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Assessment of a Day Hospital Management Program for Children With Type 1 Diabetes
Sarah Lawson1, Jacob M Redel1, Allison Smego1,2
1Cincinnati Children's Hospital Medical Center, Division of Pediatric Endocrinology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Insights
A diabetes day hospital model effectively manages new pediatric diabetes diagnoses, reducing hospital stays and patient costs. This approach improves insurance reimbursement rates and streamlines essential diabetes education.
Area of Science:
- Pediatric Endocrinology
- Quality Improvement in Healthcare
- Diabetes Management
Background:
- Type 1 diabetes diagnosis in children necessitates comprehensive education and insulin management.
- Traditional inpatient settings for new diabetes diagnoses are resource-intensive.
- A shift towards outpatient or day hospital models is being explored for pediatric diabetes care.
Purpose of the Study:
- To evaluate the efficacy and efficiency of a diabetes day hospital model for newly diagnosed pediatric patients.
- To compare the outcomes of a day hospital program with a traditional inpatient program for diabetes education and insulin titration.
Main Methods:
- A quality improvement study comparing retrospective inpatient data with prospective day hospital data.
- Inclusion criteria: new diabetes diagnosis, age 5+, no diabetic ketoacidosis.
- 96 patients completed the day hospital program; 192 completed the inpatient program.
Main Results:
- The day hospital model significantly reduced the mean length of stay from 46 to 14 hours.
- Mean patient charges decreased from $24,103 to $2,800, with over $2.1 million in cumulative savings.
- Insurance reimbursement rates increased from 52% to 72%, while denial rates dropped from 80% to 0%.
Conclusions:
- A diabetes day hospital setting is a viable and effective alternative for managing new pediatric diabetes diagnoses.
- This model reduces healthcare costs and improves patient access to essential diabetes education.
- The findings demonstrate a successful strategy for streamlining diabetes care delivery.
Importance:
A shift in the setting of care delivery for children with a new diagnosis of type 1 diabetes led to a reorganization of treatment.
Objective:
To determine whether a new diagnosis of pediatric diabetes can be successfully managed in a day hospital model.
Design, Setting, And Participants:
This quality improvement study used retrospectively collected data on pediatric patients with a new diagnosis of diabetes who completed an inpatient program for education and insulin titration prospectively compared with patients completing a diabetes day hospital program. Baseline data were collected over 12 months (January-December 2015) and intervention data collected over 14 months (March 2016-May 2017). The study was conducted at a single institution and judged as a nonhuman participant project. The referral local base included a 100-mile radius. Patient inclusion was a new diagnosis of diabetes, age 5 years or older, and no biochemical evidence of diabetic ketoacidosis. Ninety-six patients completed the day hospital program and 192 patients completed an inpatient program.
Exposures:
All patients received 2 consecutive days of insulin titration and education in either a day hospital or inpatient setting.
Main Outcomes And Measures:
Primary outcomes included the mean length of stay, patient charge, and insurance denial/reimbursement rates. The hypothesis was that a day hospital program would be associated with a reduced length of stay, which would directly affect patient charges and insurance denials.
Results:
Among the 96 day hospital patients, the mean (SD) age was 12.2 (4.7) years (range 5-20.3), with no patients experiencing diabetic ketoacidosis or hypernatremia. Among the 192 inpatient patients, the mean (SD) age was 9.4 (4.7) years (range, 1.6-20.1). The mean (SD) length of stay reduction in the day hospital was 46 (14.1) to 14 (5.1) hours. The mean day hospital patient charge was $2800, compared with a mean (SD) baseline carge of $24 103 ($9401). Within the first year, there was a cumulative reduction in patient charges of more than $2.1 million.
Conclusions And Relevance:
This study's findings suggest that a diabetes day hospital setting was associated with reductions in length of stay and patient charges, with an increase in insurance reimbursements and a decrease in insurance denials. This study demonstrates an effective way to streamline new-onset diabetes education, which may reduce length of stay and patient charges. Reimbursement rates for patients with a new diagnosis of diabetes increased from 52% to 72% and reimbursement denial rates decreased from 80% to 0%.
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