Two-Day Hospital Program Reduces Readmissions for Children Newly Diagnosed With Type 1 Diabetes
Published March 2020 | JAMA Network Open
When children are diagnosed with type 1 diabetes, they often are admitted to a hospital even if they are not especially sick at the time. In our institution this standard of care often resulted in at least a 48-hour inpatient stay.
At the time of diagnosis, children require close observation during initial insulin therapy, families need education to manage the drug, and social support is needed to live with the condition, says Sarah Lawson, MD, Division of Endocrinology. However, admitting children early in their disease course who are well at the time of diagnosis can cause confusion and anxiety for families. And when those children are not facing complications such as diabetic ketoacidosis, insurance coverage denial rates for the hospital admission can reach 80%.
In a recent quality improvement study published in JAMA Network Open, Lawson detailed an elegant solution launched at Cincinnati Children’s: the shift to a “day hospital” program. The new two-day model provides supervision for families learning how to care for diabetes and manage insulin, while retaining access to the inpatient pharmacy, food services, fluid replacement, visits from rounding physicians, and bedside nurse support. Families can also go home for a night of practice between the two days of the program.
Lawson and colleagues compared outcomes for 96 patients in the day hospital program to the previous hospital admission approach. Day hospital charges averaged $2,800 vs. $24,103 for inpatient care. The time spent in the hospital dropped from 48 to 15 hours. But the 30-day readmission rate dropped to zero compared with an industry-wide 15% average. One year later, the readmission rate for day hospital graduates was 3% compared to 24% for the traditional approach. The new insurance denial rate: 0%.
These results have since been presented at the Pediatric Endocrine Society and Cincinnati Children’s Grand Rounds. The team also created a digital book, “Diabetes Day Hospital Program Development,” to provide to other hospitals.
