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The T1DX-QI is a type 1 diabetes learning health system including over 10 diabetes centers across the U.S. The program is coordinated by the T1D Exchange in Boston, MA.
Several research studies have demonstrated the impact of insulin pump use and frequent insulin bolusing on diabetes-related clinical outcomes. Five centers in the T1DX-QI used QI methodology including Plan – Do- Study – Act (PDSA) cycles to test and expand insulin pump use initiatives among patients aged 12 – 26 years at their centers. Successful interventions include developing mobile technology classes, redesigning workflow, coaching patients to bolus for meals and corrections, and removing barriers to adoption.
The centers shared data monthly with the coordinating office. These data were used for ongoing QI coaching and to promote the cross-sharing of best practices. Statistical Process Control charts with the relevant rules for fundamental improvements were used to evaluate project effectiveness. Two examples appear in Figure 1.
Three of five participating centers had substantial improvement in this process, ranging from 6% – 17%. There was a 10% significant change among the collaborative cohort in 20 months. Successful QI interventions improved pump use. Further expansion is needed to increase the percentages of patients meeting bolusing goals.