Targeted Social Work Assessments and Interventions for High-Risk Children and Adolescents with Type 1 Diabetes (T1D) Is Associated with a Reduction in Diabetic Ketoacidosis (DKA) Admission Rates

Presentation Number: SUN 282
Date of Presentation: April 2nd, 2017

Kelly Marie Fegan-Bohm*, Rona Yoffe Sonabend and Kristen R Hendrix
Baylor College of Medicine / Texas Children's Hospital, Houston, TX

Abstract

Background: DKA, the most severe complication of T1D in children and adolescents is often preventable. In our hospital, DKA admissions rose from 7.4% to 9.2% from 2013 to 2015 and repeat DKAs admissions rose from 17.5% to 24.2%. A multi-disciplinary team comprised of physicians, social workers, CDEs and psychologists worked to address this. They found that the care team had no standard way to identify high risk patients and no standard practice for interventions to reduce barriers to optimal diabetes care. The team worked to develop systems to assist social workers in identifying at-risk patients and apply targeted, patient-specific interventions to prevent DKA.

Aims: Reduce the percent of established patients with T1D admitted in DKA to 7% by Sept 30, 2016 (baseline 9.2% in April 2015).

With the following sub aims:

1) Increase the percent of outpatient social work assessments in patients with T1D to 50% (baseline 7.5%).

2) Increase the percent of new onset T1D patients receiving a diabetes specific social work assessment to 90% (baseline 35%).

3) Enroll 90% of patients with a DKA admission into a high-risk cohort (baseline 0%).

Methods: Using principles of Quality Improvement, the team implemented several interventions. First, the number of social workers was increased from two to four in a one-year period, including a high-risk social worker to address barriers to optimal T1D management for those admitted in DKA. Standard social work assessments (including one specific for assessing risk in new onset T1D patients1) were created using the electronic medical record and implemented to better identify T1D patients at risk. Social workers then pro-actively completed these assessments on patients not seen by social work in the year prior to identify those at risk and provide patient specific interventions when needed. Established patients admitted in DKA were enrolled in a high risk diabetes cohort, led by the high risk social worker who performed family meetings, patient-centered goal setting and provided ongoing follow up/interventions.

Results: From April 2015 to Sept 2016, the percent of patients with T1D assessed by a social worker rose from 7.5% to 68.4%. The percent of new onset patients with a diabetes specific social work assessment increased from 35% to 90%. 95% of established patients admitted in DKA joined the high-risk diabetes cohort. During this time, our DKA admit rate fell from 9.2% to 6.2% and the percent of patients re-admitted in DKA fell from 24.3% to 12.3%.

Conclusion: It is difficult to create a single intervention to prevent DKA admissions, as the causes are multi-factorial. One approach is to improve identification of high-risk patients in order to provide tailored interventions by social workers specifically trained to support patients with T1D. Additionally, successful interventions rely on multi-disciplinary teams to assess barriers to care and implement sustainable processes.

 

Nothing to Disclose: KMF, RYS, KRH