Outcomes associated with a pediatric clinical diabetes network in Ontario: a population-based time-trend analysis

Abstract

Background: The Network of Ontario Pediatric Diabetes Programs was implemented in 2001. The objective of this study was to determine whether implementation of the network was associated with a decrease in the risk of acute diabetes-related complications and a reduction in the socioeconomic and geographic disparities in these outcomes.

Methods: We conducted a population-based time trend analysis of children (< 18 yr) with diabetes using health administrative databases in Ontario from 1996 to 2011. We determined the relation between network implementation and diabetes-related emergency department visits and hospital admissions using linear mixed-effects models with a Poisson link function.

Results: Data for 13 806 children with established diabetes were analyzed. After the network was implemented, there was a significant decrease in the rate per 100 children of emergency department visits (17.0 in 2001 v. 10.00 in 2011, p < 0.001) and hospital admissions (8.8 v. 5.0, p < 0.001). The decrease was most significant for those in the lowest socioeconomic quintile and in urban areas. After network implementation, children in the lowest socioeconomic quintile remained at higher risk than those in the highest socioeconomic quintile for emergency department visits (adjusted rate ratio [RRafter] 1.77 [95% confidence interval (CI) 1.55 to 2.03]) and hospital admissions (RRafter 2.11 [95% CI 1.77 to 2.52]). However, the yearly decrease in rates of emergency department visits and hospital admissions for the lowest compared to the highest socioeconomic quintile shifted toward a decreasing disparity after network implementation (p < 0.05). Before the network was implemented, geographic location was not associated with outcomes. After implementation, the risk of emergency department visits among patients from urban areas was significantly lower than that among patients from rural areas.

Interpretation: The establishment of a pediatric diabetes network was associated with better health outcomes, particularly for patients of lower socioeconomic status. Further work is needed to address the health care needs of those in rural areas.

Conflict of interest statement

Competing interests: See the end of the article.

Copyright 2017, Joule Inc. or its licensors.

Figures

Figure 1

Observed crude rates of (A) emergency department visits and (B) hospital admissions among Ontario children with type 1 diabetes mellitus, and trends in rates with (predicted rates) and without (projected rates) implementation of the Network of Ontario Pediatric Diabetes Programs. Dotted vertical line = implementation of the program.

Figure 2

Observed crude rates of (A) emergency department visits and (B) hospital admissions for the lowest (Q1) and highest (Q5) socioeconomic quintiles, and trends in rates with (predicted rates) and without (projected rates) implementation of the Network of Ontario Pediatric Diabetes Programs. Dotted vertical line = implementation of the program.

Figure 3

Observed crude rates of (A) emergency department visits and (B) hospital admissions by geographic location, and trends in rates with (predicted rates) and without (projected rates) implementation of the Network of Ontario Pediatric Diabetes Programs. Dotted vertical line = implementation of the program.