Moving the Needle on the High-Risk T1D Patient – Lessons and Perspectives from the T1D Exchange Quality Improvement Collaborative

The T1D Exchange Quality Improvement Collaborative (QIC) is a T1D learning health system that includes over 10 endocrinology centers nationwide, working collaboratively on a shared goal of improving outcomes for people with T1D. The program is coordinated by the QI team at T1D Exchange in Boston.

The research presented by the QI team at the 80th American Diabetes Association Scientific Sessions covered a range of different subjects, clinical interventions, and QI principles.

One of the posters, titled Moving the Needle on the High-Risk T1D Panel: Lessons from the T1D Exchange Quality Improvement Collaborative, looked at the increased risk of acute and chronic complications among the high-risk populations around the country. These negative outcomes were exacerbated by social contexts, systemic racism, and economic instability in the communities.

The 10 clinics used QI principles to test changes and expand effective interventions in order to reduce the the proportion of high-risk patients.

Defining and dealing with high-risk patients

The teams defined high-risk patients as those with two or more clinic visits in the past 12-month period, as well as two HbA1c measurements above 9%. Clinics shared monthly data with the coordinating office, and co-developed a design to support patient needs.

The clinics implented five key interventions:

  • Support for glycemic management
  • Glucose monitoring
  • Insulin management
  • Patient-centered care
  • Access to clinic and psycho-social care

The collaborative set a goal to decrease the percentage of patients classified as high-risk by 5 percent from the baseline over the trial period – overall, they achieved a significant 3% reduction in high-risk patients, and 6 out of 10 clinics achieved or exceeded the goal.

The clinics created a range of tools that were then tested locally and spread as best practices across the Collaborative – if you’re interested in them, they’re accessible to all clinics and can be found on the T1D Exchange website.

The data generated by this initiative permitted endocrinology divisions to advocate for additional staff to help support the high risk patients, including patient navigators, social workers, case workers, psychologists, and certified diabetes educators (CDEs).

Clinics were able to identify some common goals, ensuring that all their patients and families were coached on sick day protocols and were able to access affordable insulin.

Stay tuned to Glu for more information about research presented at ADA 2020.

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