Journal of Pediatric Psychology Advance Access originally published online on March 3, 2005
Journal of Pediatric Psychology 2005 30(8):656-666; doi:10.1093/jpepsy/jsi052
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Multisystemic Treatment of Poorly Controlled Type 1 Diabetes: Effects on Medical Resource Utilization
1 Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 2 Children’s Hospital of Michigan, 3 Department of Nursing, Wayne State University, 4 Medical University of South Carolina, and 5 Wayne State University
All correspondence concerning this article should be addressed to Deborah A. Ellis, PhD, Children’s Hospital of Michigan, Department of Child Psychitary and Psychology, 3901 Beaubien, Detroit, MI 48201. E-mail: dellis{at}med.Wayne.edu.
Objective To determine whether multisystemic therapy (MST), an intensive, home-based psychotherapy, could decrease rates of hospital utilization and related costs of care among adolescents with poorly controlled type diabetes. Methods Thirty-one adolescents were randomly assigned to receive either MST or standard care. MST lasted approximately 6 months, and all participants were followed for 9 months. Rates of inpatient admissions and emergency room (ER) visits were calculated for a 9-month prestudy period and during the 9 months of study participation. The relationship between changes in inpatient admissions and changes in metabolic control was also investigated. Results Intervention participants had a decreasing number of inpatient admissions from the baseline period to the end of the study, whereas the number of inpatient admissions increased for controls. Use of the emergency room did not differ. Related medical charges and direct care costs were significantly lower for adolescents receiving MST. Correlational analyses conducted with a subset of participants indicated that decreases in inpatient admissions were associated with improved metabolic control for MST but not control participants. Conclusions Findings suggest that MST has the potential to decrease inpatient admissions among adolescents with poorly controlled type 1 diabetes.
Key words: diabetes; ketoacidosis; multisystemic therapy.
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