Objective: Youth struggling with diabetes management are at increased risk of DKA. Novel Interventions in Children’s Healthcare (NICH) is designed for youth with T1D who are experiencing or are at high risk of experiencing DKA. Previous findings from smaller samples indicate that youth in NICH are less likely to experience a DKA event and typically experience a shorter average hospital stay. However, counter to physician anecdotes, DKA-related lab values at admission for NICH patients do not differ from labs prior to program involvement. This study aims to determine whether patients in NICH are being discharged when less stable. Methods: Retrospective chart reviews were conducted on 52 youth enrolled and treated with NICH. Data included presence and number of DKA episodes in the year prior to and the year following NICH enrollment, as well as associated lab values at discharge—ketones, blood glucose level, bicarb, and pH. The mean youth age was 14.7 years (SD=3.5); 55.8% were female; and 92.3% were caucasian. Eighteen youth had lab values associated with DKA discharge available both prior to and during NICH. Results: Youth were less likely (p=.001) to experience DKA during NICH (35.3%) than prior to NICH (69.2%) and experienced fewer DKA events (t(51)=3.53; p=.001) during NICH (M=1.0; SD=1.8) than prior (M=1.8; SD=2.1). Regarding discharge presentation, only the presence of ketones indicated a significant difference (t(17)=2.11; p=0.5), with patients in NICH being discharged with trace to small ketones on average while in the program, as opposed to negative to trace ketones prior to program involvement. Conclusions: Youth in NICH experience fewer DKA events and are less likely to experience a DKA during program involvement. In addition, youth are discharged, on average, with a stronger presence of ketones during NICH than prior to program involvement. This may reflect increased medical provider confidence that ketones and associated youth health can be managed at home when NICH providers are involved. Disclosure D.V. Wagner: None. R. Chuong: None. N.C. Koskela: None. H. Luzod: None. E. Beeson: None. I. Guttmann-Bauman: None. M.A. Harris: Consultant; Self; Eli Lilly and Company.

Objective: Novel Interventions in Children’s Healthcare (NICH) was developed for youth with T1D who experience avoidable DKAs. Previous findings suggest that NICH participation is associated with fewer PICU visits, hospital admissions, and DKA events, but interpretation is limited due to possibility of regression to the mean. This study examines whether youth experience fewer acute events during the wait period following referral to NICH. Methods: Retrospective chart reviews were conducted for youth with T1D (n=63) who participated in NICH services. Youth mean age was 14.8 years; 57% were female; and 86% were Caucasian. Mean days prior to referral, on wait list, and during NICH were 365, 129, and 353, respectively. Results were normalized across time points to reflect rate of likely event occurrence during 1 year period. Results: Youth were significantly more likely to experience a PICU stay (p=.03) while waiting for NICH compared to baseline and were significantly less likely to experience a DKA (p=.02) or PICU stay (p=.01) during NICH involvement compared to the wait period. Conclusions: Instead of spontaneously improving after baseline (i.e., regression to the mean), youth referred to NICH experience an increase in acute complications while waiting for services, then improvement during NICH involvement. Perhaps referring providers are identifying factors that suggest further deterioration of health without more intensive services. Disclosure R. Sachdej: None. N.C. Koskela: None. D.V. Wagner: None. S.A. Barry: None. C. Jenisch: None. M.A. Harris: Consultant; Self; Eli Lilly and Company.

Objective: Novel Interventions in Children’s Healthcare (NICH) is a community-based, family-focused intervention for youth with T1D who experience self-management difficulty due to social challenges. Previous findings suggest that NICH participation is associated with improved glycemic control. However, conclusions are limited due to possibility that these outcomes are influenced by regression to the mean and not reflective of intervention effect. This study examines whether glycemic control regresses during wait period following referral to NICH. Methods: Youth with T1D and consistently poor glycemic control were referred to NICH and experienced a wait based on insurance approval and program capacity. Retrospective chart reviews collected HbA1c values in the year prior to referral, during wait period, and during NICH. Thirty-nine youth had lab values for all three time periods. Youth mean age was 15.4 years; 56% were female; and 85% were Caucasian. Mean days prior to referral, on wait list, and during NICH were 365, 161, and 394 days, respectively. Results: Average youth HbA1c remained relatively stable during the wait-period (t(38)=.509, p=.61), going from 11.6 (SD=1.5) to 11.5 (SD=1.6). Average youth glycemic control significantly decreased to 10.9 (SD=1.6) during NICH intervention compared to prior to referral (t(38)=2.31, p=.03) and during wait period (t(38)=2.30, p=.03). Conclusions: Youth glycemic control while waiting for NICH remained stable and high, only demonstrating significant and clinically meaningful improvement during NICH involvement. These findings suggest that, while regression to the mean should always be considered as a threat to validity, it may not apply to youth who have a history of significantly elevated A1cs. Thus, improvements experienced by these youth likely represent change associated with their involvement in NICH, and longer waits to access a program like NICH likely increase risk of short- and long-term diabetes complications. Disclosure D.V. Wagner: None. R. Sachdej: None. N.C. Koskela: None. S.A. Barry: None. H. Luzod: None. E. James-Unrein: None. M.A. Harris: Consultant; Self; Eli Lilly and Company.

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BackgroundSerious pediatric infections are treated safely with outpatient parenteral or prolonged oral antibiotic therapy (OPAT). The OPAT delivery system can be complex with outcomes complicated by social vulnerabilities in the lives of children on OPAT. Our goal was to better understand the psycho-social challenges pediatric families face undergoing OPAT.MethodsCaregivers of patients discharged on parenteral or prolonged oral antibiotics and referred to Doernbecher Children’s Hospital OPAT program between July 1, 2017 and December 31, 2017 were eligible for enrollment. We assessed health-related social vulnerabilities using a pre-discharge survey of pediatric caregivers. Child-specific medical information was collected by EMR review. Descriptive statistics were used to characterize social challenges.ResultsTwenty-six caregivers completed the survey. Mean patient age was 7.7 years. Infections included osteomyelitis (31%), endocarditis or infectious thrombophlebitis (19%), brain abscess or meningitis (15%), complicated pneumonia (12%), device-related infections (12%), or other (12%). Combined, patients spent 1,150 days on OPAT (390 parenteral; 760 prolonged oral antibiotic days). Of the social vulnerabilities endorsed, economic hardship featured prominently with 31% of caregivers having difficulty paying for food, housing or utilities and 12% having problems with appliances working at home. Among the caregivers, 23% reported inadequate social support, 42% reported psychological problems (31% anxiety; 19% depression), 15% reported involvement with child protective services, and 19% reported other legal concerns. 27% had difficulty getting time off work and 31% requested extra help with coordination of healthcare services. 58% of caregivers had a high school degree or less.ConclusionWe identified a large number of social vulnerabilities that likely impact pediatric OPAT care after discharge. Identifying social vulnerabilities for pediatric OPAT patients prior to discharge, such as health literacy or barriers to return visits, could better enable treatment customization or prompt care coordination that better supports pediatric OPAT patients.Disclosures All authors: No reported disclosures.