746-P: Identifying Health Care Disparities in Youth with T1D: Effectiveness of Novel Interventions in Children’s Healthcare (NICH) for Rural and Urban Youth

Abstract

Objective: Novel Interventions in Children’s Healthcare (NICH), an intensive behavioral health program, has demonstrated promise in reducing avoidable complications in youth with T1D. However, it is unclear whether these outcomes are consistent across regions, and how those variables may impact intensity of service delivery. This study aims to identify whether region and distance from NICH team base, when considering treatment intensity, moderate NICH outcomes. Methods: Youth with T1D served by NICH and covered by one of four major Medicaid providers were included (n=47). EHR review included frequency of DKA one year prior and two years following initiation of NICH services, distance from NICH team, type of region, and intensity of services delivered. Results: NICH youth demonstrated similar DKA reduction regardless of living in a rural or urban community. NICH providers delivered a per-family mean of 3 hours and 58 minutes per week of indirect and direct services, with more time spent in face-to-face service delivery and less time on transportation with families living closer to NICH team. NICH providers were significantly (p<.05) more likely to meet weekly with caregivers if youth lived within an hour of the team. When examining DKA incidence following NICH initiation, youth living more than one hour from the NICH team averaged a 46% decrease, those within 1-2 hours showed a 71% decrease, and those living more than 2 hours away showed no change in DKA frequency. Conclusion: This study represents the first examination of how system-level characteristics might moderate NICH services and related effectiveness. While outcomes were similar across urban and rural communities, NICH youth living closer to the NICH team experienced greater caregiver access to services and were more likely to demonstrate reductions in DKAs compared to those living more than 2 hours away. Such findings have implications for model adaptation and dissemination. Disclosure C. Jenisch: None. D.V. Wagner: None. A.F. Manabat: None. M. Heywood: None. E. Karkula: None. A. Sheffield: None. J.D. Ogden: None. H. Nagra: None. M.A. Harris: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust