Twenty years of a multidisciplinary paediatric diabetes home care unit

Area of Science:

• Pediatrics
• Endocrinology
• Healthcare Management

Background:

• Type 1 diabetes diagnosis often occurs when patients are not severely unwell.
• Hospitalization at diagnosis can cause significant emotional distress and separation for children.
• Home-based care models require appropriate support facilities.

Purpose of the Study:

• To evaluate the long-term effectiveness and sustainability of a multidisciplinary diabetes home care service for newly diagnosed children.
• To assess the impact of home care on hospital admissions, patient outcomes, and cost-effectiveness.

Main Methods:

• Establishment and long-term operation of a multidisciplinary diabetes home care service.
• Tracking the proportion of newly diagnosed children managed entirely at home.
• Monitoring hospital admission rates, particularly for diabetic ketoacidosis.
• Assessing overall blood glucose control in the patient cohort.

Main Results:

• Sustained management of a median of 43% of newly diagnosed children at home (range 31-67%) over 20 years.
• Significant reduction in hospital admissions, with a sustained diabetic ketoacidosis readmission rate of 4.1 bed-days per 100 patients/year.
• No deterioration in overall blood glucose control observed.
• Cost savings from reduced hospital bed occupancy exceeded the operational costs of the home care unit.

Conclusions:

• Home-based diabetes care for children is a feasible and effective model from diagnosis.
• This service reduces emotional burden, hospitalizations, and healthcare costs.
• The model demonstrates long-term sustainability and positive patient outcomes.