Care Coordination Reduced Hospitalizations in Pediatric Type 1 Diabetes Care

Natalya Latysheva, MD

Due to the difficulties of pediatric uncontrolled type 1 diabetes (T1D) care, a new study aimed to reduce diabetes related emergency department admission and hospitalizations, as well as improve diabetes control in patients.

A team of investigators, led by Natalya Latysheva, MD, Pediatric Endocrinology Fellow, UMass Medical School - Baystate, observed the result of the study showed care coordination seemed to decrease the frequency of negative outcomes in pediatric T1D care, including emergency department visits and hospitalizations.

The data was presented during the American Academy of Pediatrics (AAP) 2021 Virtual Conference.

Methods

The study was performed at a mid-sized tertiary hospital in Massachusetts with care of >700 patients with T1D, patients with HbA1c persistently >9.0%, and a recurrent amount of ED and hospital admissions were offered services with a Care Coordinator.

Patients were enrolled between May 2017 - April 2018, with inclusion criteria including children between 2 - 21 years old with T1D. Investigators collected data from medical records on HbA1C level and frequency of ED visits and hospitalizations during the study period.

A total of 3 quality improvement (QI) cycles were implemented by the study designers.

The first cycle took place between May 2018 - April 2019 with first contact including a direct 24/7 cell phone number to call or text for advice, supply requests or appointment reminders. A care coordinator was involved to become a link between the clinicians and the patient’s families.

Next, the second cycle transpired between May 2019 - April 2020 with added alerts of emergency department admission to the care coordinator, contact with school nurses, and goals set with patients and families.

Then, the third cycle occurred between May 2020 - April 2021 and included collaboration with a social worker on social barriers, as well as behavioral health consults on the day of patient’s visit.

Outcomes included changes in HbA1C level, number of ED visits, and the number of hospital admissions.

Findings

Out of a total of 3A total of 21 patients were enrolled in the study, with a mean age of 16 years and mean time from diagnosis at 8 years.

Additionally, the mean  ± SD HbA1C level decreased from 11.6% ± 2.6 at the baseline to 10.2% ± 2.6 during Cycle 3. Investigators noted 6 patients showed a decrease of >2.5% and 3 patients showed a decrease of >5.0%.

Data show the decrease in emergency department visits from the baseline to Cycle 3 from 26% with 0.71 person/year to 0.52 person/year.

Then, hospitalization rates from the baseline to Cycle 3 decreased 19% from 0.52/person/year to 0.43/person/year, while hospitalizations showed an increase of 50% during Cycle 3, which investigators attributed to the 2020 pandemic.

Takeaways

“The use of intensive interventions implemented by Personalized Care Coordinator/Liaison as a part of the diabetes care team was associated with a sustained decrease in ED visits, hospital admissions, and HbA1C levels over 3 years,” investigators wrote.

The study, “Intensive Care Coordination Reduced ED Visits and Hospital Admissions in Pediatric Patients with Uncontrolled Type 1 Diabetes,” was published by AAP 2021.