Outpatient care preceding hospitalization for diabetic ketoacidosis

Stephanie Crossen, Darrell M. Wilson, Olga Saynina, Lee M. Sanders

Research output: Contribution to journalArticle

3 Citations (Scopus)

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 languageEnglish (US)
Article numbere20153497
JournalPediatrics
Volume137
Issue number6
DOIs
StatePublished - Jun 1 2016
Externally publishedYes

Fingerprint

Diabetic Ketoacidosis
Ambulatory Care
Hospitalization
Type 1 Diabetes Mellitus
Hospital Emergency Service
Odds Ratio
Confidence Intervals
Primary Health Care
Endocrinology
Pharmacies
Medicaid
Case Management
Chronic Disease
Cohort Studies
Outpatients
Multivariate Analysis
Retrospective Studies
Pediatrics

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 journalArticle

Crossen, Stephanie ; Wilson, Darrell M. ; Saynina, Olga ; Sanders, Lee M. / Outpatient care preceding hospitalization for diabetic ketoacidosis. In: Pediatrics. 2016 ; Vol. 137, No. 6.
@article{d1ecc9e556704c99b4b25919337ced17,
title = "Outpatient care preceding hospitalization for diabetic ketoacidosis",
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.",
author = "Stephanie Crossen and Wilson, {Darrell M.} and Olga Saynina and Sanders, {Lee M.}",
year = "2016",
month = "6",
day = "1",
doi = "10.1542/peds.2015-3497",
language = "English (US)",
volume = "137",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "6",

}

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 -