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The T1D Exchange Quality Improvement Collaborative (QIC) 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 quality of care and outcomes, for individuals living with T1D. Growth has been tremendous, with 40 endocrine clinics from across the U.S. participating in the Collaborative.
Fueled by top leaders in diabetes care, the QIC has become an engine of innovation and inspiration. By engaging with the shared, data-driven, and systematic methods of the QIC, 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.
Dr. Sarah Corathers: On Mental Health and Care Transitions
By joining the QIC at its inception, Sarah Corathers, MD, a pediatric and adult endocrinologist at Cincinatti Children’s, has been a forerunner in diabetes research and quality improvement for the Collaborative’s initiatives.
“I was privileged to be part of the QIC from the get-go, starting at the design conception. It’s incredibly rewarding and exciting to see how the work has progressed,” states Dr. Corathers, who also serves as co-chair of the QIC Clinical Leadership Committee. “I’m thrilled that we have a network of clinics in the U.S. that are interested in learning from one another — accelerating improvements in care by sharing best practices freely, and by advancing the science of diabetes care delivery. It creates a collective learning opportunity and helps us to adopt changes that make sense.”
As the Director of the Diabetes Transition Program for the Division of Endocrinology at Cincinnati Children’s Hospital, Dr. Corathers’ impactful work has wide applications.
“While I started with depression screening, I immediately began thinking more comprehensively and holistically about adolescents — and how to get them ready for adult care,” said Corathers, who is the lead author of the Depression Screening Change Package. “Even though we all have the same psychosocial needs, it hasn’t been built into our care delivery system in a very systematic way. I realized the attention to psychosocial needs was really critical.”
Symptoms of depression in youth are 2 to 3 times more common in those living with chronic conditions, explained Corathers. Because this population sees their specialty care providers more often than primary care providers, it generated a pilot idea — to have endocrine clinics screen for, and address, these needs. This paved the way for a successful implementation of depression screening at the Cincinnati Children’s Endocrinology Clinic.
Mental health and transition of care are closely tied together, explained Corathers, with depression screening functioning as “a piece of a larger puzzle of adolescent wellness that’s necessary for a successful transition to adult care.”
She points to the unique developmental stages, needs, and circumstances that adolescents and emerging adults face navigating healthcare, and has a palpable sense of understanding and empathy for these individuals. As a practitioner and researcher, Corathers is dedicated to providing purposeful attention and solutions throughout these life stages.
“Understanding the challenges of individuals graduating from pediatric to adult care is vital. There’s an immediate shift that happens between the two,” said Corathers, highlighting that, “we don’t want people to transition twice.” While ages for this transition are center-specific (ranging from 18 to 25-years-old), “it’s clear that adding anything new during this time may not be ideal.”
“I think about the continuum of diabetes care and needs for patients and families. It’s often a diagnosis that occurs in childhood — but it’s a lifelong condition, and needs are quite different over time. I’m conscientious about how to optimize that transition in particular, and about all of the other things that go into diabetes care that have nothing to do with A1c, glucose, or finger sticks. Everything that lands on top may fall into this psychosocial category.”
Part of her recipe for success has been a “thoughtful layering of care components that are reliable, efficient, and feasible — that can seamlessly weave into the fabric of how things currently operate.”
Corathers continues to think more broadly, welcoming patients (who she refers to as the “true experts”) in co-production work. “As a clinician I learn so much from the folks who come to my clinic every day. The T1D Exchange puts people on equal footing, so they can tell us if we’re focusing on the right stuff — it helps us to figure out how to attack this together, and move forward.”
Outside of the hospital, Sarah enjoys spending time with her husband and children visiting National Parks and traveling internationally. She has a 15-year-old son, 12-year-old daughter, 2 dogs, and 2 pandemic, adopted kittens! Ballet, art history, hiking, gardening — but most of all — spending family-time outdoors are favorite pastimes.
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