Pediatric type 1 diabetes

Reducing admission rates for diabetes ketoacidosis

Jeniece Trast Ilkowitz, Steven J. Choi, Michael L. Rinke, Kathy Vandervoot, Rubina A. Heptulla

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Diabetes ketoacidosis (DKA) is a life-Threatening complication of type 1 diabetes mellitus (T1DM). Reducing DKA admissions in children with T1DM requires a coordinated, comprehensive management plan. We aimed to decrease DKA admissions, 30-day readmissions, and length of stay (LOS) for DKA admissions. Methods: A multipronged intervention was designed in 2011 to reach all patients: (1) increase insulin pump use and basal-bolus regimen versus sliding scales, (2) transform educational program, (3) increased access to medical providers, and (4) support for patients and families. A before-After study was conducted comparing performance outcomes in years 2007-2010 (preintervention) to 2012-2014 (postintervention) using administrative data and Wilcoxon rank sum and Fischer exact tests. Results: DKA admissions decreased by 44% postintervention (16.7 vs 9.3 per 100 followed patient-years; P = .006), unique patient 30-day readmissions decreased from 20% to 5% postintervention (P = .001), and median LOS significantly decreased postintervention (P < .0001). Although not an original goal of the study, median hemoglobin A1C of a subset of the population transitioned from sliding scale decreased, 10.3% to 8.9% (P < .02). Conclusions: When clinical andwidespread program interventionswere used, significant reductions in DKA hospitalizations, 30-day readmissions, and LOS occurred for pediatric T1DM. Continuous performance improvement efforts are needed for improving DKA outcomes.

Original languageEnglish (US)
Pages (from-to)231-237
Number of pages7
JournalQuality Management in Health Care
Volume25
Issue number4
DOIs
StatePublished - Oct 1 2016

Fingerprint

Ketosis
Type 1 Diabetes Mellitus
chronic illness
Pediatrics
Length of Stay
Diabetes Complications
Hemoglobins
Hospitalization
Insulin
hospitalization
educational program
performance
Population

Keywords

  • Admissions
  • Diabetes Ketoacidosis
  • Length Of Stay
  • Pediatrics
  • Type 1 Diabetes Mellitus

ASJC Scopus subject areas

  • Leadership and Management
  • Health(social science)
  • Health Policy
  • Care Planning

Cite this

Pediatric type 1 diabetes : Reducing admission rates for diabetes ketoacidosis. / Ilkowitz, Jeniece Trast; Choi, Steven J.; Rinke, Michael L.; Vandervoot, Kathy; Heptulla, Rubina A.

In: Quality Management in Health Care, Vol. 25, No. 4, 01.10.2016, p. 231-237.

Research output: Contribution to journalArticle

Ilkowitz, Jeniece Trast ; Choi, Steven J. ; Rinke, Michael L. ; Vandervoot, Kathy ; Heptulla, Rubina A. / Pediatric type 1 diabetes : Reducing admission rates for diabetes ketoacidosis. In: Quality Management in Health Care. 2016 ; Vol. 25, No. 4. pp. 231-237.
@article{a2389a22b9034ee28ec4d5b53babce01,
title = "Pediatric type 1 diabetes: Reducing admission rates for diabetes ketoacidosis",
abstract = "Background: Diabetes ketoacidosis (DKA) is a life-Threatening complication of type 1 diabetes mellitus (T1DM). Reducing DKA admissions in children with T1DM requires a coordinated, comprehensive management plan. We aimed to decrease DKA admissions, 30-day readmissions, and length of stay (LOS) for DKA admissions. Methods: A multipronged intervention was designed in 2011 to reach all patients: (1) increase insulin pump use and basal-bolus regimen versus sliding scales, (2) transform educational program, (3) increased access to medical providers, and (4) support for patients and families. A before-After study was conducted comparing performance outcomes in years 2007-2010 (preintervention) to 2012-2014 (postintervention) using administrative data and Wilcoxon rank sum and Fischer exact tests. Results: DKA admissions decreased by 44{\%} postintervention (16.7 vs 9.3 per 100 followed patient-years; P = .006), unique patient 30-day readmissions decreased from 20{\%} to 5{\%} postintervention (P = .001), and median LOS significantly decreased postintervention (P < .0001). Although not an original goal of the study, median hemoglobin A1C of a subset of the population transitioned from sliding scale decreased, 10.3{\%} to 8.9{\%} (P < .02). Conclusions: When clinical andwidespread program interventionswere used, significant reductions in DKA hospitalizations, 30-day readmissions, and LOS occurred for pediatric T1DM. Continuous performance improvement efforts are needed for improving DKA outcomes.",
keywords = "Admissions, Diabetes Ketoacidosis, Length Of Stay, Pediatrics, Type 1 Diabetes Mellitus",
author = "Ilkowitz, {Jeniece Trast} and Choi, {Steven J.} and Rinke, {Michael L.} and Kathy Vandervoot and Heptulla, {Rubina A.}",
year = "2016",
month = "10",
day = "1",
doi = "10.1097/QMH.0000000000000109",
language = "English (US)",
volume = "25",
pages = "231--237",
journal = "Quality Management in Health Care",
issn = "1063-8628",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Pediatric type 1 diabetes

T2 - Reducing admission rates for diabetes ketoacidosis

AU - Ilkowitz, Jeniece Trast

AU - Choi, Steven J.

AU - Rinke, Michael L.

AU - Vandervoot, Kathy

AU - Heptulla, Rubina A.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Background: Diabetes ketoacidosis (DKA) is a life-Threatening complication of type 1 diabetes mellitus (T1DM). Reducing DKA admissions in children with T1DM requires a coordinated, comprehensive management plan. We aimed to decrease DKA admissions, 30-day readmissions, and length of stay (LOS) for DKA admissions. Methods: A multipronged intervention was designed in 2011 to reach all patients: (1) increase insulin pump use and basal-bolus regimen versus sliding scales, (2) transform educational program, (3) increased access to medical providers, and (4) support for patients and families. A before-After study was conducted comparing performance outcomes in years 2007-2010 (preintervention) to 2012-2014 (postintervention) using administrative data and Wilcoxon rank sum and Fischer exact tests. Results: DKA admissions decreased by 44% postintervention (16.7 vs 9.3 per 100 followed patient-years; P = .006), unique patient 30-day readmissions decreased from 20% to 5% postintervention (P = .001), and median LOS significantly decreased postintervention (P < .0001). Although not an original goal of the study, median hemoglobin A1C of a subset of the population transitioned from sliding scale decreased, 10.3% to 8.9% (P < .02). Conclusions: When clinical andwidespread program interventionswere used, significant reductions in DKA hospitalizations, 30-day readmissions, and LOS occurred for pediatric T1DM. Continuous performance improvement efforts are needed for improving DKA outcomes.

AB - Background: Diabetes ketoacidosis (DKA) is a life-Threatening complication of type 1 diabetes mellitus (T1DM). Reducing DKA admissions in children with T1DM requires a coordinated, comprehensive management plan. We aimed to decrease DKA admissions, 30-day readmissions, and length of stay (LOS) for DKA admissions. Methods: A multipronged intervention was designed in 2011 to reach all patients: (1) increase insulin pump use and basal-bolus regimen versus sliding scales, (2) transform educational program, (3) increased access to medical providers, and (4) support for patients and families. A before-After study was conducted comparing performance outcomes in years 2007-2010 (preintervention) to 2012-2014 (postintervention) using administrative data and Wilcoxon rank sum and Fischer exact tests. Results: DKA admissions decreased by 44% postintervention (16.7 vs 9.3 per 100 followed patient-years; P = .006), unique patient 30-day readmissions decreased from 20% to 5% postintervention (P = .001), and median LOS significantly decreased postintervention (P < .0001). Although not an original goal of the study, median hemoglobin A1C of a subset of the population transitioned from sliding scale decreased, 10.3% to 8.9% (P < .02). Conclusions: When clinical andwidespread program interventionswere used, significant reductions in DKA hospitalizations, 30-day readmissions, and LOS occurred for pediatric T1DM. Continuous performance improvement efforts are needed for improving DKA outcomes.

KW - Admissions

KW - Diabetes Ketoacidosis

KW - Length Of Stay

KW - Pediatrics

KW - Type 1 Diabetes Mellitus

UR - http://www.scopus.com/inward/record.url?scp=84995580393&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84995580393&partnerID=8YFLogxK

U2 - 10.1097/QMH.0000000000000109

DO - 10.1097/QMH.0000000000000109

M3 - Article

VL - 25

SP - 231

EP - 237

JO - Quality Management in Health Care

JF - Quality Management in Health Care

SN - 1063-8628

IS - 4

ER -