Feasibility test of a shared care network for children with type 1 diabetes mellitus.
The purpose of this feasibility study was to examine primary care pediatricians and a diabetes specialty team sharing the care of children with type 1 diabetes in a structured network.



A diabetes specialty team and 3 pediatric practice groups participated in training and shared care of patients with type 1 diabetes. The diabetes team-consisting of 1 pediatric endocrinologist, 2 nurses in advanced practice, and 1 master's-prepared registered dietitian-initiated therapy and self-management training for families; pediatricians implemented maintenance therapy. Role definitions, specially developed records, and a communication framework guided the interaction of providers. Satisfaction of families and pediatricians was assessed by questionnaire. The A1C level was used to assess patients' metabolic control.



Twenty-nine patients accepted pediatrician referral, 25 kept initial training sessions, and 20 completed at least 1 year in the network. All 24 invited pediatricians participated, and 17 enrolled patients. All families who completed satisfaction surveys were highly satisfied with the network. Nineteen pediatricians completed end-of-study questions and were also highly positive about sharing care with the specialty team. The mean A1C value was near target levels or better the first year, and it rose during the second year.



The study supports the feasibility of integrating general pediatrician and diabetes specialty services for children with type 1 diabetes. Larger studies are justified to assess the efficacy and effectiveness of shared care.
King
Elaine Boswell
EB
Vanderbilt Diabetes Research and Training Center, Nashville, Tennessee
Gregory
Rebecca Pratt
RP
Vanderbilt Diabetes Research and Training Center, Nashville, Tennessee
Flannery
Mary Ellen
ME
Vanderbilt Diabetes Research and Training Center, Nashville, Tennessee
D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000534:rehabilitation*; D005240:Feasibility Studies; D006801:Humans; D007858:Learning; D010348:Patient Care Team; D010353:Patient Education as Topic / Q000458:organization & administration*; D012017:Referral and Consultation