Abstract
OBJECTIVE: To identify patterns of outpatient care associated with diabetic ketoacidosis (DKA) abstract among pediatric patients with type 1 diabetes (T1D). METHODS: Retrospective cohort study using Medicaid claims data from 2009 to 2012 for children with T1D enrolled ≥365 consecutive days in California Children's Services, a Title V program for low-income children with chronic disease. Outcome was DKA hospitalization >30 days after enrollment. Outpatient visits to primary care, endocrinology, pharmacies, and emergency departments (EDs) were assessed during the 6 months before an index date: Either date of first DKA hospitalization or end of enrollment for those without DKA. Univariate and multivariate analysis was used to evaluate independent associations between DKA and outpatient care at clinically meaningful intervals preceding the index date. RESULTS: Among 5263 children with T1D, 16.7% experienced DKA during the study period. Patients with DKA were more likely to have had an ED visit (adjusted odds ratio [aOR] 3.99, 95% confidence interval [CI]: 2.60-6.13) or a nonpreventive primary care visit (aOR 1.35, 95% CI: 1.01-1.79) within 14 days before the index date, and less likely to have visited an endocrinologist (aOR 0.76, 95% CI: 0.65-0.89) within the preceding 120 days. Preventive visits and pharmacy claims were not associated with DKA. CONCLUSIONS: For children with T1D, recent ED visits and long intervals without subspecialty care are important signals of impending DKA. Combined with other known risk factors, these health-use indicators could be used to inform clinical and case management interventions that aim to prevent DKA hospitalizations.
| Original language | English (US) |
|---|---|
| Article number | e20153497 |
| Journal | Pediatrics |
| Volume | 137 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 1 2016 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
Cite this
Outpatient care preceding hospitalization for diabetic ketoacidosis. / Crossen, Stephanie; Wilson, Darrell M.; Saynina, Olga; Sanders, Lee M.
In: Pediatrics, Vol. 137, No. 6, e20153497, 01.06.2016.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Outpatient care preceding hospitalization for diabetic ketoacidosis
AU - Crossen, Stephanie
AU - Wilson, Darrell M.
AU - Saynina, Olga
AU - Sanders, Lee M.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - OBJECTIVE: To identify patterns of outpatient care associated with diabetic ketoacidosis (DKA) abstract among pediatric patients with type 1 diabetes (T1D). METHODS: Retrospective cohort study using Medicaid claims data from 2009 to 2012 for children with T1D enrolled ≥365 consecutive days in California Children's Services, a Title V program for low-income children with chronic disease. Outcome was DKA hospitalization >30 days after enrollment. Outpatient visits to primary care, endocrinology, pharmacies, and emergency departments (EDs) were assessed during the 6 months before an index date: Either date of first DKA hospitalization or end of enrollment for those without DKA. Univariate and multivariate analysis was used to evaluate independent associations between DKA and outpatient care at clinically meaningful intervals preceding the index date. RESULTS: Among 5263 children with T1D, 16.7% experienced DKA during the study period. Patients with DKA were more likely to have had an ED visit (adjusted odds ratio [aOR] 3.99, 95% confidence interval [CI]: 2.60-6.13) or a nonpreventive primary care visit (aOR 1.35, 95% CI: 1.01-1.79) within 14 days before the index date, and less likely to have visited an endocrinologist (aOR 0.76, 95% CI: 0.65-0.89) within the preceding 120 days. Preventive visits and pharmacy claims were not associated with DKA. CONCLUSIONS: For children with T1D, recent ED visits and long intervals without subspecialty care are important signals of impending DKA. Combined with other known risk factors, these health-use indicators could be used to inform clinical and case management interventions that aim to prevent DKA hospitalizations.
AB - OBJECTIVE: To identify patterns of outpatient care associated with diabetic ketoacidosis (DKA) abstract among pediatric patients with type 1 diabetes (T1D). METHODS: Retrospective cohort study using Medicaid claims data from 2009 to 2012 for children with T1D enrolled ≥365 consecutive days in California Children's Services, a Title V program for low-income children with chronic disease. Outcome was DKA hospitalization >30 days after enrollment. Outpatient visits to primary care, endocrinology, pharmacies, and emergency departments (EDs) were assessed during the 6 months before an index date: Either date of first DKA hospitalization or end of enrollment for those without DKA. Univariate and multivariate analysis was used to evaluate independent associations between DKA and outpatient care at clinically meaningful intervals preceding the index date. RESULTS: Among 5263 children with T1D, 16.7% experienced DKA during the study period. Patients with DKA were more likely to have had an ED visit (adjusted odds ratio [aOR] 3.99, 95% confidence interval [CI]: 2.60-6.13) or a nonpreventive primary care visit (aOR 1.35, 95% CI: 1.01-1.79) within 14 days before the index date, and less likely to have visited an endocrinologist (aOR 0.76, 95% CI: 0.65-0.89) within the preceding 120 days. Preventive visits and pharmacy claims were not associated with DKA. CONCLUSIONS: For children with T1D, recent ED visits and long intervals without subspecialty care are important signals of impending DKA. Combined with other known risk factors, these health-use indicators could be used to inform clinical and case management interventions that aim to prevent DKA hospitalizations.
UR - http://www.scopus.com/inward/record.url?scp=84971571120&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84971571120&partnerID=8YFLogxK
U2 - 10.1542/peds.2015-3497
DO - 10.1542/peds.2015-3497
M3 - Article
C2 - 27207491
AN - SCOPUS:84971571120
VL - 137
JO - Pediatrics
JF - Pediatrics
SN - 0031-4005
IS - 6
M1 - e20153497
ER -