Day 2: Improving Diabetes Patient Care — Highlights from T1DX-QI Learning Session 2023  - T1D Exchange

The T1D Exchange Quality Improvement Collaborative (T1DX-QI) Learning Session event 2023 took place in New York City on November 14 and 15 — “T1DX-QI: Sustaining Performance Improvement in Diabetes Care.”  

The T1DX-QI has grown from just over a dozen participating clinics in 2019 to 55 participating clinics in 2023, serving over 100,000 patients across the U.S. with type 1 and type 2 diabetes.  

Members from participating endocrinology clinics across the country come together to share insights on improving the care provided to people with diabetes — with the goal of improving quality of life and overall health.  

DAY 2 SESSION HIGHLIGHTS 

• Read all Learning Session 2023 abstracts here: The Diabetes Journal 
• Read: Highlights from Day 1 

Here are highlights from presentations during Day 2. 

Transitioning Children and Adolescents to Hybrid Closed Loop (HCL) Insulin Pumps  

WEILL CORNELL MEDICINE PEDIATRICS & NEW YORK PRESBYTERIAN KOMANSKY CHILDREN’S HOSPITAL: Emily Coppedge CPNP, CDCES, Isabel Reckson, RD, CDCES, Zoltan Antal, MD 

Background: 

“In children with type 1 diabetes, use of Hybrid Closed Loop Systems are associated with increased time in range, reductions in HbA1c, and decreased rates of hypoglycemia,” explains the abstract. “Only 14% of the pump population at WCM Pediatric Endocrinology use HCLs.” 

Goals: 

• Within 12 months, get 50% of all pump users on HCLs 

Methods: 

Develop a standardized process for educating patients about HCL pump technology: 

• Patient education 
• Provider education 
• Target existing pump users 
• Target patients with A1cs over 10% 
• Upgrade Omnipod users to Omnipod 5 
• Develop a pump policy 
• Help patients choose the best HCL for them 
• Offer a “Technology Night” monthly pump information class 

Results: 

• 80% of pump users on HCLs 
• Median A1c before HCL: 8.1% 
• Median A1c with HCL: 7.1% 
• Increase 50% time-in-range before HCL: 38% to 62% of patients 
• Increase in 70% time-in-range with HCL: 13% to 21% of patients  

“The use of HCLs increased access for telehealth visits and resulted in more patient-centered appointments,” explains the abstract. “We need to incorporate provider-patient shared decision making to help patients make the best pump choice and equal insurance access across all payer systems allowed for an entire practice change.” 

Next steps include individualizing the pump selection process and recruiting additional providers to become pump trainers. 

Leveraging EMR Data to Enable Remote Patient Monitoring in the ROCKET T1D Program 

TEXAS CHILDREN’S HOSPITAL, BAYLOY COLLEGE OF MEDICINE: Daniel J. DeSalvo, MD, Rona Sonabend, MD, David D. Schwartz, PhD, ABPP, Kelly Timmons, RN, BSN, Sarah Lyons, MD 

Background: 

“The implementation of an EMR-based diabetes registry dashboard with predictive analytics and clinical metrics enables remote care and targeted outreach,” explains the abstract. “ROCKET T1D (Remote Outreach & Care for Kids’ Empowerment and Technology use in T1D) is a remote patient monitoring (RPM) program at Texas Children’s Hospital supported by diabetes educators.”  

ROCKET T1D includes a proactive “Launch Phase” with frequent virtual touchpoints for education and insulin therapy adjustments over a 1-3 month period, followed by an “Orbit Phase” with monthly data review and therapy adjustments over 3-6 months. 

Methods: 

“We developed an Epic EMR-based diabetes registry with reports to enable visualization of a validated DKA risk score and clinical data (e.g., device use, HbA1C, etc.) to quickly assess clinical progress and facilitate targeted outreach,” explains the abstract.  

“Patients are added to the ROCKET T1D registry via a flowsheet entry, which allows visualization of progress through the Launch and Orbit Phases in the dashboard. We have incorporated weekly ROCKET T1D Mission Control meetings and utilize Glooko Population Health tracker to access remote data on-demand as interactive reports to facilitate insulin adjustments.” 

Results: 

“The ROCKET T1D RPM program went live in October 2022 with an initial target population of patients with established T1D with moderate-to-high risk for DKA, recent hospitalization, and/or starting new diabetes devices,” explains the abstract. “In April 2023, we expanded the program to include new onset T1D patients, and as of May 2023, we have enrolled ~80 new-onset patients.” 

Conclusion: 

“Inclusion of new-onset T1D patients will enable proactive outreach at a pivotal time in the diabetes journey, with goals of optimizing diabetes self-management habits and glycemic outcomes.” 

Pre-Visit Diabetes Device Data Capture 

NYU LANGONE HEALTH: Edelina Cohen MS RD CDN CDCES, Michael Natter, MD; Lauren Golden, MD 

Background: 

“Diabetes device data capture is essential for effective and efficient patient care,” explains the abstract. “Our practice identified a deficit in pre-visit diabetes device data capture. Strategies to improve pre-visit downloads/uploads (data) were implemented with the aim of increasing diabetes device data capture prior to patient visits to maximize direct patient care.” 

Benefits of pre-visit diabetes device data capture includes: 

• Better patient outcomes  
• Active role of patients in their treatment  
• Improved glycemia  
• Time-stamped analysis of how self-management behavior or glycemic control changes  
• Objective measures of self-management vs. relying on self-reported measures  
• Data from multiple devices (pump, CGM, BGM, smart pen) integrated and viewed together  
• Remote review by healthcare provider  
• Targeted diabetes care and education 

Challenges of pre-visit diabetes device data capture includes: 

• Patient tech literacy 
• Data sharing not already set up 
• Remembering username and password to facilitate access 
• Lack of computer access 
• Variety of USB and cable connectors required for data extraction from multiple brands and models of diabetes devices 
• Time consuming 
• Staffing 
• Inability to connect some devices due to using outdated device brands 
• Patient perspective of perceived value of downloading diabetes devices data 

Methods: 

• Patient care coordinator (PCC) collected 2-week glucose data prior to patient visits 
• Intervention period: November 2022 to mid-April 2023 (24 weeks) 
• PCC sent 5 day notice to patients via MyChart with instructions on how to download their diabetes device (continuous glucose monitor, meter, insulin pump, or smart pen) reports and upload as an attachment on MyChart, if not already linked to share their data with our practice 
• PCC placed follow up call 24-48 hours prior to the patient’s visit to remind them to download/upload their diabetes device data or link their device with the practice 
• PCC provided verbal instructions on how to share their data with the practice, if not already linked 
• Logged & tallied o # available downloads/uploads to capture prior to visit o # available downloads/uploads captured prior to visit 

Results: 

• At week one of the intervention, data capture was 43% 
• Data capture improved to an average of 52% over the intervention period of 24 weeks 
• Data capture reached a peak of 65% 

“The pre-visit data capture enabled clinicians to tailor patient care and provide targeted diabetes care given they had the data needed to make clinical decisions,” explains the abstract. “We attributed the increase in data capture to:  

• Multi-modal reminders 
• Patients’ increased familiarity with pre-visit diabetes device data process 
• Patients linking their devices to share with the practice 

 Limitation of intervention:  

• Amount of time spent by PCC to collect diabetes device data prior to visit  
• Timing of data collection occurred over major holidays  
• Type of diabetes device  

“Future steps include assessing interventions to diabetes care after implementation of data capture, monitoring and adjusting data capture strategies, and staffing consideration.” 

Learn more: T1D Exchange Quality Improvement Collaborative