How a program succeeds in reducing inequalities in type 1 diabetes care
Disparities are common in healthcare and can be related to a person’s place of residence, race / ethnicity, financial well-being, etc. To address these concerns, programs have been developed to tackle the problems. One of these programs is the Novel Interventions in Children’s Healthcare (NICH) program developed at Oregon Health & Science University in Portland. At the 81st American Diabetes Association Virtual Scientific Session, David Wagner, PhD, Associate Professor and NICH Research Director, and Winniebhelle Cadiz, BUILD EXITO Fellow, discussed the effect of the NICH program in children and adolescents with type 1 diabetes.
The NICH program was designed to help families with children with complex or chronic illnesses who have limited resources and face social or personal challenges that make managing a child’s illness difficult. The program matches the family with an interventionist available 24/7 for the family. The caregiver meets with the medical team dealing with the child’s condition and also meets with the child and family every week or every two weeks at home. He or she also helps arrange medical appointments, attends clinical visits, and connects the family with resources such as translators, food assistance programs, and transportation assistance. Type 1 diabetes is just one of the many conditions that can qualify a family for the NICH program.
Enrollment in NICH was associated with fewer complications such as contacts with pediatric intensive care units and admissions for diabetic ketoacidosis, as well as a reduction in the frequency of complications such as visits and admissions to departments. emergency. Wagner and his team wanted to see what the relationship was between participation in the NICH program and access to recommended outpatient care. There were 144 children included, 51 of whom were part of the program and 92 who could not be in the program. The average age was 13.7 years and 81% of the participants were non-Hispanic Caucasian. Although not ideal, all non-white participants were grouped into a Black, Native, Person of Color (BIPOC) intervention group and a BIPOC control group due to the small sample size. The research team found that there was little overall difference in outpatient appointment attendance in the NICH group, but when only the NICH BIPOC group was examined, there was a significant improvement in appointment attendance. you are ambulatory. BIPOC children who were not part of NICH had the lowest rates of access to care. The results indicate that NICH can significantly address disparities in access to health care for BIPOC children who would otherwise have difficulty accessing care.
Wagner and Cadiz noted that the original NICH groups were predominantly non-Hispanic whites and that other groups for the program would represent a more diverse patient population.
1. Wagner D, Cadiz, W. Reducing Racial / Ethnic Inequalities in Young People with T1D: New Interventions in Childhood Health Care (NICH). American Diabetes Association Scientific Sessions 2021; June 25, 2021; virtual. Accessed June 25, 2021.