Real-Time Support of Pediatric Diabetes Self-Care by a Transport Team

OBJECTIVE The study seeks to improve access for underserved patients via novel integration of Pedi-Flite (a critical care transport team) and to validate whether this safely enhances diabetes care and effectively expands the endocrine workforce. RESEARCH DESIGN AND METHODS The study retrospectively...

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Bibliographic Details
Published in:	Diabetes care Vol. 37; no. 1; pp. 81 - 87
Main Authors:	FRANKLIN, Brandi E, CRISLER, S. Crile, SHAPPLEY, Rebekah, ARMOUR, Meri M, MCCOMMON, Dana T, FERRY, Robert J
Format:	Journal Article
Language:	English
Published:	Alexandria, VA American Diabetes Association 01-01-2014
Subjects:	Allied Health Personnel - economics Allied Health Personnel - utilization Biological and medical sciences Care and treatment Child Child Health Services - economics Child Health Services - standards Child Health Services - utilization Clinical Care/Education/Nutrition/Psychosocial Research Cost Savings Cost-Benefit Analysis Diabetes Diabetes in children Diabetes Mellitus, Type 1 - economics Diabetes Mellitus, Type 1 - therapy Diabetes Mellitus, Type 2 - economics Diabetes Mellitus, Type 2 - therapy Diabetes. Impaired glucose tolerance Diabetic Ketoacidosis - economics Diabetic Ketoacidosis - etiology Diagnosis Emergency medical care Emergency Service, Hospital - statistics & numerical data Emergency Service, Hospital - utilization Endocrine pancreas. Apud cells (diseases) Endocrinology - manpower Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Female General aspects Health Services Accessibility - economics Health Services Accessibility - standards Hospitalization - economics Hospitalization - statistics & numerical data Humans Male Medical personnel Medical sciences Medically Underserved Area Metabolic diseases Odds Ratio Patient Care Team - organization & administration Pediatrics Referral and Consultation Regression analysis Retrospective Studies Risk factors Self Care - economics Self Care - standards Self-care, Health Social Support Telemedicine - economics Telemedicine - utilization Telephone - economics Telephone - utilization Transportation of Patients Tennessee Endocrinopathy Human Pediatrics Selfcare Nutrition Diabetes mellitus Metabolic diseases Real time Transport Child Endocrinology
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Summary:	OBJECTIVE The study seeks to improve access for underserved patients via novel integration of Pedi-Flite (a critical care transport team) and to validate whether this safely enhances diabetes care and effectively expands the endocrine workforce. RESEARCH DESIGN AND METHODS The study retrospectively analyzed pager service use in a cohort of established diabetic patients (n = 979) after inception of Pedi-Flite support. Outcomes included incidence and severity of recurrent diabetic ketoacidosis (DKA) and cost savings generated from reduced referrals to the emergency department (ED) and on-call endocrinologist. We generated descriptive statistics to characterize the study population and ED visits for DKA and constructed logistic regression models to examine associations of pager use and likelihood of ED visitation and nonelective inpatient admission from an ED for DKA. RESULTS Pager users comprised 30% of the patient population. They were younger but had more established diabetes than nonusers. While pager users were 2.75 times more likely than nonusers to visit the ED for DKA (P < 0.0001), their visits were less likely to lead to inpatient admissions (odds ratio 0.58; P < 0.02). More than half (n = 587) of all calls to the pager were resolved without need for further referral. Estimates suggest that 439 ED visits and 115 admissions were avoided at a potential cost savings exceeding 760,000 USD. CONCLUSIONS Integration of a transport service provides a novel, cost-effective approach to reduce disparities in diabetes care. Advantages include scalability, applicability to other disease areas and settings, and low added costs. These findings enrich an emerging evidence base for telephonic care-management models supported by allied health personnel.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Undefined-2 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	0149-5992 1935-5548
DOI:	10.2337/dc13-1041