Comparing Outpatient and Inpatient Diabetes Education for Newly Diagnosed Pediatric Patients

Siminerio, Linda M.; Charron‐Prochownik, Denise; Banion, Carolyn R.; Schreiner, Barbara

doi:10.1177/014572179902500607

Cited by 35 publications

(26 citation statements)

References 24 publications

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“…24,41 A good system of care, including education, can be maintained through multidisciplinary cooperation, inpatient diabetes resources, and common goals. 30 Tools and supporting education can be and have been the responsibility of dedicated inpatient diabetes nurse and dietitian specialists. Care pathways, standardized assessment tools, and readily available teaching materials can solve many problems.…”

Section: Inpatient Diabetes Teamsmentioning

confidence: 99%

Patient Education in the Hospital

Nettles¹

2005

Diabetes Spectrum

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In Brief Recent concern about the optimum management of hyperglycemia for hospital patients has heightened awareness of necessary standards of care. Publications have confirmed that diabetes is not diagnosed or treated when detected in acute care settings, and opportunities for education are missed. Hospitalization presents an opportunity to address patients' unique urgent learning needs. In centers where quality diabetes management is a priority, education is readily available, roles are clear, and quality is monitored, evidence supports the notion that inpatient education is related to earlier discharge and improved outcomes following discharge.

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Section: Inpatient Diabetes Teamsmentioning

confidence: 99%

Patient Education in the Hospital

Nettles¹

2005

Diabetes Spectrum

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“…Initial diabetes education is important for establishing successful diabetes self-management, long-term glycemic control, and complication free survival [3]. Often, new-onset type 1 diabetic children are admitted to hospitals for metabolic stabilization and disease education, regardless of disease severity [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…While fifteen percent of newly diagnosed type 1 diabetic children require urgent insulin and fluid replacement treatment, one-third to one-half of them present with mild symptoms [6,7]. For children with mild to moderate symptoms and who are clinically stable, there is not definite evidence as to which healthcare setting is most cost-effective for the provision of initial type 1 diabetes management education and patient care [3]–[6,8]–[13]. …”

Section: Introductionmentioning

confidence: 99%

Healthcare cost of type 1 diabetes mellitus in new-onset children in a hospital compared to an outpatient setting

et al. 2013

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BackgroundType 1 diabetes is among the most prevalent chronic childhood diseases in the US. Initial type 1 diabetes management education and care can take place in different clinical settings. This study assessed metabolic outcomes (i.e. hemoglobin A1C), healthcare utilization and costs among new-onset type 1 diabetic children who received initial diabetes education and care in a hospital compared to those children in an outpatient pediatric endocrinology clinic.MethodsA retrospective cross-sectional study was conducted from the payer’s perspective. New-onset type 1 diabetic children, aged 1–18, presented at Baystate Children’s Hospital (Massachusetts) from 2008–2009 were included in the study if lab test confirmed diagnosis and there was one year of follow-up. Inpatients spent at least one night in the hospital during a 10-day diagnosis period and received all or part of diabetes education there. Outpatients were diagnosed and received all diabetes education in a pediatric endocrinology clinic. Metabolic outcomes were measured at diagnosis and at one year post-diagnosis. Healthcare charges and electronic medical records data were reviewed from 2008–2010. Healthcare costs components included diagnostic test, pediatric, endocrinology and hospitalists care, critical and emergency care, type 1 diabetes related supplies, prescription drugs, and IV products.ResultsStudy sample included 84 patients (33 inpatient and 51 outpatients). No statistically significant differences in patient demographic characteristics were found between groups. There were no statistically significant differences in metabolic outcomes between groups. Total cost at one year post-diagnosis per new-onset type 1 diabetic child was $12,332 and $5,053 in the inpatient and outpatient groups, respectively. The average healthcare cost for pediatric endocrinology care was $4,080 and $3,904 per child in the inpatient and outpatient groups, respectively.ConclusionProvision of initial type 1 diabetes education and care to new-onset non-critically ill children in a hospital setting increases healthcare costs without improving patient’s glycemic control in the first year post-diagnosis.

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“…2 Unfortunately, many studies of this issue are limited by differences in study populations 3,4 or short duration of reported follow-up after diagnosis. 5,6 Some studies suggest a neutral association between type of initial education and longer-term outcomes. For example, no differences in glycemic control or T1D-related hospitalization rates were found 2 years from time of diagnosis in children who had received inpatient or outpatient education at diagnosis from the same diabetes team.…”

mentioning

confidence: 99%

Long-Term Glycemic Control as a Result of Initial Education for Children With New Onset Type 1 Diabetes

et al. 2013

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Purpose The purpose of this study was to examine the role of initial diabetes education delivery at an academic medical center (AMC) versus non-AMCs on long-term glycemic control. Methods We performed a retrospective study of children with type 1 diabetes referred to an AMC after being educated at non-AMCs. These children were matched to a group of children diagnosed and educated as inpatients at an AMC. The A1C levels at 2, 3, and 5 years from diagnosis were compared between the 2 groups of children. Results Records were identified from 138 children. Glycemic control was comparable in the non-AMC-educated versus AMC-educated patients at 2, 3, and 5 years from diagnosis. The A1C was also highly consistent in each patient over time. Conclusions Long-term glycemic control was independent of whether initial education was delivered at an AMC or non-AMC. Formal education and location at time of diagnosis do not appear to play a significant role in long-term glycemic control. Novel educational constructs, focusing on developmental stages of childhood and reeducation over time, are likely more important than education at time of diagnosis.

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Comparing Outpatient and Inpatient Diabetes Education for Newly Diagnosed Pediatric Patients

Abstract: Findings support the safety and efficacy of the outpatient program method.

Cited by 35 publications

References 24 publications

Patient Education in the Hospital

Patient Education in the Hospital

Healthcare cost of type 1 diabetes mellitus in new-onset children in a hospital compared to an outpatient setting

Long-Term Glycemic Control as a Result of Initial Education for Children With New Onset Type 1 Diabetes

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