Collaborative Updates - Expansion of the T2DX-QI Pilot
T1D Exchange launched the Type 2 Diabetes (T2D) Quality Improvement Pilot Program in 2021 to address quality gaps in T2D using a similar model to the T1DX-QI program. The pilot with Stanford Health Care (Primary Care) and SUNY Upstate Medical University was successful. Key highlights from the pilot were presented at ADA 2022 and summarized below.
Improved T2D QI team capacity
Increased prescribing rates of Sodium-glucose Co transporter-2 (SGLT2) and Glucagon-like peptide-1 (GLP-1) receptor agonists by 18%
Increased depression screening by 34%.
We are excited to announce the expansion of the project to include three more active QI teams thanks to support from Abbott Diabetes. We are actively seeking additional funding to support further expansion of the T2DX-QI program.
Interested centers can now participate by contributing aggregate T2D data for benchmarking. Please email qi@t1dexchange.com to learn more.
T1DX-QI Recent Publications
In the past month, there have been two new publications!
Connecting From Afar: Implementation of Remote Data-Sharing for Patients With Type 1 Diabetes on Insulin Pump Therapy
Authors: Monica Grinaldi, Lisania Cardenas, Aledia Maria Saenz, Maddison Saalinger, Ori Odugbesan, Nicole Rioles, Osagie Ebekozien, Ernesto Bernal-Mizrachi, Francesco Vendrame. Check out this article using this link
Implementation of Psychosocial Screening into Diabetes Clinics: Experience from the Type 1 Diabetes Exchange Quality Improvement Network
Authors: Sarah Corathers, Desiree Wilford, Jessica Kichler, Laura Smith, Emma Ospelt, Saketh Rompicherla, Alissa Roberts, Priya Prahalad, Marina Basina, Cynthia Muñoz, Osagie Ebekozien. Use this link to view the article
T 1DX-QI representation at ATTD Berlin 2023
T1DX-QI six abstract presentations at ATTD Berlin 2023 were well received. Thank you for your contributions. Use this link to view these presentations!
PATIENT-REPORTED SEVERE HYPOGLYCEMIA AMONG HYBRID CLOSED LOOP SYSTEM (HCLS) USERS: REAL-WORLD EVIDENCE FROM A MULTI-CENTER STUDY FOR PEOPLE WITH TYPE 1 DIABETES
REDUCED ODDS OF DIABETIC KETOACIDOSIS AMONG HYBRID CLOSED LOOP SYSTEM (HCLS) USERS: PROPENSITY SCORE MATCH OF 8,455 PEOPLE WITH TYPE 1 DIABETES
CONTINUOUS GLUCOSE MONITOR (CGM) DERIVED GLYCEMIC OUTCOMES AMONG REAL-TIME CGM VS. FLASH CGM USERS IN A MULTI-CENTER EMR DATABASE FOR PEOPLE WITH T1D
HEMOGLOBIN A1C LEVELS AMONG PEOPLE WITH TYPE 1 DIABETES SWITCHING FROM SELF-MONITORING OF BLOOD GLUCOSE TO REAL-TIME CGM USE: A RETROSPECTIVE LONGITUDINAL STUDY
MULTI-CENTER DIABETES PROVIDER PERSPECTIVE ON BARRIERS TO SMART INSULIN PEN USE IN THE UNITED STATES
PRACTICAL STRATEGIES TO INCREASE CONTINUOUS GLUCOSE MONITOR (CGM) USE FOR UNDERSERVED PATIENTS WITH T1D IN THE US: RESULTS FROM THE T1D EXCHANGE MULTICENTER EQUITY STUDY
QI Portal Plot
This quarter six new centers have completed data mapping! Congratulations to our newest mapped centers! Log in today to compare with all 27 mapped centers!
QI Portal User Feature
1. What is your favorite feature in the Portal and why?
I love being able to quickly glance at “My Dashboard” on the T1DX-QI Portal to get a sense of how our site is doing compared to others in the Collaborative. Who doesn’t love a little friendly competition?!! All kidding aside, it’s inspiring to see how other centers are doing with our shared mission to measurably improve the lives of people with T1D.
2. Practically speaking, which feature (in addition to the above) do you use most often and why?
The “Compare” tab is very practical for viewing metrics of interest, assessing how our center is progressing over time, and visualizing how we compare to our peer institutions. We often show these run charts and comparative analytics at our multidisciplinary Division Meetings to highlight the amazing work that our QI and diabetes care team members are doing, as well as a call to therapeutic action to close our gap areas by highlighting the success of other centers
Name: Daniel DeSalvo, MD
Site: Texas Children's Hospital
Years with the T1DX-QI: 7
3. How does the Portal support your improvement efforts?
In the metric areas that we are lagging, we have connected with other centers who are doing exceptionally well to learn from their experience. This has informed many of our interventions and PDSA cycles towards closing those gaps.
4. What do you dream the portal could do that it doesn’t do currently?
Many of the features I used to dream of have now taken shape! For example, the ability to filter metrics of interest by race, ethnicity, gender, and insurance type. This helps us stay anchored in an equity framework in our QI initiatives. One dream that I still have is for device data including glycemic metrics beyond A1c (e.g., time-in-range, GMI, % <70 mg/dL, %<54 mg/dL, etc.) to sync directly to the EMR to enable data sharing with T1DX to facilitate reports and dashboards visualizing these important outcomes on the QI Portal. Can you imagine having the ability to select MDI vs. pump vs. AID users and visualize the differences in these important glycemic outcomes with the ability to filter by age, race/ethnicity, insurance, etc? Perhaps this could help move the bar in getting more public and private payers to cover these devices.
Q&A Corner
There have been several newly asked questions on the internal member website. Please use this link to respond and see all questions.
New Questions:
What QI resources and support do you have for QI efforts in your center and/or division? I recognize this will be highly variable based on clinic size and institutional resources, but I am curious about: (1) faculty support for QI efforts (FTE, protected time), (2) involvement of your clinic leadership (medical or associate medical directors) on the QI team, (3) who are the clinic/staff members on your team, (4) support and protected time for QI team members, (5) institutional resources available to you beyond your clinic or division, and (6) anything else? Please feel free to reach out individually if more appropriate. Thank you!
Name: Jenise Wong, MD
Clinic: UCSF Benioff Children’s Hospital
Does your clinic use saline education when starting insulin pumps? Or have you eliminated this from your practice?
Name: Olivia Docter, BSN, RN, CDCES Clinic: Barbara Davis Center
Answers:
1. Until recently, we required a saline start for all pump starts. For new to pump users transitioning to a Hybrid Closed Loop system, we no longer require this (mostly Tandem and Omnipod at this point). For those new to traditional pumping I think we may still consider a saline trial.
Name: Whitney Beaton, MSN, RN, ACCNS-P, CDCES
Clinic: UW Health Kids
2. Only for patients not starting hybrid closed loop.
Name: Janine Sanchez, MD,
Clinic: University of Miami Pediatrics
T1DX-QI In the News
If you or a member of your QI team were showcased in the news, celebrated a new promotion/milestones/award please share with us at qi@t1dexchange.org
New 2023-2025 QI measure are now live. You can find the measures here along with the most recent data specs (Core) and (Diabetes).
CME opportunity! For those that missed Dr. Akturk's session on
Prescribing and Educating Patients with T1D on the Use of Rapid and Inhaled Insulins, you can use this link to view the talk and see instructions on how to claim credit.
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