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Youth Repeatedly Hospitalized for DKA: Proof of Concept for Novel Interventions in Children’s Healthcare (NICH)

Diabetic ketoacidosis (DKA) is the most common reason for hospitalization of youth with type 1 diabetes. The annual cost of care for youth with type 1 diabetes with and without DKA was estimated to be $14,236 and $8,398, respectively (1). There appears to be a subgroup of youth with type 1 diabetes that encounters many psychosocial challenges that put them at risk for repeated hospitalizations for DKA. With intervention, these DKA-related hospitalizations may be avoidable. Thus, consistent with the triple aim of health care reform (i.e., reducing costs, improving health, and improving care) (2), Novel Interventions in Children’s Healthcare (NICH) was developed to address the triple aim in youth with type 1 diabetes (3).

NICH is theoretically grounded in Urie Bronfenbrenner’s (4) social ecological …