Pediatric Type 1 Diabetes: Reducing Admission Rates for Diabetes Ketoacidosis. Issue 4 (October 2016)

• Record Type: Journal Article
• Authors: Ilkowitz, Jeniece Trast; Choi, Steven; Rinke, Michael L.; Vandervoot, Kathy; Heptulla, Rubina A.
• Is Part Of: Quality management in health care. Volume 25:Issue 4(2016)
• Publication Date: 2016-10
• Subjects: admissions -- diabetes ketoacidosis -- length of stay -- pediatrics -- type 1 diabetes mellitus; Medical care -- Quality control -- Periodicals; Total quality management -- Periodicals; Health services administration -- Periodicals; 362.1068
• DOI: 10.1097/QMH.0000000000000109
• Languages: English
• ISSNs: 1063-8628

Abstract

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 and widespread program interventions were 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.