Franklin Brandi E, Crisler S Crile, Shappley Rebekah, Armour Meri M, McCommon Dana T, Ferry Robert J
Corresponding author: Robert J. Ferry Jr.,
Diabetes Care. 2014;37(1):81-7. doi: 10.2337/dc13-1041. Epub 2013 Aug 19.
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) after inception of Pedi-Flite support. Outcomes included incidence and severity of recurrent diabetic ketoacidosis (DKA) and cost savings generated from reduced referrals to the emergency department (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 nonelective inpatient admission from an ED for DKA. RESULTS Pager users comprised 30% of the patient population. They were younger but had more established diabetes than nonusers. While pager users were 2.75 times more likely than nonusers 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 that 439 ED visits and 115 admissions were avoided at a potential cost savings exceeding 760,000 USD. 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.
目的 本研究旨在通过将儿科急救转运团队（Pedi-Flite）进行创新性整合，改善医疗服务不足患者的就医机会，并验证这是否能安全地加强糖尿病护理并有效扩充内分泌科医护人员队伍。研究设计与方法 本研究回顾性分析了在Pedi-Flite支持开始后，一组已确诊糖尿病患者（n = 979）的传呼机服务使用情况。结果包括复发性糖尿病酮症酸中毒（DKA）的发生率和严重程度，以及因减少急诊转诊和内分泌科医生随叫出诊而节省的费用。我们生成描述性统计数据以描述研究人群及DKA患者的急诊就诊情况，并构建逻辑回归模型来检验传呼机使用与DKA患者急诊就诊及非选择性住院的可能性之间的关联。结果 传呼机用户占患者总数的30%。他们更年轻，但糖尿病病程比非用户更长。虽然传呼机用户因DKA前往急诊就诊的可能性是非用户的2.75倍（P < 0.0001），但他们就诊后住院的可能性较小（优势比为0.58；P < 0.02）。所有传呼机呼叫中超过一半（n = 587）无需进一步转诊即可解决。据估计，避免了439次急诊就诊和115次住院，潜在节省成本超过76万美元。结论 整合转运服务为减少糖尿病护理差异提供了一种新颖且具成本效益的方法。优点包括可扩展性、适用于其他疾病领域和环境以及新增成本低。这些发现丰富了由专职医护人员支持的电话护理管理模式的新兴证据基础。
