Redesigned Care Delivery for Insulin-Requiring Diabetes in Pregnancy Improves Perinatal Glycemic Control While Reducing Neonatal Intensive Care Admissions, Length of Stay, and Costs

Craig H Syrop, Sarah A Wernimont, Diedre K Fleener, Joseph M Kardos, Linda M Rubenstein, Janet I Andrews

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: We sought to improve perinatal glycemic control and downstream neonatal outcomes through redesigned ambulatory management for women with insulin-requiring diabetes in pregnancy. Methods: To address gaps in perinatal glycemic management of women with insulin-requiring diabetes in pregnancy, redesigned care delivery (RCD) utilized integrated practice unit and minimally disruptive medicine concepts with incorporation of cellular-enabled glucose monitoring. Primary outcomes of RCD (N = 129) included hemoglobin A1c ([HbA1c], within RCD cohort), and gestational age (GA) at delivery, neonatal intensive care (NICU) admission, and NICU length of stay (LOS) compared with a preredesign care cohort (Pre-RCD; N = 122). Secondary outcomes included facility, payer reimbursement, and program costs. Generalized linear models assessed continuous variables while logistic regression methods assessed categorical outcomes. Results: Utilizing RCD, 92% of women with an initial HbA1c <6.5% maintained glycemic control until delivery, and 67.2% with an initial HbA1c ≥6.5% achieved delivery levels <6.5%. NICU admissions and GA-adjusted LOS decreased significantly [Pre-RCD vs. RCD: NICU admissions, 41.0% vs. 27.3%, p < 0.024; NICU LOS (95% confidence interval [CI]), 21.9 (17.1-26.6) vs. 14.6 (9.1-20.1), p = 0.045]. Every 10 days of redesigned management decreased mean NICU LOS by 1 day. Mean payer neonatal reimbursements decreased over $18,000 per delivery (p = 0.08) compared with implementation costs of $1,942 per delivery. Conclusion: Redesigned perinatal diabetes care with remote glucose monitoring demonstrated improved outcomes and value through downstream neonatal outcomes and lower payer costs. Therefore, subsequent dissemination and sustainability of similar programs' improved outcomes will likely require payer support.

Original languageEnglish (US)
Pages (from-to)557-568
Number of pages12
JournalJournal of women's health (2002)
Volume30
Issue number4
DOIs
StatePublished - Apr 1 2021
Externally publishedYes

Bibliographical note

Funding Information:
This initiative was, and continues to be, funded by the University of Iowa Health Care.

Publisher Copyright:
© Copyright 2021, Mary Ann Liebert, Inc., publishers 2021.

Keywords

  • Blood Glucose
  • Blood Glucose Self-Monitoring
  • Child
  • Diabetes Mellitus
  • Female
  • Glycemic Control
  • Humans
  • Infant, Newborn
  • Insulin/therapeutic use
  • Intensive Care, Neonatal
  • Length of Stay
  • Pregnancy
  • perinatal diabetes outcomes
  • integrated practice unit
  • health care delivery
  • remote monitoring

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Journal Article
  • Research Support, N.I.H., Extramural

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