November 22, 2011

Brennen Kim Class of '12, Mark Ayoub Class of '12, Hilary Freed Class of '12 and Tom Shull Class of '13 analyzed hospital admissions data to build their PCH4 report.

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By Molly O'Brien-Foelsch

LEWISBURG, Pa. — A group of Bucknell University students has conducted crucial data analyses and helped to prepare a report on diabetes-related hospitalizations in Pennsylvania.

The report, issued by the Pennsylvania Health Care Containment Council (PHC4), highlights the number and rate of hospitalizations of Pennsylvania residents whose primary diagnosis is diabetes.

It is publicly available as a reference for further research and policy decisions on health care, with data summaries broken out by age, race, county of residence, type of diabetes and type of payer for the years 2000-09. || View report and news release.

The partnership between PHC4 and Bucknell began in 2010, when Associate Professor of Economics Amy Wolaver and then Chief of Staff to the President Dave Myers met with PHC4 representatives determine how student researchers might support the agency. PHC4 was particularly interested in learning more about hospital admissions rates related to diabetes, the seventh leading cause of death in the United States. The disease accounts for hundreds of billions of dollars in direct and indirect medical costs.

Two million records
Excited at the opportunity for students to learn while helping PHC4, Bucknell purchased two million hospital admission records representing every state resident admitted to a non-federal hospital in Pennsylvania in 2009. Pennsylvania is unique in requiring hospitals to provide a state agency with the records related to every hospital admission.

PHC4 then developed a job description for several interns — to be mentored by Wolaver — to analyze the data specifically related to diabetes and build a report. From the internship applicant pool, Wolaver selected three students: Hilary Freed, Class of 2012; Mark Ayoub, Class of 2012; and Tom Shull, Class of 2013. Shull and Ayoub received stipends from the Bucknell Public Interest Program, which provides funding to students pursuing unpaid summer internships at nonprofit or government organizations.

"The data presented us with an opportunity for students to learn how to use large data sets and look for meaning," said Wolaver, who supervised the students as part of the Bucknell Institute for Public Policy, which supports social science research, analysis and teaching on campus and beyond.

"I wanted to work on this not just because I'm an economics and mathematics major," said Shull, "but also because it's a really important area to look into and a good skill set to have for analyzing data."

Outcomes by age, county and diabetes type
Freed looked at how a patient's type of insurance affected treatment. She hypothesized that more prevalent insurance policies would lead to better outcomes, but the results indicated that it was age, not insurance type, that affected length of stay. "The older you are, the more likely you are to have a longer length of stay, and there are more readmissions," said the economics major.

Shull examined how admissions rates, amputations and renal failure rates differed across counties in 2009. "We found huge differences," he says. Philadelphia County had the highest hospital admission rate for diabetes in the state, at 38.4 per 10,000 residents. Other counties with high rates included Delaware, Schuylkill, Columbia, Allegheny, Lawrence and Fayette. Northern and central counties had the lowest rates.

Ayoub gathered primary data on the hospitalization rate differences between type 1 and type 2 patients to see if any trends existed. "For type 2 diabetes, oftentimes brought on through obesity, hospitalization rates have significantly increased over the past decade," said the management major, "while type 1 diabetes rates have decreased. As a Pennsylvanian, this statistic is particularly alarming and alludes to the need for improved dietary habits across the state."

Brennen Kim, Class of 2012, also worked with the data as part of Bucknell's Program for Undergraduate Research. His work did not focus specifically on diabetes. With Wolaver as his mentor, Kim looked at the effects of weekend vs. weekday admissions of patient outcomes among whites and Hispanics. His analysis indicated that whites had lower average total hospital charges than Hispanics, whites averaged longer lengths of stay than Hispanics, and whites had significantly higher mortality rates than Hispanics on weekends.

Diabetes hospitalizations on the rise
In August, Freed, Shull, Ayoub and Kim presented their results at an undergraduate research poster session sponsored by the Bucknell Public Interest Program, Bloomsburg University and Geisinger's Henry Hood Center for Health Research. Soon after, they provided a draft report to PHC4.

PHC4 reviewed and verified the students' analyses and merged them with data covering the entire decade from 2000-09. The key findings show that the number of hospitalizations among patients with the principal diagnosis of diabetes grew by 10.5 percent from 2000-09, that rates increased for the 18 to 44 years and 45 to 64 years groups, and that hospitalization rates for diabetes were consistently higher for black non-Hispanic residents compared to all other groups.

"Overall, these students can be very proud of their work," said Flossie Wolf, director of health policy research for PHC4. "In completing this research, they used advanced statistical tools to conduct a series of complicated analyses. This important work has added to our current understanding of diabetes and will be a valuable contribution as we continue to examine issues related to diabetes and other chronic conditions."

"They exceeded my expectations," said Wolaver.

"I had never really done anything like this before," said Shull. "I learned how to do research, how to be meticulous and precise, how understand how to manipulate data and know what it means, and how to document and be clear about what you do so that other people can use it. I appreciated being able to work with PHC4, knowing in some way the work makes a difference and affects policy."

Contact: Division of Communications

November is National Diabetes Awareness Month.