This project is part of the Maternal-Child Health Nurse Leadership Academy (MCHNLA), presented by Sigma Theta Tau International Honor Society of Nursing (Sigma) in partnership with Johnson & Johnson. About 132,000 Americans under the age of 18 years were diagnosed diabetes in 2017 and the incidence of pediatric Type I diabetes is rising. The cost of healthcare is 2.3 times higher for patients diagnosed with diabetes than that of those without diabetes. For children diagnosed between 3 and 9 years of age, their expected lifetime medical cost is estimated at $746,000,000. Parents of young children diagnosed with Type 1 Diabetes feel stressed, have a hard time feeling “normal”, fear giving up control of their child to others, and are always worried about their child suffering negative events. Case management is an efficient way to reduce parental stress, provide education, and to aid in improving social determinants of health. Case management after a new diabetes diagnosis is aimed at providing support and education once the child has been discharged and is settling into their new home routine. Addressing gaps in diabetes care is also important, as well visits and screenings may decrease the prevalence of complications.
Goals
This project was aimed at increasing support for parents of newly diagnosed children with diabetes. To meet this goal, the project was divided into two objectives – improve outreach, education, and support to parents and improve the method in which parents are identified for case management support.
Method
Prior to implementation, baseline data was collected as to how many children were identified for outreach monthly. To better capture parents in need of case management, the current criteria for outreach was made more inclusive to increase identification of children with diabetes and to identify all newly diagnosed children. To evaluate the effectiveness of the new criteria, the number of referrals each month was calculated . To increase education and support for parents, monthly educational blogs were developed. Social media, organizational emails, hospital transition coordinator, and participation at community events were used to market the blogs. Education was measured using a pre/post-test survey, website analytics for the blogs, as well as satisfaction questions during case management phone calls. To develop blog postings, a team was formed, meetings were held with the web design group at our organization, and blogs were collaboratively written based on topics identified by parents of children with Type 1 Diabetes. A research page containing community resources was incorporated into a link available within the blogs.
Results
The following data was collected to support the goal of increasing outreach to parents of children who have been newly diagnosed with diabetes. After the change in criteria for outreach, monthly referrals increased from an average of 14 per month to an average of 110 per month. All newly diagnosed children within the health plan were captured in this number. Of eight parents surveyed, parent pre-test answers were 80% average and post-tests were all 100% correct. The following positive feedback was from the mom of a newly diagnosed 4 year old child. “I cannot express our gratitude enough for all you are doing to help us. In experiencing the broken system firsthand, I feel strongly that change needs to happen. Not just for my son, but for anyone who has experienced the same struggles.” Data supporting implementation to increase education and support include that the blog postings had an average of 78 views per month with an average time on page of two minutes and thirty two seconds (after one month posted).
Conclusions
While hospitalized, stress can lessen the amount of education that parents absorb. Follow up education and support by a nurse case manager is beneficial. Addressing social determinants of health and providing community resources helps to fulfill basic needs of families so that they may be more successful in their child’s diabetes care. Answering questions, providing encouragement and reminders to take their child with diabetes to appointments and screenings is important in identifying complications early. Being that families are visiting the blog and spending time on the site, more support is needed in our communities for parents whose children are diagnosed with Type 1 Diabetes.