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Research

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

Meranda Nakhla, Elham Rahme, Marc Simard and Astrid Guttmann
July 25, 2017 5 (3) E586-E593; DOI: https://doi.org/10.9778/cmajo.20170022
Meranda Nakhla
Department of Pediatrics (Nakhla), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme), Montréal, Que.; Institut national de santé publique du Québec (Simard), Québec, Que.; Department of Pediatrics (Guttmann), The Hospital for Sick Children, University of Toronto; Institute of Health Policy, Management and Evaluation (Guttmann), University of Toronto; Institute for Clinical Evaluative Sciences (Guttmann), Toronto, Ont.
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Elham Rahme
Department of Pediatrics (Nakhla), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme), Montréal, Que.; Institut national de santé publique du Québec (Simard), Québec, Que.; Department of Pediatrics (Guttmann), The Hospital for Sick Children, University of Toronto; Institute of Health Policy, Management and Evaluation (Guttmann), University of Toronto; Institute for Clinical Evaluative Sciences (Guttmann), Toronto, Ont.
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Marc Simard
Department of Pediatrics (Nakhla), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme), Montréal, Que.; Institut national de santé publique du Québec (Simard), Québec, Que.; Department of Pediatrics (Guttmann), The Hospital for Sick Children, University of Toronto; Institute of Health Policy, Management and Evaluation (Guttmann), University of Toronto; Institute for Clinical Evaluative Sciences (Guttmann), Toronto, Ont.
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Astrid Guttmann
Department of Pediatrics (Nakhla), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme), Montréal, Que.; Institut national de santé publique du Québec (Simard), Québec, Que.; Department of Pediatrics (Guttmann), The Hospital for Sick Children, University of Toronto; Institute of Health Policy, Management and Evaluation (Guttmann), University of Toronto; Institute for Clinical Evaluative Sciences (Guttmann), Toronto, Ont.
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    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.

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    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.

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    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.

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    Table 1: Risk of diabetes-related emergency department visits and hospital admission by socioeconomic status and geographic location before and after implementation of the Network of Ontario Pediatric Diabetes Programs
    Variable*Adjusted rate ratio (95% CI)
    Before implementationAfter implementation
    Emergency department visits
    Socioeconomic quintile
        Q1 (lowest)1.60 (1.36 to 1.89)1.77 (1.55 to 2.03)
        Q21.49 (1.26 to 1.75)1.48 (1.28 to 1.70)
        Q31.20 (1.02 to 1.41)1.25 (1.09 to 1.44)
        Q41.14 (0.97 to 1.34)1.23 (1.07 to 1.41)
        Q5 (highest)1.001.00
    Geographic location
        Rural0.93 (0.80 to 1.07)1.20 (1.06 to 1.34)
        Urban1.001.00
    Hospital admissions
    Socioeconomic quintile
        Q12.40 (1.91 to 3.03)2.11 (1.77 to 2.52)
        Q21.76 (1.38 to 2.24)1.73 (1.44 to 2.08)
        Q31.47 (1.16 to 1.87)1.44 (1.19 to 1.74)
        Q41.21 (0.95 to 1.54)1.33 (1.11 to 1.60)
        Q51.001.00
    Geographic location
        Rural0.92 (0.75 to 1.12)0.93 (0.80 to 1.10)
        Urban1.001.00

    Note: CI = confidence interval.

    *Other variables in the multivariate model: sex, age group, fiscal year, dummy variable network implementation and the interaction terms fiscal year*network implementation, socioeconomic status*network implementation and geographic location*network implementation.

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      Table 2: Adjusted annual trend in diabetes-related emergency department visits and hospital admissions before and after network implementation
      Variable*Adjusted rate ratio (95% CI)
      Before implementationAfter implementation
      Emergency department visits
      Overall0.99 (0.97 to 1.01)0.94 (0.93 to 0.95)
      Socioeconomic quintile
          Q1 (lowest)1.01 (0.97 to 1.06)0.94 (0.92 to 0.96)
          Q20.98 (0.94 to 1.03)0.95 (0.93 to 0.97)
          Q30.95 (0.91 to 0.99)0.94 (0.92 to 0.96)
          Q40.99 (0.95 to 1.03)0.93 (0.92 to 0.95)
          Q5 (highest)0.99 (0.95 to 1.04)0.93 (0.91 to 0.96)
      Geographic location
          Rural1.01 (0.96 to 1.06)0.96 (0.94 to 0.98)
          Urban0.98 (0.96 to 1.00)0.94 (0.93 to 0.95)
      Hospital admissions
      Overall1.03 (1.01 to 1.06)0.94 (0.93 to 0.95)
      Socioeconomic quintile
          Q11.03 (0.97 to 1.09)0.93 (0.91 to 0.95)
          Q21.03 (0.97 to 1.10)0.96 (0.93 to 0.98)
          Q31.08 (1.01 to 1.15)0.93 (0.90 to 0.95)
          Q41.00 (0.94 to 1.07)0.96 (0.93 to 0.99)
          Q51.04 (0.96 to 1.12)0.95 (0.92 to 0.98)
      Geographic location
          Rural0.96 (0.89 to 1.03)0.97 (0.94 to 1.01)
          Urban1.05 (1.01 to 1.08)0.94 (0.93 to 0.95)

      Note: CI = confidence interval.

      *Other variables in the model: sex, age group and the interaction terms fiscal year*network implementation*socioeconomic status and fiscal year*network implementation*geographic location.

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      CMAJ Open: 5 (3)
      Vol. 5, Issue 3
      25 Sep 2017
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      Outcomes associated with a pediatric clinical diabetes network in Ontario: a population-based time-trend analysis
      Meranda Nakhla, Elham Rahme, Marc Simard, Astrid Guttmann
      Jul 2017, 5 (3) E586-E593; DOI: 10.9778/cmajo.20170022

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      Outcomes associated with a pediatric clinical diabetes network in Ontario: a population-based time-trend analysis
      Meranda Nakhla, Elham Rahme, Marc Simard, Astrid Guttmann
      Jul 2017, 5 (3) E586-E593; DOI: 10.9778/cmajo.20170022
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