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Outcomes associated with a pediatric clinical diabetes network in Ontario: a population-based time-trend analysis
Meranda Nakhla1, Elham Rahme1, Marc Simard1
1Affiliations: Department of Pediatrics (Nakhla), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme), Montréal, Que.; Institut national de santé publique du Québec (Simard), Québec, Que.; Department of Pediatrics (Guttmann), The Hospital for Sick Children, University of Toronto; Institute of Health Policy, Management and Evaluation (Guttmann), University of Toronto; Institute for Clinical Evaluative Sciences (Guttmann), Toronto, Ont.
Insights
Implementing a pediatric diabetes network in Ontario reduced acute complications for children with diabetes. The network improved outcomes, especially for those with lower socioeconomic status, though rural disparities persist.
Area of Science:
- Pediatric Endocrinology
- Public Health
- Health Services Research
Background:
- The Network of Ontario Pediatric Diabetes Programs was established in 2001.
- This study evaluated its impact on acute diabetes-related complications and disparities.
Purpose of the Study:
- To assess if the pediatric diabetes network decreased acute complications.
- To determine if the network reduced socioeconomic and geographic disparities in outcomes.
Main Methods:
- Population-based time trend analysis of children (<18 years) with diabetes in Ontario (1996-2011).
- Used health administrative data and linear mixed-effects models to analyze emergency department visits and hospital admissions.
Main Results:
- Significant decrease in emergency department visits (17.0 to 10.00 per 100 children) and hospital admissions (8.8 to 5.0 per 100 children) post-network implementation (p < 0.001).
- Greatest decrease observed in lowest socioeconomic quintile and urban areas.
- Disparities in outcomes between lowest and highest socioeconomic quintiles decreased (p < 0.05).
- Urban patients had lower emergency visit risk than rural patients post-implementation.
Conclusions:
- Pediatric diabetes network establishment led to improved health outcomes, particularly for lower socioeconomic status patients.
- Further research is needed to address healthcare needs in rural pediatric diabetes populations.
Background:
The Network of Ontario Pediatric Diabetes Programs was implemented in 2001. The objective of this study was to determine whether implementation of the network was associated with a decrease in the risk of acute diabetes-related complications and a reduction in the socioeconomic and geographic disparities in these outcomes.
Methods:
We conducted a population-based time trend analysis of children (< 18 yr) with diabetes using health administrative databases in Ontario from 1996 to 2011. We determined the relation between network implementation and diabetes-related emergency department visits and hospital admissions using linear mixed-effects models with a Poisson link function.
Results:
Data for 13 806 children with established diabetes were analyzed. After the network was implemented, there was a significant decrease in the rate per 100 children of emergency department visits (17.0 in 2001 v. 10.00 in 2011, p < 0.001) and hospital admissions (8.8 v. 5.0, p < 0.001). The decrease was most significant for those in the lowest socioeconomic quintile and in urban areas. After network implementation, children in the lowest socioeconomic quintile remained at higher risk than those in the highest socioeconomic quintile for emergency department visits (adjusted rate ratio [RRafter] 1.77 [95% confidence interval (CI) 1.55 to 2.03]) and hospital admissions (RRafter 2.11 [95% CI 1.77 to 2.52]). However, the yearly decrease in rates of emergency department visits and hospital admissions for the lowest compared to the highest socioeconomic quintile shifted toward a decreasing disparity after network implementation (p < 0.05). Before the network was implemented, geographic location was not associated with outcomes. After implementation, the risk of emergency department visits among patients from urban areas was significantly lower than that among patients from rural areas.
Interpretation:
The establishment of a pediatric diabetes network was associated with better health outcomes, particularly for patients of lower socioeconomic status. Further work is needed to address the health care needs of those in rural areas.
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