Presentation Abstract

Session: Pediatric Type 1 Diabetes–Complications and Health Care Delivery
Abstract Number: 1251-P
Title: Emergency Healthcare Utilization for Young Adults (YA) with Type 1 Diabetes (T1D) Who Have Aged Out of Pediatric Healthcare
Presentation Start: 6/9/2012 11:30:00 AM
Presentation End: 6/9/2012 12:30:00 PM
Authors: PAOLA A. SEQUEIRA, MARC J. WEIGENSBERG, ELIZABETH A. PYATAK, LUCY MONTOYA, JAMIE R. WOOD, SUSAN CLARK, VALERIE RUELAS, ANNE L. PETERS, Los Angeles, CA, Orange, CA.
Abstract: Transitional care for YA with T1D is understudied and particularly important because of the change from family-focused care to independent disease management leaving the emerging adult without familiar resources and care. Our objective was to examine differences in emergency healthcare utilization among YA who had on-going care versus those lost to follow-up. Nonpregnant YA with T1D age 19-25yrs were recruited into 2 groups for a transition care program: 1)Continuity Group (CG), currently receiving routine diabetes care by pediatrics providers (n=81) and 2)Rescue Group (RG), finished pediatric care and were lost to medical follow-up for >3 mo (n=22). Baseline assessment for both groups included emergency department (ED) visits, hospitalizations, and paramedic utilization for the previous 6 mo and A1C. RG group was older and more predominantly Latino (Table). Within the 6 mo prior to enrollment, about 5 times as many people in RG used paramedics (p=0.02), more than 3 times as many had ED visits (p=<0.01), and ~3 times more were hospitalized (p=0.04) than in CG. RG also had significantly higher A1C values, adjusting for age and ethnicity (p< 0.05). Our results demonstrate that YA with T1D who experience absent or poor health care transition demonstrate increased emergency healthcare utilization and poorer glycemic control. Programs to improve transitional care for emerging adults with T1D may be useful in reducing excess emergency healthcare use and acute complications of diabetes.
Subject Characteristics and Healthcare UtilizationCG
(n=81)
RG
(n=22)
p value
Age (yrs)19.6 +0.9 21.1 + 1.1<0.001
Sex (% F)43.8%45.5%0.93
Age of Diagnosis
(yrs)
10.2+3.69.3+4.60.41
Ethnicity
(% Latino)
53.1%68.2%<0.01
Paramedic Use
n (%)
3 (3.7%)4 (18.2%) 0.02
ED Visits
n (%)
10 (12.3%)9 (40.9%)<0.01
Hospitalizations
n (%)
8 (9.9%)6 (27.3%)0.04
A1C (%)9.3+2.010.9+2.3<0.01

*Statistical analysis: Chi square for categorical variables; ANCOVA, adjusting age/ethnicity, for A1C.





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