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Introduction: The T1DX-QI is a Type 1 diabetes learning health system with fifteen endocrinology centers in the United States. The program is coordinated by the T1D Exchange in Boston, Massachusetts.
Objectives: There have been several studies on the impact and benefit of insulin pumps and the impact of frequent insulin bolusing on clinical outcomes. This work describes how five centers in the T1DX-QI used QI methods including the Plan – Do- Study – Act (PDSA) cycles to test and expand different interventions at their respective centers. Some of the successful efforts include developing mobile technology classes, redesigning workflow, coaching patients to bolus for meals and corrections, and removing barriers to adoption. The centers piloted changes among patients aged 12–26 years.
Methods: 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 shifts (improvements) were used to evaluate the effectiveness of the project. (Figure 1). Factors that lead to improvement were identified as well as challenges to the implementation and scaling of different interventions.
Results: Three of the five participating centers had substantial improvement in this process. The increase ranged from 6% – 17%. There was a 10% significant change among the participating collaborative cohort in 20 months.
Conclusions: This project demonstrates the value of multi-center sharing, learning and using quality improvement principles to improve clinical systems.
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