Real-time Support of Pediatric Diabetes Self-care by a Transport Team

  1. Robert J. Ferry Jr., MD2,4,*
  1. 1Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Science Center (Memphis TN);
  2. 2Le Bonheur Children’s Hospital (Memphis TN);
  3. Divisions of 3Pediatric Critical Care Medicine and
  4. 4Pediatric Endocrinology, Department of Pediatrics, University of Tennessee Health Science Center (Memphis TN)
  1. *Corresponding author: Robert Ferry, Jr., E-mail: bob{at}uthsc.edu

Abstract

Objective The study seeks to improve access for underserved patients via novel integration of Pedi-Flite (a critical care transport team) and to validate whether this safely enhances diabetes care and effectively expands the endocrine workforce.

Research design and methods The study retrospectively analyzed pager service use in a cohort of established diabetic patients (n=979) following inception of Pedi-Flite support. Outcomes included incidence and severity of recurrent DKA and cost savings generated from reduced referrals to the ED and on-call endocrinologist. We generated descriptive statistics to characterize the study population and ED visits for DKA and constructed logistic regression models to examine associations of pager use and likelihood of ED visitation and inpatient admission from an ED for non-elective DKA.

Results Pager users comprised 30% of the patient population. They were younger but had more established diabetes than non-users. While pager users were 2.75 times more likely than non-users to visit the ED for DKA (p<0.0001), their visits were less likely to lead to inpatient admissions (odds ratio 0.58; p<0.02). More than half (n=587) of all calls to the pager were resolved without need for further referral. Estimates suggest 439 ED visits and 115 admissions were avoided, at a potential cost-savings exceeding $760,000.

Conclusions Integration of a transport service provides a novel, cost-effective approach to reduce disparities in diabetes care. Advantages include scalability, applicability to other disease areas and settings, and low added costs. These findings enrich an emerging evidence base for telephonic care management models supported by allied health personnel.

  • Received May 1, 2013.
  • Accepted August 13, 2013.

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