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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 type 1 diabetes (T1D). Growth has been tremendous, with 41 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.
Priya Prahalad, MD, PhD is a Clinical Associate Professor of Pediatrics and Medical Director of Clinical Informatics at Stanford Children’s Hospital. Additionally, Dr. Prahalad serves as co-chair of the QIC Publications Committee and has been an active member of the Collaborative since 2016. Her research interests are focused on utilizing technology to improve quality of care and reduce health disparities in individuals living with T1D.
What piqued your interest in clinical informatics?
“I’m really interested in technology both inside and outside of my clinical career. That’s one of the reasons I gravitated towards clinical informatics. It’s a field that helps to manage data and create usable actions out of it. We generate huge volumes of data in medicine nowadays — from hospital records to patient generated data, such as continuous glucose monitor (CGM) and pump data.”
“When I started working at Stanford, I sought out roles that combined my interests of clinical work in T1D and QI, ” explained Dr. Prahalad. “I started working with Dr. Avni Shah who was a founding member of the Collaborative — and when she moved on, I took over the role of PI for our site. That led to working with the clinical informatics team as I was trying to improve our data collection. As part of that, I began focusing on telemedicine and remote patient monitoring. I really saw this as a great mix for creating quality improvement, and I became board certified in clinical informatics in 2021.”
In the Stanford clinic, what quality improvements have you seen?
“Our focus over the last several years at Stanford Children’s has been to increase CGM use in our patients with T1D,” said Dr. Prahalad. “We really feel like it’s a better way to manage diabetes, and as a component of automated insulin delivery, we really want to maximize its use.”
With their concentrated efforts, they’ve done just that. CGM utilization has increased from about 30-40% to an impressive 70%.
“While we are encouraging CGM use in all patients, we’re targeting efforts to initiate CGM use in two groups right now: newly diagnosed patients and those on public insurance,” explained Dr. Prahalad. “For those newly diagnosed, we’re starting CGM within the first month of diagnosis, along with weekly remote monitoring. By reviewing data and helping with dose adjustments, we’ve seen a half percent improvement in hemoglobin A1c over historic controls.”
“For those on public insurance, we’ve been very fortunate to receive philanthropic funding from the Lucile Packard Children’s Hospital Auxiliaries Endowment Grants,” said Dr. Prahalad. She went on to explain that California has tough standards for children on public insurance, and because of this, Stanford Children’s has made CGM accessibility for this population a top priority. To date, they’ve provided CGM supplies to more than 100 patients awaiting insurance approval.
“Improving these processes is something that our team is very proud of,” said Dr. Prahalad. It’s a huge step forward to have patients benefiting from CGM use, while the wheels are in motion for public insurance approval. And although it wasn’t part of their original plan, CGM became an entry point for patients to start on automated insulin delivery systems, too.
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One of the major QIC goals has been to increase CGM use in pediatric and young adult populations, explained Dr. Prahalad. This initiative is very important, because CGM adoption is tied to improved health outcomes and quality of life measures in individuals living with T1D.
“Early on we found that if you hand someone a box of sensors, a transmitter, and receiver — it can be a really poor experience. To keep people using CGM, they really need to learn how to use it well, so it doesn’t turn into a burden.”
For this T1DX-QI initiative, data was collected from 2018 to 2020, with 10 centers using focused interventions to promote CGM use, explained Dr. Prahalad. “We were able to identify four critical areas to help patients start on CGM, they include: Training clinical teams on CGM use, consistent discussion of CGM with patients and documentation in the EMR, simplify the ordering process, and offering ongoing CGM patient support.”
The study results were promising, Dr. Prahalad explained. “We saw an increase in CGM uptake from 34 to 55%, with the largest uptake in clinics that were using quality improvement methodology and documentation of interventions.” Research is ongoing to test these interventions and understand their impact on clinical outcomes.
“Something we really want to tackle is to identify individuals who are struggling the most with their diabetes, get them started on CGM — and on an automated insulin delivery system. We’ve already been doing this, informally, but we’d like to develop this program to ease the burden of diabetes and improve clinical outcomes in this population.”
Outside of work, Dr. Prahalad enjoys traveling and exploring new places. She’s also likely to be found on the tennis court or in the kitchen, cooking and experimenting with different foods.
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