title: Pediatric Type 1 Diabetes: Reducing Admission Rates for Diabetes Ketoacidosis.
abstract: Diabetes ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM). Reducing DKA admissions in children with T1DM requires a coordinated, comprehensive management plan. We aimed to decrease DKA admissions, 30-day readmissions, and length of stay (LOS) for DKA admissions.
  
  
  
  A multipronged intervention was designed in 2011 to reach all patients: (1) increase insulin pump use and basal-bolus regimen versus sliding scales, (2) transform educational program, (3) increased access to medical providers, and (4) support for patients and families. A before-after study was conducted comparing performance outcomes in years 2007-2010 (preintervention) to 2012-2014 (postintervention) using administrative data and Wilcoxon rank sum and Fischer exact tests.
  
  
  
  DKA admissions decreased by 44% postintervention (16.7 vs 9.3 per 100 followed patient-years; P = .006), unique patient 30-day readmissions decreased from 20% to 5% postintervention (P = .001), and median LOS significantly decreased postintervention (P < .0001). Although not an original goal of the study, median hemoglobin A1C of a subset of the population transitioned from sliding scale decreased, 10.3% to 8.9% (P < .02).
  
  
  
  When clinical and widespread program interventions were used, significant reductions in DKA hospitalizations, 30-day readmissions, and LOS occurred for pediatric T1DM. Continuous performance improvement efforts are needed for improving DKA outcomes.
authors.affiliation: The Children's Hospital at Montefiore, Bronx, New York (Mss Ilkowitz and Vandervoot, and Drs Choi, Rinke, and Heptulla); and Albert Einstein College of Medicine, Bronx, New York (Drs Choi, Rinke, and Heptulla).
authors.forename: Jeniece Trast
authors.initials: JT
authors.lastname: Ilkowitz
authors.forename: Steven
authors.initials: S
authors.lastname: Choi
authors.forename: Michael L
authors.initials: ML
authors.lastname: Rinke
authors.forename: Kathy
authors.initials: K
authors.lastname: Vandervoot
authors.forename: Rubina A
authors.initials: RA
authors.lastname: Heptulla
mesh_terms: D000293:Adolescent; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy*; D016883:Diabetic Ketoacidosis / Q000517:prevention & control*; D005260:Female; D006442:Glycated Hemoglobin; D006297:Health Services Accessibility / Q000458:organization & administration; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007332:Insulin Infusion Systems; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010353:Patient Education as Topic / Q000458:organization & administration; D010359:Patient Readmission / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000458:organization & administration*
chemical_list: D006442:Glycated Hemoglobin