Construction And Application Of Family-Centered Case Management Program For Children With Type 1 Diabetes

Background:Type 1 diabetes is a chronic lifelong disease,easy to cause acute and chronic damage to multiple organs in the body.In addition,the children have poor self-care ability and treatment adherence,which seriously affects the quality of life of children with diabetes.According to the latest statistics of the International Diabetes Federation,the number of children and adolescents with type 1 diabetes has reached 1.11 million,with 128,900 new cases every year.The incidence of type 1 diabetes in China ranks the fourth in the world.The implementation of continuous and overall individual medical care services is an important way to improve the quality of life of children.Studies and practices in developed countries such as the United States,Germany and Canada and Taiwan in China have shown that case management can effectively address the medical management needs of diabetic children.Case management is still in its infancy in China,with limited experience and system construction,and it is rarely used in children with diabetes.In this study,on the basis of literature analysis and clinical research,combining with the characteristics of diabetes specialist clinical practice and the combination of family-centered care and case management,through Delphi expert letter consultation for constructing a family-centered case management program for children with type 1 diabetes.To verify the effectiveness of the intervention through experimental studies,with a view to providing high-quality,targeted and sustainable personalized medical care services for children and families.Objective:1.To investigate the current status of case management for children with diabetes in hospitals,and to provide model sample for the construction of case management of children with diabetes.2.To construct a family-centered case management program for children with type 1 diabetes,so as to standardize the clinical nursing practice of children with T1DM.3.To evaluate the effect of family-centered case management for children with type 1 diabetes.Methods:1.Cross-sectional study:A self-designed electronic questionnaire was used for a convenience sample survey of nursing managers and diabetes nurses from 89 hospitals in 31 provinces and autonomous regions of China.2.Delphi technique:Based on literature review and clinical investigation,combined with the clinical practice characteristics of diabetes specialty,a draft of family-centered case management program for children with type 1 diabetes was formulated.Then 19 experts from 6 regions of China were selected to join in the two rounds of Delphi expert letter consultation and conduct statistical analysis and screening of indicators at all levels.The credibility of expert consultation results was analyzed by calculating the positive coefficient,authority coefficient and coordination coefficient of experts.3.Quasi-experimental study:Using the method of convenient sampling to select 62 children with type 1 diabetes admitted to the department of endocrinology of a tertiary children's hospital from September 2018 to July2019 as the research object.The experimental group?33 cases?received family-centered case management,and the control group?29 cases?received routine care.The intervention duration was 6 months.HbA_1c,early morning blood glucose,fasting blood glucose,bedtime blood glucose and quality of life were compared between the two groups.Results:1.A total of 28 children's hospitals,49 general hospitals and 12maternal and child health care institutions were investigated.Among them,23 hospitals?25.84%?carried out case management for children with diabetes.However,among the 178 respondents,only 124?69.66%?were aware of case management.The development rate of pediatric diabetes case management in children's hospitals and tertiary hospitals was better than that in non-specialized children's hospitals and secondary hospitals.The top three reasons why hospitals did not develop case management for diabetic children included knowing little about case management among relevant professional personnel,imperfection of operation system and staff shortage.2.The effective recovery rates of the two rounds of expert correspondence questionnaire were separately 95.0%and 100.0%with the authoritative coefficient being 0.89 and 0.87,and the Kendall's W values were all statistically significant?P<0.001?.The concentration of various indicators was relatively high.Finally,the family-centered case management program for children with type 1 diabetes was obtained,including the family-centered case management working process and evaluation indicators that consisted of 5 first-level ones,14 second-level ones and 34 third-level ones.3.After intervention for 6 months,self-assessment and parental-representative quality of life scale in the experimental group perform significant higher score than that in the control group?P<0.05?except for physiological function?P>0.05?;The early morning blood glucose,fasting blood glucose and bedtime blood glucose were lower than those of the control group?P<0.05?,and there was no statistically significant difference in HbA_1c between the two groups?P>0.05?.Conclusion:1.Case management for diabetic children is far beyond fully covered in domestic hospitals.Taking full advantage of children's hospitals and tertiary hospitals will facilitate the establishment of standardized work flows and effectiveness evaluation system,providing high-quality services for diabetic children.2.The family-centered case management program for children with type 1 diabetes is of significant credibility and feasibility,which can provide guidance and model sample for the nursing of children with type 1 diabetes.3.Family-centered case management can enhance control of glucose metabolism and improve life quality of children.