest in people of Pacific Island ethnicity at 11.4% (95% CI 11.2% to 11.5%) for males and 11.6% (11.4% to 11.8%) for females, followed closely by people of Indian ethnicity at 10.8% (10.6% to 11.1%) and 9.3% (9.1% to 9.6%), respectively. Among the indigenous Maori population, the prevalence was 8.2% (7.9% to 8.4%) and 7% (6.8% to 7.2%), while for 'Others' (mainly Europeans) it was 3% (3% to 3.1%) and 2.2% (2.1% to 2.2%), respectively. CONCLUSIONS: We have demonstrated that the data linkage between a laboratory repository and national administrative datasets has the potential to provide a systematic and consistent individual level clinical information that is relevant to medical auditing for a large geographically defined population.

Reduced acute hospitalisation with the healthy housing programme.

BACKGROUND: This study investigated the impact of the Healthy Housing Programme in reducing acute hospitalisations in South Auckland, New Zealand. The programme involved house modifications to reduce overcrowding, insulation and ventilation improvements, and health and social service assessments, referrals and linkages. METHODS: An intervention evaluation was used. Participants in the programme were considered cases following their house's intervention and counterfactuals/controls prior to the intervention. Rigorous age-censoring was used to construct a case-counterfactual comparison. 9736 residents of 3410 homes were involved in the programme from September 2001 to December 2007. All lived in areas of relative deprivation (NZDep01=decile 10) and almost all self-identified as Pacific ethnic group. The main outcome measure was acute hospitalisation rates before, during and after a health and housing intervention. Hospital data were gathered from July 1999 to January 2009. RESULTS: In the post-intervention group, people aged 5-34 years had a HR of 0.77 (95% CI 0.70 to 0.85) for acute hospitalisations compared to the counterfactual (pre-intervention). For children aged 0-4 years the HR was 0.89 (95% CI 0.79 to 0.99); a non-significant increase occurred in adults aged 35 years plus. When the causes of hospitalisation were restricted to those related to housing, further falls in the HRs were seen: 0.88 (95% CI 0.74 to 1.05) for 0-4 year olds and 0.73 (95% CI 0.58 to 0.91) for 5-34 year olds. CONCLUSION: A package of care that addresses housing conditions that impact on health and improves access to health and social services is associated with a reduced acute hospitalisation rate for 0-34 year olds.

Hospital admissions for people with diagnosed diabetes: challenges for diabetes prevention and management programmes.

AIM: To identify the extent to which people with diabetes are admitted as inpatients to Counties Manukau District Health Board (CMDHB) hospitals compared to all New Zealand, and the costs of these admissions. METHOD: Search of National Minimum Dataset for inpatient public hospital discharges with any mention of Type 1 or Type 2 diabetes from 1996-2007. RESULTS: Overall 13% of all CMDHB inpatient discharges mentioned diabetes in 2007 compared with 12% nationally. There were differences by ethnicity among those discharges aged 45 to 64 years, with Pacific (38%), Indian (31%) and Maori (31%) being more than three times as likely as European/Other people (10%) to experience a diabetes-recorded admission. There was a substantial increase in the rate of admission per 1000 where diabetes was recorded over 1996-2007, with Maori (31%) and Pacific (52%) people aged 45-64 years showing the largest increases. Findings from Counties Manukau tended to be comparable with total New Zealand data in terms of the percentage of people with diabetes who were inpatients in 2007, but relatively more inpatients in Counties Manukau had diabetes recorded (consistent with its high population of people with diabetes). Costs of admissions, laboratory investigations, and pharmaceuticals for people with diabetes were estimated to be $66 million per annum higher than for people without diabetes, in Counties Manukau alone. CONCLUSION: The findings give support to balanced system-wide strategies (such as the Let's Beat Diabetes programme in Counties Manukau) that focus on both upstream (prevention) and downstream (management and coordinated care) responses to diabetes. The study points to a long-term and significant capacity challenge for secondary care services to respond to the forecast growth in the incidence of Type 2 diabetes, particularly in Counties Manukau. The findings also pose challenges for transfer of care to primary care providers after a hospital episode and the flow of information between care settings.