Cost Analysis of the Credentialled Diabetes Educator Diabetes in Pregnancy Care Model versus Conventional Care

Neil, A; Weber, H; Murfet, G

Cost Analysis of the Credentialled Diabetes Educator Diabetes in Pregnancy Care Model versus Conventional Care

Neil, A Weber, H Murfet, G

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Publication Type:: Poster
Citation:: 2015
Issue Date:: 2015-04-16

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Field	Value	Language
dc.contributor.author	Neil, A
dc.contributor.author	Weber, H
dc.contributor.author	Murfet, G https://orcid.org/0000-0003-4486-388X
dc.date.accessioned	2022-01-29T00:28:18Z
dc.date.available	2022-01-29T00:28:18Z
dc.date.issued	2015-04-16
dc.identifier.citation	2015
dc.identifier.uri	http://hdl.handle.net/10453/153776
dc.description.abstract	INTRODUCTION: Diabetes in pregnancy (DIP) increases the risk of short and long-term adverse health outcomes in mothers and infants, with consequential resource implications. Reliance on conventional care including care initiation by an endocrinologist in rural/remote areas with resource and/or workforce constraints may compromise timely diagnosis and/or management. Innovative strategies such as the Credentialled Diabetes Educator (CDE) DIP Care Model, an evidence-based integrated interdisciplinary, screening and management protocol, may facilitate appropriate and timely care. AIM: Assess the economic credentials of the CDE DIP Care Model in a rural region of Australia. METHODS: Simple modelled economic analysis of Credentialled Diabetes Educator Diabetes in Pregnancy (DIP) care model compared with standard antenatal diabetes care, over a one-year period, from a health care system perspective. Assumed 1250 pregnancies, approximately the annual number in North West Tasmania. Source Data: Two, three-year uncontrolled clinical audits (07/2003-06/2006-retrospective; 01/2010-12/2012-prospective) of pregnancies identified as complicated by diabetes pre-and post-full implementation of the DIP Model in 2009. Model inputs: Rates of screening, identification, and outcomes assessed relative to all births in the region over each three year period. Adverse neonatal outcomes assessed as i) infants with congenital abnormalities (CA); and ii) infants with a severe metabolic impact (SMI), defined as infants born with macrosomia and hypoglycaemia +/-birth injuries. Resource use-derived from protocol (number and length of visits) and spectrum of use (tests, scripts) ascertained during clinical audits (2010-2012 post-audit). Neonates experiencing an adverse outcome were assigned an AR-DRG, P06A-B or P67A-C. Unit costs were based on salary costs for AHPs and published standards otherwise (2012 AUD). Average annual costs were assessed. RESULTS: Total costs increased by $33,447 under the CDE model including universal screening. Average expenditure for diabetes care reduced by $219 per patient managed given workforce changes (↓ physician and ↑ allied HPs visits). Five fewer babies were born without congenital abnormalities, and another five without severe metabolic impacts generating annual care savings estimated at over $150,000. CONCLUSIONS: Universal screening (CDE Model) more than doubled identification of women with GDM. The CDE DIP Care Model post-pregnancy follow-up facilitates pre-conception/early care. The Model is efficient and sustainable within a severely resource constrained rural context.
dc.language	en
dc.relation.ispartof	8th International Diabetes in Pregnancy Symposium 15-18 April 2015, Berlin, Germany. ePoster.
dc.rights	info:eu-repo/semantics/openAccess
dc.title	Cost Analysis of the Credentialled Diabetes Educator Diabetes in Pregnancy Care Model versus Conventional Care
dc.type	Poster
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Public Health
utslib.copyright.status	open_access	*
dc.date.updated	2022-01-29T00:28:17Z

Abstract:

INTRODUCTION: Diabetes in pregnancy (DIP) increases the risk of short and long-term adverse health outcomes in mothers and infants, with consequential resource implications. Reliance on conventional care including care initiation by an endocrinologist in rural/remote areas with resource and/or workforce constraints may compromise timely diagnosis and/or management. Innovative strategies such as the Credentialled Diabetes Educator (CDE) DIP Care Model, an evidence-based integrated interdisciplinary, screening and management protocol, may facilitate appropriate and timely care. AIM: Assess the economic credentials of the CDE DIP Care Model in a rural region of Australia. METHODS: Simple modelled economic analysis of Credentialled Diabetes Educator Diabetes in Pregnancy (DIP) care model compared with standard antenatal diabetes care, over a one-year period, from a health care system perspective. Assumed 1250 pregnancies, approximately the annual number in North West Tasmania. Source Data: Two, three-year uncontrolled clinical audits (07/2003-06/2006-retrospective; 01/2010-12/2012-prospective) of pregnancies identified as complicated by diabetes pre-and post-full implementation of the DIP Model in 2009. Model inputs: Rates of screening, identification, and outcomes assessed relative to all births in the region over each three year period. Adverse neonatal outcomes assessed as i) infants with congenital abnormalities (CA); and ii) infants with a severe metabolic impact (SMI), defined as infants born with macrosomia and hypoglycaemia +/-birth injuries. Resource use-derived from protocol (number and length of visits) and spectrum of use (tests, scripts) ascertained during clinical audits (2010-2012 post-audit). Neonates experiencing an adverse outcome were assigned an AR-DRG, P06A-B or P67A-C. Unit costs were based on salary costs for AHPs and published standards otherwise (2012 AUD). Average annual costs were assessed. RESULTS: Total costs increased by $33,447 under the CDE model including universal screening. Average expenditure for diabetes care reduced by $219 per patient managed given workforce changes (↓ physician and ↑ allied HPs visits). Five fewer babies were born without congenital abnormalities, and another five without severe metabolic impacts generating annual care savings estimated at over $150,000. CONCLUSIONS: Universal screening (CDE Model) more than doubled identification of women with GDM. The CDE DIP Care Model post-pregnancy follow-up facilitates pre-conception/early care. The Model is efficient and sustainable within a severely resource constrained rural context.

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