T1D Exchange Quality Improvement Coalition Panel Tackles Issues of Type 1 Diabetes Care

T1D Exchange Quality Improvement Coalition Panel Tackles Issues of Type 1 Diabetes Care
Daniel Pereira
In 2016, T1D Exchange launched its Quality Improvement Collaborative, bringing together 10 diabetes clinics to augment the quality of care across its locations. Over two years, the Collaborative grew to 12 sites and approximately 30,000 patients. Using the QIC model, the care teams worked hard to monitor and improve outcomes, redefine best practices, and better manage population health.
Their challenges and successes were highlighted last month at the 2019 T1D Exchange annual meeting in Cambridge, MA. 
A panel featured representatives from across the spectrum of care and clinical management, including patient advocacy, IT management, and clinic administration. The conversation ranged from how clinicians might maximize impact between clinic visits, to the promise of technology to the importance of the physician-patient relationship. Below are some highlights from the discussion.

Making the most of “the precious 45 minutes”

When asked, “What do you see are the particular challenges for the type 1 diabetes community?”, Dr. Mehta responded with the concept of “the precious 45 minutes.”
“There’s so much more we can do between visits,” he said. “It’s something everyone in this room thinks about.”

For many people with type 1 diabetes, a significant amount of a visit is spent updating, transferring, and recording data. As a result, it becomes difficult to tackle critical issues, such as managing bolus and basal rates and mental health concerns.
The panel agreed that technology will play a vital role in streamlining this process and improving both the delivery and the standard of care. At the same time, no one suggested that technology was a silver bullet to solve all the shortcomings of care. Devices that record and synchronize patient data, ideally on cloud-based platforms, can arm doctors with the metrics needed to quickly assess a patient’s blood sugar management trends between visits, possibly even before the patient arrives. 
Fully utilizing this technological help might require some investment, however.
One of the common threads identified by the panel members was the need for IT support and augmentation throughout differing medical practices. Medical technology available outside the walls of hospitals and clinics has often outstripped the systems used within medical care. For example, panelists discussed the challenges of delivering care when dealing with antiquated or restrictive electronic medical records (EMR) systems. The takeaway: to get the most out of today’s effective type 1 diabetes management technologies, one must optimize data systems and protocols. 

Outside the walls of the hospital

Beyond the clinical visit is life. As Melissa Anderson, patient advocate and mother of a daughter with type 1 diabetes, put it: “We see you [doctors] 4 times a year, and the other 361 days a year we’re doing it ourselves.”
What that means is that data, however critical, cannot replace a personal, patient-to-physician relationship. 
For example, the panel discussed strategies for working with patients who have been living with type 1 diabetes for several decades, many of whom learned their core strategies well before the advent of modern pumps, CGMs, and even brands of insulin. For that patient population, more technology and data-intensive care strategies may not work best. Ultimately, decision support should be individualized.

Balancing resources, technology, and human resources

That same close relationship with patients and parents, while a vital element of good care, can be hard to accomplish without enough full-time staff and professional training. Part of the goal of the Quality Improvement Collaborative is to generate the data necessary to identify and secure those kinds of human and educational resources. In fact, the Collaborative was able to make that case for bolstering staff and procedure to increase depression screening at particular clinics, helping them realize real improvements in clinical outcomes.
The panel was led and facilitated by Dominique Hurley, a member of the T1D Exchange Board of Directors, and a Vice President of Strategy and Innovation at HealthVerity and was comprised of  the following QIC members: 

  • Todd Alonso, MD,  assistant medical director for quality and access
  • at Barbara Davis Center for Diabetes at the University of Colorado.Melissa Anderson, a representative of the T1D Exchange Patient/Parent Advisory group and the parent of a child with type 1 diabetes.
  • Sanjeev Mehta, MD, MPH, chief medical information officer, chief quality officer, and a staff physician at Joslin Diabetes Center.
  • Ruth Weinstock, MD, PhD, division chief of Endocrinology and medical director of the Joslin Diabetes Center,at Upstate SUNY Upstate Medical University.

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