Newly diagnosed children with juvenile Type 1 Diabetes (T1D) typically stay in hospital, which incurs healthcare costs and can be disruptive to families. A range of alternative models of care have been trialled to reduce costs and improve health outcomes and experiences for children and families. This research aims to explore implemented alternative models of care and their effectiveness.
We conducted a literature search of four databases, for peer reviewed studies focused on new diagnosis T1D models of care published from 2010 to 2021 written in English.
A total of eight studies met study inclusion. Model components included hybrid short hospital stays followed by home based, or outpatient clinic visits, for education and monitoring, and early integration of technology, specifically CGM (4T model). Outcomes included HbA1c levels, readmissions, cost, and model preference.
For home based or hybrid short hospital stays, four studies reported no significant differences in HbA1c or readmission rates between patients treated with in- and out- patient care. Cost reductions were observed when patients spent less time in hospital, along with reductions in health service usage. Patients and families preferred out-patient models of care to in-hospital care. Nurses looking after children with newly diagnosed T1D also preferred home-based care models, feeling that it improved relationships with families and opportunities for more effective education. A model based on the “four Ts” (teamwork, targets, technology and tight control) resulted in lower levels of HbA1c compared to a historic cohort.
Home-based or hybrid short-stay models proved cost efficient, did not reduce health education or outcomes, and were acceptable to healthcare professionals, patients and families. Additionally, technology with education support improves health outcomes. With only eight studies identified, there is a need for further research, especially on the effectiveness, cost-effectiveness and implementation determinants of each model of care.