Cost-effectiveness of home versus hospital management of children at onset of type 1 diabetes: the DECIDE randomised controlled trial

McCarroll, Zoe; Townson, Julia; Pickles, Timothy; Gregory, John Welbourn; Playle, Rebecca; Robling, Michael; Hughes, Dyfrig

doi:10.1136/bmjopen-2020-043523

Cited by 4 publications

(2 citation statements)

References 27 publications

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“…In addition, from the perspective of health care providers, they could immediately respond to patients’ concerns in real time and monitor their actual lifestyle outside the clinic to jointly provide individualized support for behavioral modification. Another major benefit of this home care program is its potential to reduce costs without compromising its clinical effectiveness [ 29 ]. It could be cost-effective by reducing hyperglycemic events and minimizing acute complications that lead to emergency department visits or unplanned hospitalizations.…”

Section: Discussionmentioning

confidence: 99%

Clinical Effects of a Home Care Pilot Program for Patients with Type 1 Diabetes Mellitus: A Retrospective Cohort Study

Lee¹,

Kim²,

Kim

et al. 2023

Diabetes Metab J

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Background: Given the importance of continuous self-care for people with type 1 diabetes mellitus (T1DM), the Ministry of Health and Welfare of Korea launched a pilot program for chronic disease management. Herein, we applied a home care pilot program to people with T1DM to investigate its effects.Methods: This retrospective cohort study was conducted at a single tertiary hospital (January 2019 to October 2021). A multidisciplinary team comprising doctors, nurses, and clinical nutritionists provided specialized education and periodically assessed patients’ health status through phone calls or text messages. A linear mixed model adjusting for age, sex, and body mass index was used to analyze the glycemic control changes before and after implementing the program between the intervention and control groups.Results: Among 408 people with T1DM, 196 were enrolled in the intervention group and 212 in the control group. The reduction in glycosylated hemoglobin (HbA1c) after the program was significantly greater in the intervention group than in the control group (estimated marginal mean, –0.57% vs. –0.23%, <i>P</i>=0.008); the same trend was confirmed for glycoalbumin (GA) (–3.2% vs. –0.39%, <i>P</i><0.001). More patients achieved the target values of HbA1c (<7.0%) and GA (<20%) in the intervention group than in the control group at the 9-month follow-up (34.5% vs. 19.6% and 46.7% vs. 28.0%, respectively).Conclusion: The home care program for T1DM was clinically effective in improving glycemic control and may provide an efficient care option for people with T1DM, and positive outcomes are expected to expand the program to include more patients.

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Section: Discussionmentioning

confidence: 99%

Clinical Effects of a Home Care Pilot Program for Patients with Type 1 Diabetes Mellitus: A Retrospective Cohort Study

Lee¹,

Kim²,

Kim

et al. 2023

Diabetes Metab J

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“…A more in-depth comparison of AHaH operations is required. [18,41] and national healthcare [38]. Most evaluated daily expenditures, length of hospitalization, and immediate results.…”

Section: Comparing "Apples To Oranges" Te Fndings Show Thatmentioning

confidence: 99%

A SWOT Analysis of Hospitals’ and HMO Representatives’ Opinions regarding Hospital at Home in Israel

Harel,

Magnezi

2024

Health & Social Care in the Community

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Purpose. To examine attitudes regarding acute hospital at home (AHaH). Materials and Methods. A SWOT (strengths, weaknesses, opportunities, and threats) questionnaire was developed to interview 14 managers from health management organizations (HMOs) and hospitals. A mixed-method (qualitative/quantitative) analysis was used. Results. AHaH was provided by hospital or HMO staff or outsourced (private suppliers). Differences in service pertained mainly to on-site testing and imaging tools. All agreed that AHaH is favorable for patient outcomes and experience and that AHaH promotes medical service and clinical development. Barriers expressed were as follows: choosing the right patient; burden for caregivers and family; unclear financial incentive for providers; insufficient standardization, risk management, and quality control (expressed mainly by hospital representatives); and limited on-site testing, imaging, and telemonitoring (mainly expressed by HMO representatives). Conclusions. To increase use of AHaH, further development of on-site testing, imaging, telemonitoring, standards, and financial planning is needed. Research regarding quality and quantity, mid- and long-term medical implications, caregiver implications, and long-term systemic financial implications is required. Evaluating the fit between AHaH service provider (hospital/outsourced/HMO), patient group, and diagnosis is advised.

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General population screening for childhood type 1 diabetes: is it time for a UK strategy?

Besser

Gregory

et al. 2021

Arch Dis Child

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Type 1 diabetes (T1D) is a chronic autoimmune disease of childhood affecting 1:500 children aged under 15 years, with around 25% presenting with life-threatening diabetic ketoacidosis (DKA). While first-degree relatives have the highest risk of T1D, more than 85% of children who develop T1D do not have a family history. Despite public health awareness campaigns, DKA rates have not fallen over the last decade. T1D has a long prodrome, and it is now possible to identify children who go on to develop T1D with a high degree of certainty. The reasons for identifying children presymptomatically include prevention of DKA and related morbidities and mortality, reducing the need for hospitalisation, time to provide emotional support and education to ensure a smooth transition to insulin treatment, and opportunities for new treatments to prevent or delay progression. Research studies of population-based screening strategies include using islet autoantibodies alone or in combination with genetic risk factors, both of which can be measured from a capillary sample. If found during screening, the presence of two or more islet autoantibodies has a high positive predictive value for future T1D in childhood (under 18 years), offering an opportunity for DKA prevention. However, a single time-point test will not identify all children who go on to develop T1D, and so combining with genetic risk factors for T1D may be an alternative approach. Here we discuss the pros and cons of T1D screening in the UK, the different strategies available, the knowledge gaps and why a T1D screening strategy is needed.

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Cost-effectiveness of home versus hospital management of children at onset of type 1 diabetes: the DECIDE randomised controlled trial

Cited by 4 publications

References 27 publications

Clinical Effects of a Home Care Pilot Program for Patients with Type 1 Diabetes Mellitus: A Retrospective Cohort Study

Clinical Effects of a Home Care Pilot Program for Patients with Type 1 Diabetes Mellitus: A Retrospective Cohort Study

A SWOT Analysis of Hospitals’ and HMO Representatives’ Opinions regarding Hospital at Home in Israel

General population screening for childhood type 1 diabetes: is it time for a UK strategy?

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