For decades, patients with new-onset diabetes who needed to begin insulin therapy were automatically admitted to the hospital. But as parents began requesting an outpatient alternative and insurance denials increased, pediatric endocrinologists at Cincinnati Children’s decided to consider an alternative way. The result was a new Diabetes Center Day Hospital that has dramatically reduced the cost of care, lowered the post-onset diabetes readmission rate and earned high marks from families.

New-onset patients with diabetic ketoacidosis (DKA) are still admitted to the hospital. Patients with ketones might be admitted, depending on the results of a renal panel. But all other patients—approximately 60 percent of children with newly diagnosed diabetes at Cincinnati Children’s—are sent home, with a care plan that includes a next-day admission to the day hospital. Their two-day visit involves meeting with physicians, certified nurse educators, registered dietitians and a social worker to learn essential information about diabetes, insulin therapy, carbohydrate counting and related topics.

“We began studying the traditional model because of insurance concerns, but soon realized that changing the way we cared for newly diagnosed patients could solve other problems as well,” says Sarah Lawson, MD, a pediatric endocrinologist at Cincinnati Children’s. “As we considered changing our approach, we talked to parents about their experiences at diagnosis. They remembered feeling confused —their child had been diagnosed early and was not in immediate danger, so why was a hospital stay necessary? They also described a sense of feeling overwhelmed by the amount of diabetes education they received during their child’s inpatient stay.”

Families build on their basic understanding of diabetes in the weeks and months following the day hospital stay. As part of a pilot program, the Diabetes Center livestreams educational classes and invites parents and other caregivers to watch online. “We didn’t change the content of our diabetes education program, but we did change where and how we teach it,” Lawson says. “Feedback has been very positive—patients and their families seem to retain the information better and need less help in between appointments.”

Since launching the Diabetes Center Day Hospital in mid-2017, the one-year readmission rate for new-onset pediatric diabetes patients has decreased from 14% to 3% (compared to a national baseline of 24%). The average cost for new-onset diabetes admissions has decreased from $24,000 to $2,800, insurance denial rates for patients who were not in DKA at diagnosis have dropped from 80% to 0%, and insurance reimbursement for day hospital charges is at 72%.