2404-PUB: Evaluating a Multidisciplinary Chronic Illness Management Program for Children and Adolescents

Objective: Among youth with type 1 diabetes mellitus (T1DM), older adolescents have demonstrated decreased compliance to treatment adherence, resulting in unfavorable disease control. Poor disease management established in this population can continue into adulthood, perpetuating the health and economic burden to the individual and society. This study aims to evaluate the effectiveness and sustainability of an inpatient multidisciplinary approach to treating children and adolescents with T1DM.

Methods: Patients with a diagnosis of T1DM admitted to the Chronic Illness Management Program (CIMP) between 1/1/2016 and 12/31/2017 were eligible for inclusion. Data related to physiological and psychosocial outcomes were compared between admission and discharge. Outpatient providers were contacted following a patient’s discharge from the CIMP for A1C and health care utilization data.

Results: During the 2-year study period, 57 inpatient admissions of children and adolescents with T1DM were included in the analysis sample. On average, there was a significant (p < 0.0001) reduction in A1C values from admission (11.1%) to discharge (9.1%). Patients improved significantly (p < 0.01) in all psychosocial outcome measures during their inpatient stay. While patient’s A1C values increased 3 months after discharge, they still sustained clinically significant improvements from admission values. Among outpatient providers successfully contacted, none reported any patient hospitalizations or diabetic ketoacidosis episodes in the 3 months following discharge from the CIMP.

Conclusion: The inpatient setting allows for an intensive multidisciplinary treatment model for T1DM management that demonstrates sustainable clinical improvements post discharge. This program model should be considered for adolescents who have been unable to successfully manage their T1DM with outpatient treatment alone. Evaluation of successful long-term management after the CIMP is currently underway.