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Get a glimpse in this interview with Nudrat Noor, on how the T1D Exchange Quality Improvement Collaborative (QIC) is gathering “big data” from people with type 1 diabetes (T1D) to iteratively improve the care of all people with T1D.
Q1: Who is Nudrat Noor, MS, PhD?
A (Nudrat): I am the Associate Director of Population Health working with the Quality Improvement and Population Health team at the T1D Exchange. My background is in genomics, epidemiology and applied statistics, with a DPhil (PhD) in Genomic Medicine and Statistics from the University of Oxford, in the U.K. Upon moving to the U.S. with my family and prior to joining the T1D Exchange, I was mainly involved in academic research at the Harvard T. H. Chan School of Public Health and Brigham and Women’s Hospital in Boston. I joined T1D Exchange in April 2019. Working at T1D Exchange alongside an exceptional team (see Q2) passionate about making a difference in the lives of people with T1D continues to be an incredible experience.
Q2: Who is on the QIC team?
A (Nudrat): The Quality Improvement and Population Health team based at the Boston headquarters, also referred to as the QIC coordinating center, combines the talents of seven staff members, broadly specializing in clinical science, QI methods and data analytics. The team at the coordinating center is split between two interrelated areas: Quality Improvement and Population Health, led by Osagie Ebekozien, MD, MPH, CPHQ Vice President, Quality Improvement and Population Health.
Together we coordinate the work of the Quality Improvement Collaborative (QIC), which includes 30+ diabetes clinics across the U.S., caring for over 48,000 people with T1D. Every QIC member clinic has at least one lead clinician who participates in the QIC along with other providers and patient/parent advisors. The QIC members engage in monthly QI coaching calls, as well as biannual learning sessions hosted by T1D Exchange. These sessions further understanding of the QI methodology, share best practices to improve patient outcomes and allow members to network. It is the unique skills and vantage points and collective work output of all QIC members that continually accelerates this cross-clinical collaboration and moves us towards our goal of improving T1D care and outcomes.
Q3: What is your role on the QIC team?
A (Nudrat): As the Associate Director of population health, my core responsibilities include strategizing and facilitating population health research and implementing advanced analytics to derive insights from complex patient-level data gathered from the electronic health records (EHR) systems of participating clinics.
Q4: When was the QIC initiated?
A (Nudrat): In 2016, T1D Exchange embarked on improving the quality of health care delivered to people with T1D by establishing the QIC.1 This initiative has evolved. The QIC integrated a proven QI methodology known as the Model of Improvement Plan-Do-Study-Act Process (PDSA) into action.1 The QIC team offers interactive coaching sessions on this approach to support implementation at member sites with a goal to improve patient care and outcomes. Effective findings from QIC projects are documented into a “change package”, which is a guide for clinics to use to implement new practices and improve existing ones.
Q5: What are the main goals of the QIC at T1D Exchange?
A (Nudrat): The overarching goal is, through benchmarking, networking and sharing among experts in diabetes care; speed up improvements in diabetes care delivery across all T1D Exchange clinics and to the wider population of people with T1D.
Q6: What types of data does the QIC collect?
A (Nudrat): The QIC collects both patient-level and clinic level data. The patient-level EHR data (deidentified) includes a broad range of information on people with T1D, including sociodemographic characteristics, use of various diabetes technologies, laboratory values, clinical outcomes, diabetes and related medications, and any existing diabetes-related diseases.
In addition to patient-level data, we collect clinic level data or aggregate data on a monthly basis. Simply, this is clinic level data reporting on QI measures; for example, percentage of people cared for in each clinic who have had a screening completed for depression, or percentage of people who use a continuous glucose monitor (CGM) or insulin pump or pod management system. We also conduct qualitative research with healthcare providers and their team members on different topics.
Q7: How does the QIC use ‘BIG DATA’ to improve diabetes care?
A (Nudrat): The QIC’s EHR database is a fast-growing data resource, currently comprised of over 30,000 T1D individuals. With an incredible depth of information, T1D Exchange has the capacity to improve care delivery and outcomes through innovative solutions and scientific research which can inform decision making. An example that demonstrates the potential of this database is the development of a novel web-based QI portal which supports the QIC in improving patient management at their clinics (see Q4). The QIC team-at-large identifies a set of QI measures and implements changes for improvement. The database is then used to summarize and track key QI measures. The findings are then displayed in real-time on the QI portal, where member sites are able to track their own clinic performance and evaluate by benchmarking.
Q8: How does the QIC further share their big data findings to diabetes-focused healthcare providers and the T1D Exchange community-at-large?
A (Nudrat): In addition to all of the networking and sharing of data and learnings in our biannual learning sessions, we share our findings further with presentations at diabetes-related and other medical meetings and publish results in peer-reviewed scholarly journals.1,2 The T1D Exchange staff and the healthcare providers at our clinics represent the best brains in diabetes care today. The QIC provides all of us with the opportunity for collegial sharing, gaining of deep insights and collectively improving the quality of care for people with T1D.
Learn more about the T1D Exchange QIC and stay abreast of their accomplishments.
Alonso GT, Corathers S, Shah A, et al. Establishment of the Type 1 Diabetes Exchange QI Learning Collaborative (T1DX-LC). Clinical Diabetes. 2020;39(2):141-151. https://doi.org/10.2337/cd19-0032.
Corathers SD, DeSalvo DJ. Therapeutic Inertia in Pediatric Diabetes: Challenges to and Strategies for Overcoming Acceptance of the Status Quo. Diabetes Spectrum. 2020; 33(1): 22-30. https://doi.org/10.2337/ds19-0017.
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