Introduction: The T1DX-QI is a Type 1 diabetes learning health system with thirteen endocrinology centers working collaboratively on the goal of improving outcomes for people with type 1 diabetes. The program is coordinated by the T1D Exchange in Boston, Massachusetts.

Objectives: For this project, “high-risk” is defined as having the two most recent HbA1c above 9% and at least two clinic visits in the preceding 12 months. There is an increased risk of acute and chronic complications among high-risk patients. Social, racial, and economic factors significantly contribute to further complicate the difficulty in reducing HbA1c levels among these patients.

This abstract describes how ten centers in the T1DX-QI used QI principles to test and expand different interventions in their clinic to reduce the proportion of high-risk patients. Some of the successful efforts include the increased engagement with a navigator, workflow redesign, developed mobile technology classes for insulin pump and CGM use, screening for depression, and addressing social determinants of health.

Methods: The centers shared data monthly with the coordinating office that used statistical process control charts to evaluate the effectiveness of the interventions (Figure 1).

Results: There was a collaborative-wide significant change of 3% from baseline. Six of ten centers met the collaborative goal of 35% that directly impacts over 200 patients in the piloted 12–26 year age group.

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