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The Diabetes Educator, Vol. 32, No. 5, 723-733 (2006)
DOI: 10.1177/0145721706292599

TODAY'S EDUCATOR

Feasibility Test of a Shared Care Network for Children With Type 1 Diabetes Mellitus

Elaine Boswell King, MSN, APRN, BC, CDE, Rebecca Pratt Gregory, MS, RD, LDN, CDE and Mary Ellen Flannery, MSN, RN, CDE

From Vanderbilt Diabetes Research and Training Center, Nashville, Tennessee.

Correspondence to Elaine Boswell King, MSN, APRN, BC, CDE, Vanderbilt Diabetes Research and Training Center, 315 Medical Arts Building, 1211 21st Avenue S, Nashville, TN 37212 (elaine.boswell.king{at}vanderbilt.edu).

Purpose

The purpose of this feasibility study was to examine primary care pediatricians and a diabetes specialty team sharing the care of children with type 1 diabetes in a structured network.

Methods

A diabetes specialty team and 3 pediatric practice groups participated in training and shared care of patients with type 1 diabetes. The diabetes team—consisting of 1 pediatric endocrinologist, 2 nurses in advanced practice, and 1 master's-prepared registered dietitian—initiated therapy and self-management training for families; pediatricians implemented maintenance therapy. Role definitions, specially developed records, and a communication framework guided the interaction of providers. Satisfaction of families and pediatricians was assessed by questionnaire. The A1C level was used to assess patients' metabolic control.

Results

Twenty-nine patients accepted pediatrician referral, 25 kept initial training sessions, and 20 completed at least 1 year in the network. All 24 invited pediatricians participated, and 17 enrolled patients. All families who completed satisfaction surveys were highly satisfied with the network. Nineteen pediatricians completed end-of-study questions and were also highly positive about sharing care with the specialty team. The mean A1C value was near target levels or better the first year, and it rose during the second year.

Conclusions

The study supports the feasibility of integrating general pediatrician and diabetes specialty services for childrenwith type 1 diabetes. Larger studies are justified to assess the efficacy and effectiveness of shared care.


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