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The T1D Exchange Quality Improvement Collaborative (T1DX-QI) was established in 2016 — with the support of The Leona M. and Harry B. Helmsley Charitable Trust — in an effort to refine best practices and improve the quality of care and outcomes for individuals living with type 1 diabetes (T1D). Growth has been tremendous, with 47 endocrine clinics from across the U.S. participating in the Collaborative.
Fueled by top leaders in diabetes care, the T1DX-QI has become an engine of innovation and inspiration. By engaging with the shared, data-driven, and systematic methods of the T1DX-QI, participating clinics have seen unprecedented success in their approach to diabetes management.
With members working closely together to identify gaps in care, discover and refine best practices, and share research, the process has become knowledge-sharing at its very best. While collated data gives clinics a clear sense of “where they are,” it also demonstrates “where they can be” by applying shared, evidence-based methods for improving care.
Interview with Shideh Majidi, MD, MSCS
Shideh Majidi, MD, MSCS, is a Pediatric Endocrinologist and Associate Director of the Childhood and Adolescent Diabetes Program at Children’s National Hospital — recently transitioning from Barbara Davis Center — where she was Assistant Professor of Pediatric Endocrinology. Dr. Majidi led innovative research on the psychosocial and behavioral aspects of type 1 diabetes care.
Why pediatric endocrinology?
“I went into pediatrics because my mom is a nanny, and she’s amazing with kids,” explained Majidi “Witnessing her interactions inspired me to become a pediatrician, as did our childhood pediatricians.”
“My parents were immigrants and we didn’t have a lot of money,” shared Majidi. “Our family went to a physician that saw us on a sliding scale. It was really impactful for me to see the care everyone should be receiving, regardless of their circumstance. Even as a child, I appreciated the care these pediatricians provided, and it made me want to do similar things. I knew that I wanted to take care of kids no matter what their situation — and this fueled my desire to be a pediatrician, too.”
Once in Medical school, Majidi enjoyed her pediatric endocrinology rotation and learning about endocrine feedback loops. While Majidi’s interest was initially in endocrine more than diabetes, she found a particular interest in diabetes care throughout her residency and fellowship.
“I love the bonds with families and seeing patients throughout their entire childhood. It’s a special part of what I do,” explained Majidi.
Psychosocial and behavioral care
Seeking to support and impact the lives of people with T1D on a bigger scale through quality improvement (QI) and research, Majidi began working towards a Master of Clinical Science (MSCS) degree after her fellowship.
“This was a way for me to arm myself with more tools, so I can make longer-lasting changes,” said Majidi, whose research passion is focused on psychosocial and behavioral health care.
“I bring my learnings into the clinic as well, making sure to see patients fully and not just looking at their diabetes numbers or trends — rather, how diabetes may be affecting their lives and how we can help in that process,” said Majidi. “I still do research, but I’m much more involved in QI right now. A lot of what I’ve learned with my MSCS degree continues to be helpful for this work.”
T1DX-QI: Depression screening
“Depression screening was among my initial work with the T1DX-QI and started as a fellowship project,” explained Majidi, who will begin serving as the T1DX-QI site lead at Children’s National this summer.
“While I was implementing clinical screening, it ended up being more about QI. This work was significant, as it expanded from a feasibility and acceptability project during my fellowship, to a routine part of in-clinic T1D care and became part of the Depression Screening Change Package that’s available for T1DX-QI clinics to utilize.”
Majidi discussed the pressure mental health stigma can place on individuals, how it can reduce the likelihood of getting treatment, and her wholehearted goal of seeing this decreased and normalized.
“I let my families know that this is something we see, and it happens more often with T1D, so they aren’t alone. This is why we ask, have resources available, and try to normalize that mental health issues exist — that it’s okay to talk about them, and get treatment.”
Majidi emphasized that mental health treatment can significantly affect diabetes care, too.
“Social workers and psychologists are an integral part of an interdisciplinary diabetes team and are so valuable,” reminded Majidi. “We all convey to families that it’s okay to have these feelings, and if they become overwhelming, there are resources that we can provide.”
“I’ve always been really interested in working on psychosocial aspects of T1D. The Collaborative has done a great job working on depression screening, ideas, and resources — the next step is to focus on suicidal ideation.”
T1D and suicide prevention
“What I’ve been working on most recently, both when I was at Barbara Davis Center and now at Children’s National, is suicide prevention in youth and adults with T1D,” said Majidi, who serves as co-chair of the RESCUE Collaborative Community.
“I’ve had many providers tell me they wouldn’t have known a patient would screen positive without self-reported results in-hand. It goes to show that you often can’t ‘see’ outwardly that someone is depressed. People can appear happy even while they’re sad inside — and if you don’t ask, they’re not necessarily going to tell you.”
Majidi stressed that more information is still needed on suicide and T1D to better understand how to help.
“What we do know from various studies that we’ve done through the T1DX-QI is suicidal ideation rates in youth and young adults tends to be about 8 to13%. That’s not suicide attempts or completions — it’s having thoughts of self-harm, so it’s significant in this population.”
Majidi said suicide is an issue that’s underreported, underrecognized, and underresearched, but it’s affecting youth and young adults that have T1D.
“Depending upon the study you’re looking at, there’s a similar or increased rate compared to the general population. We know for certain that depression is significantly higher in people with T1D, and that depression is linked to suicidal ideation.”
The most impactful first step in helping is likely simply asking the question.
“By asking, it invites someone to talk about their feelings. There’s a stigma, or thought, that if you ask someone about suicide, it’ll put thoughts into their head about it. This is absolutely not true, and it’s why I address this when I talk to parents and provider groups about depression and suicide. Please, don’t be afraid to ask.”
“With QI, we can help patients by making changes in real-time, right now,” said Majidi, who continues to work diligently on mental health care and on health disparities.
“This is one of the reasons that I’m really excited to be at Children’s National Hospital. There’s a very diverse population here with an opportunity to investigate and reduce health disparities, which is an ongoing goal that I continue to have.”
As Associate Director of the Childhood and Adolescent Diabetes Program at Children’s National, a significant portion of Majidi’s work will be focused on using quality improvement methodology to make programmatic changes.
“We have an amazing diabetes program,” explained Majidi, “and we’ll continue to push forward through quality improvement measures to benefit our patients and clinic as a whole, so that ultimately we’re providing the best diabetes care for everyone.”
Dr. Majidi strongly believes in having a good life-work balance, finding that it enriches her work. She loves spending time outdoors walking and hiking, watching movies, reading books, and enjoys going to concerts and sporting events.
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Meet the Expert: Addressing the Mental Health Burdens of T1D
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