Pediatric type 1 diabetes: Reducing admission rates for diabetes ketoacidosis

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

Research output: Contribution to journalArticle

9 Scopus citations

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

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

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