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Ashley Garrity, MPH, is a project manager at the Susan B. Meister Child Health Evaluation and Research (CHEAR) Center and the Division of Pediatric Endocrinology, C.S. Mott Children’s Hospital at the University of Michigan in Ann Arbor, Michigan. As project manager, Garrity has been leading quality improvement (QI) projects that strive to create and execute real changes in patient care.
Interview with Ashley Garrity, MPH
In this interview, Garrity discusses her expertise in supporting people with type 1 diabetes (T1D) and working to improve patient care through the T1D Exchange Quality Improvement Collaborative (T1DX-QI).
The 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 daily life for people with type 1 diabetes (T1D). Growth has been tremendous, with 54 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, 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.
How did you become involved in quality improvement?
“I’ve always been excited to work directly with patients, but over time, my career opportunities led me into research. While I initially joined Dr. Lee’s team primarily for research purposes, it unfolded into other projects, including QI efforts for the pediatric T1D population,” explained Garrity.
Garrity, who describes herself as a “behaviors” person, received her Master of Public Health degree in Health Behavior and Health Education from the University of Michigan School of Public Health, and has been working alongside Dr. Joyce Lee at U-M Health for nearly eight years.
“In a way, I feel like I’ve come full circle with QI work. Even though I’m not involved in a lot of direct patient care, I’m ‘one step behind the scenes,’ which is personally fulfilling,” explained Garrity, whose previous experience in program evaluation and qualitative analysis has blossomed into engineering solutions to produce positive outcomes in T1D care.
What do you enjoy most about your work in diabetes patient care?
Garrity finds fulfillment in the real-life impact that quality improvement work can have on patients’ lives.
“Witnessing measurable improvements and outcomes in T1D care is a rewarding aspect of my QI work. It’s brought me closer to the patient-family experience while fostering collaboration with the diabetes clinical team,” shared Garrity.
Working with the T1DX-QI to improve patient care
“Being involved in the T1DX-QI Collaborative has personally strengthened my understanding of QI methodology,” said Garrity, who has been a member of the Collaborative since 2015. “And as a team, it reinvigorates and motivates us to think through challenges in new and different ways.”
“Witnessing real-world applications from other collaborative sites reinforces the usability of QI data to systematically improve care,” explained Garrity. “I find myself energized by every call and meeting — inspired by how other members tackle similar issues. We’re all dealing with common challenges, so the more we can share, the better.”
At Michigan, the core T1DX-QI team consists of Garrity, who serves as the site coordinator, Dr. Lee, who serves as the lead PI and has been a Collaborative member since 2014 with the initial design and planning phase; and Dr. Inas Thomas, the Division Director of Pediatric Endocrinology at U-M Health.
Building their pediatric diabetes website for families
Building a strong online presence has always been a part of Dr. Lee’s vision, explained Garrity. “Out of the gates, our goal was to create a more cohesive experience to guide families through the new onset process — which is often an overwhelming time.”
In order to lay a solid foundation, they enlisted the creative talents of a graphic designer.
“While it was a bit atypical in terms of research and QI, the graphic designer took it to the ‘next level,’ solidifying our brand and presenting educational materials in meaningful, engaging ways,” said Garrity.
In the distant past, U-M’s educational materials were a “stack of loose, xeroxed papers in a folder” begging for a modern platform, explained Garrity. “Now, our information can be found on an interactive website that’s built for a diverse audience.”
While the website was tailored to U.M. patients and families, it’s widely available to the public.
“I often direct patients, families, and providers to our website — particularly other T1DX-QI clinics,” said Garrity. “People are so appreciative of our work.”
Screening children with T1D for depression
“Depression screening was one of the first QI projects at the T1DX-QI, and our team at Michigan was part of that initial cohort with seven other centers. At the time, we weren’t screening kids for depression in any formal way — so the project was exciting and held great promise,” explained Garrity.
“Testing out PDSA cycles, collecting data, and making adaptations was a learning curve for us,” shared Garrity, whose team believed strongly in regular psychosocial assessments for their patients.
“While it took about two years for our depression screening process to become sustainable when I look back and reflect upon it, I’m proud of our team — it was such a great success to go from nothing to having a seamless EMR process in place. And it’s not just our patients that benefit; we share our processes with other T1DX-QI centers so they can replicate it, too.”
The Diabetes, Data & Devices (D3) Education Program
“The D3 program (Diabetes, Data & Devices) is a project that’s been underway since 2018. We developed a curriculum to teach patients and families how to make sense of diabetes data, identify patterns and trends, and develop confidence in making informed adjustments between appointments,” said Garrity.
“I presented some of our preliminary outcomes data at the last T1DX-QI Learning Sessions, and we’re hoping to publish a paper on our outcomes data. It’s in a sustained mode for now, but we’re tying it into some ongoing QI work related to time-in-range education at the point of care.” Garrity added, “We’re trying to socialize the concept of time-in-range, what it is, and what the goals are in relation to it. If patients or families want to learn more about optimizing time in range, we refer them to D3.”
QI for Fellows
“At U-M, we’re committed to training the next generation of endocrinologists in QI,” explained Garrity. “We’ve integrated QI education and methodology into our fellowship curriculum over the past few years, with each fellow leading a project-based QI initiative of their own. For the upcoming T1DX-QI Learning Sessions, we’re proud to share that each of our three fellows submitted abstracts for QI projects.”
Outside of work
Outside of work, Ashley enjoys spending time on the lake with her husband, gardening, playing with her two Newfoundland dogs, and watching live music. As a Michigan football fan, Ashley jokes that she truly “bleeds maize and blue,” having been a student, or employee, at the University of Michigan since graduating high school.
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