The T1D Exchange Learning Collaborative also uncovered that adult diabetes clinics were much less likely than pediatric clinics to offer psychological services.
-by Craig Idlebrook/GluCraig
Most medical providers who care for people with type 1 diabetes want to provide the very best care for the type 1 community. And yet social media is filled with complaints from the type 1 community about substandard diabetes care. How can diabetes medical providers know that the care they are giving is meeting their patients’ needs?
“Measure it,” said Nicole Rioles, Director of Quality Care and Clinical Innovation with T1D Exchange*. “Stop and measure it. When I worked in a hospital, the chief of general medicine used to say to us, ‘If we aren’t measuring it, we aren’t doing it.’”
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That idea has become something like a mantra for the T1D Exchange Learning Collaborative, a network of seven pediatric clinics and three adult clinics which works with the quality improvement team at T1D Exchange to measure the quality of care provided and to pilot new methods to better serve the type 1 community.
The Collaborative presented findings of their initial work through three poster presentations at the American Diabetes Association’s 78th Annual Scientific Sessions, including a poster which discussed how the process works. Clinic staff across various centers use patient input and data to identify potential gaps in care. They then collectively test interventions to enhance their services. To make such a group effort work requires forging strong relationships and fostering open and honest communication among the participants of the Collaborative, said Rioles.
“That way, people don’t feel like they are being judged,” she said. “They feel supported enough to try and test something new, even if it might fail.”
One of the first initiatives of the Collaborative was screenings for depression. There is a growing body of evidence that untreated depression is associated with poor blood glucose management for people with diabetes. Despite this, depression screening at clinics can be spotty. Within a group of six Collaborative clinics, for example, some clinics were screening most patients for depression and others weren’t doing depression screening at all. That meant that, on average, just 10 percent of the eligible patient population were being screened at the time when the group began to examine this issue.
These six clinics participated in three learning sessions and then designed and tested ways to incorporate depression screenings in a way that worked for both patients and clinics. Within 18 months, they found that 60 percent of eligible patients were screened for depression. Most recently, that number has risen to 72 percent. Rioles is encouraged by the results.
“We’re hoping we set that for our benchmark,” she said. “If we can do that for depression, we can do that for many other areas.”
The Collaborative also decided to examine a perceived difference in staffing ratios between pediatric diabetes clinics and adult diabetes clinics. Collaborative members were concerned that adult diabetes clinics too often lacked support staff that might be more often found in pediatric clinics. That could lead to a lack of comprehensive care.
“There’s a case that kids need to be taught, they’re young, they need to keep learning,” Rioles said. “But if you’re a person with a new disease, regardless of your age, you still need to be taught. And people with type 1 diabetes always benefit from support when getting on new devices and technology or managing major transitions in life.”
The Collaborative collected data on 10 diabetes pediatric and adult diabetes clinics which collectively cared for roughly 23,000 people with type 1 diabetes. The researchers found the diversity of the staff differed greatly between the two groups of clinics. Clinics that cared primarily for adults had about half the diversity in staff roles as pediatric clinics, and often lacked personnel like psychologists and social workers. Armed with this data, Rioles said, officials connected with some of the adult clinics were able to use this data to make a case for their staffing needs.
“They were able to actually hire people based on that data,” she said.
The Collaborative is just two years old, and its work is just beginning. We’ll keep you posted on the progress of future initiatives in the coming months.
*T1D Exchange is the publisher of Myglu.org.