1
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Ebekozien O, Mungmode A, Hardison H, Rapaport R. Improving Outcomes for People with Type 1 Diabetes Through Collaboration: Summary of Type 1 Diabetes Exchange Quality Improvement Collaborative Studies. Endocrinol Metab Clin North Am 2024; 53:1-16. [PMID: 38272589 DOI: 10.1016/j.ecl.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Type 1 diabetes (T1D) management has evolved over the last decade. Innovations and groundbreaking research have paved the way for improved outcomes for people with T1D. One of the major T1D focused research network that has supported real-world research studies in the United States is the T1D Exchange Quality Improvement Collaborative (T1DX-QI) Network.T1DX-QI is a large multicenter network of 55 T1D clinics that uses quality improvement, health equity framework, and population health principles to improve outcomes for people with T1D. This article summarizes insights from T1DX-QI clinical and population health improvement studies.
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Affiliation(s)
- Osagie Ebekozien
- T1D Exchange, Boston, MA, USA; University of Mississippi School of Population Health, Jackson, MS, USA.
| | | | | | - Robert Rapaport
- Department of Pediatrics at Icahn School of Medicine; Mount Sinai Kravis Children's Hospital, New York, NY, USA
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2
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Ebekozien O. The Evolving Landscape of Type 1 Diabetes Management. Endocrinol Metab Clin North Am 2024; 53:xvii-xix. [PMID: 38272603 DOI: 10.1016/j.ecl.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Affiliation(s)
- Osagie Ebekozien
- T1D Exchange, 101 Federal Street, Boston, MA 02110, USA; John D Bower School of Population Health, University of Mississippi, Jackson, MS 39216, USA.
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3
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Ebekozien O, Mungmode A, Sanchez J, Rompicherla S, Demeterco-Berggren C, Weinstock RS, Jacobsen LM, Davis G, McKee A, Akturk HK, Maahs DM, Kamboj MK. Longitudinal Trends in Glycemic Outcomes and Technology Use for Over 48,000 People with Type 1 Diabetes (2016-2022) from the T1D Exchange Quality Improvement Collaborative. Diabetes Technol Ther 2023; 25:765-773. [PMID: 37768677 DOI: 10.1089/dia.2023.0320] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Objective: Previous studies revealed that hemoglobin A1c (HbA1c) increased overall in the United States in the past decade. In addition, health inequities in type 1 diabetes (T1D) outcomes by race/ethnicity and insurance type persist. This study examines the trends in HbA1c from 2016 to 2022 stratified by race/ethnicity and insurance in a large multicenter national database. Research Design and Methods: We analyzed glycemic outcomes and diabetes device use trends for >48,000 people living with type 1 diabetes (PwT1D) from 3 adult and 12 pediatric centers in the T1D Exchange Quality Improvement Collaborative (T1DX-QI), comparing data from 2016 to 2017 with data from 2021 to 2022. Results: The mean HbA1c in 2021-2022 was lower at 8.4% compared with the mean HbA1c in 2016-2017 of 8.7% (0.3% improvement; P < 0.01). Over the same period, the percentage of PwT1D using a continuous glucose monitor (CGM), insulin pump, or hybrid closed-loop system increased (45%, 12%, and 33%, respectively). However, these improvements were not equitably demonstrated across racial/ethnic groups or insurance types. Racial/ethnic and insurance-based inequities persisted over all 7 years across all outcomes; comparing non-Hispanic White and non-Hispanic Black PwT1D, disparate gaps in HbA1c (1.2%-1.6%), CGM (30%), pump (25%-35%), and hybrid-closed loop system (up to 20%) are illuminated. Conclusion: Population-level data on outcomes, including HbA1c, can provide trends and insights into strategies to improve health for PwT1D. The T1DX-QI cohort showed a significant improvement in HbA1c from 2016 to 2022. Improvements in diabetes device use are also demonstrated. However, these increases were inconsistent across all racial/ethnic groups or insurance types, an important focus for future T1D population health improvement work.
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Affiliation(s)
- Osagie Ebekozien
- Office of Chief Medical Officer, T1D Exchange, Boston, Massachusetts, USA
- School of Population Health, University of Mississippi, Jackson, Mississippi, USA
| | - Ann Mungmode
- Office of Chief Medical Officer, T1D Exchange, Boston, Massachusetts, USA
| | - Janine Sanchez
- Department of Endocrinology, Miller School of Medicine, University of Miami, Maimi, Florida, USA
| | - Saketh Rompicherla
- Office of Chief Medical Officer, T1D Exchange, Boston, Massachusetts, USA
| | - Carla Demeterco-Berggren
- Department of Endocrinology, Rady Children's Hospital, San Diego, California, USA
- Department of Endocrinology, University of California, San Francisco, California, USA
| | - Ruth S Weinstock
- Department of Endocrinology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Laura M Jacobsen
- Department of Endocrinology, University of Florida, Gainsville, Florida, USA
| | | | - Alexis McKee
- Department of Endocrinology, Washington University at St Louis, St Louis, USA
| | - Halis K Akturk
- Department of Endocrinology, Barbara Davis Center, Aurora, Colorado, USA
| | - David M Maahs
- Department of Pediatric Endocrinology, Lucile Packard Children's Hospital at Stanford University, Palo Alto, California, USA
| | - Manmohan K Kamboj
- Department of Endocrinology, Nationwide Children's Hospital, Columbus, Ohio, USA
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4
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Ospelt E, Hardison H, Rioles N, Noor N, Weinstock RS, Cossen K, Mathias P, Smego A, Mathioudakis N, Ebekozien O. Understanding Providers' Readiness and Attitudes Toward Autoantibody Screening: A Mixed-Methods Study. Clin Diabetes 2023; 42:17-26. [PMID: 38230325 PMCID: PMC10788649 DOI: 10.2337/cd23-0057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Screening for autoantibodies associated with type 1 diabetes can identify people most at risk for progressing to clinical type 1 diabetes and provide an opportunity for early intervention. Drawbacks and barriers to screening exist, and concerns arise, as methods for disease prevention are limited and no cure exists today. The availability of novel treatment options such as teplizumab to delay progression to clinical type 1 diabetes in high-risk individuals has led to the reassessment of screening programs. This study explored awareness, readiness, and attitudes of endocrinology providers toward type 1 diabetes autoantibody screening.
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Affiliation(s)
| | | | | | | | | | | | - Priyanka Mathias
- Albert Einstein College of Medicine–Montefiore Medical Center, Bronx, NY
| | - Allison Smego
- University of Utah, Intermountain Health, Salt Lake City, UT
| | | | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi Medical Center School of Population Health, Jackson, MS
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5
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Gallagher MP, Noor N, Ebekozien O. Variations in Clinic Staffing for Adult and Pediatric Diabetes Centers in the United States: Data From T1D Exchange. Endocr Pract 2023; 29:678-679. [PMID: 37286103 DOI: 10.1016/j.eprac.2023.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023]
Affiliation(s)
| | - Nudrat Noor
- T1D Exchange, 11 Avenue de Lafayaette, Boston 02111, Massachusetts.
| | - Osagie Ebekozien
- T1D Exchange, 11 Avenue de Lafayaette, Boston 02111, Massachusetts; University of Mississippi School of Population Health, Jackson, Mississippi.
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6
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Noor N, Norman G, Sonabend R, Chao L, Kamboj M, Golden L, Bekx MT, Hseih S, Levy C, Sanchez J, Rapaport R, Ebekozien O. An Observational Crossover Study of People Using Real-Time Continuous Glucose Monitors Versus Self-Monitoring of Blood Glucose: Real-World Evidence Using EMR Data From More Than 12,000 People With Type 1 Diabetes. J Diabetes Sci Technol 2023:19322968231178017. [PMID: 37264642 DOI: 10.1177/19322968231178017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND We used real-world electronic health record (EHR) data to examine HbA1c levels among children and adults with type 1 diabetes (T1D) who are classified as continuous glucose monitor (CGM) users after T1D diagnosis and switch to self-monitoring of blood glucose (SMBG) during follow-up, versus people who opt for SMBG after T1D diagnosis and switch to CGM during follow-up visits. METHODS We conducted an observational, case-crossover study using electronic medical record (EMR) data from the T1D Exchange Quality Improvement Collaborative. The primary outcome in this study was HbA1c. Baseline HbA1c levels were taken at the index date, corresponding to initial device classification, and compared with HbA1c value recorded at the clinic visit following device switch. RESULTS Of all patients classified in the SMBG group, 7,706 switched to CGM use within the 5-year study time frame, and 5,123 of all initial CGM users switched to SMBG within the study time frame and were included in this analysis. At baseline, median (interquartile range [IQR]) HbA1c for SMBG use was 8.1 (2.4), whereas postcrossover to CGM use, there was a decline in median (IQR) levels to 7.7 (1.9) (P < .001). For baseline CGM users, median (IQR) HbA1c levels were 7.9 (2.0), and postcrossover to SMBG, median (IQR) HbA1c levels increased to 8.0 (2.9) (P < .001). CONCLUSION We found that people who switched to CGM use had significantly improved HbA1c levels compared to those who switched to glucose monitoring with SMBG.
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Affiliation(s)
| | | | - Rona Sonabend
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Lily Chao
- Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | | | | | - M Tracy Bekx
- UW Health, University of Wisconsin, Madison, WI, USA
| | - Susan Hseih
- Cook Children's Hospital, Fort Worth, TX, USA
| | - Carol Levy
- Icahn School of Medicine, New York City, NY, USA
| | - Janine Sanchez
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Osagie Ebekozien
- T1D Exchange, Boston, MA, USA
- School of Population Health, University of Mississippi, University, MS, USA
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7
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Grimaldi M, Cardenas L, Saenz AM, Saalinger M, Odugbesan O, Rioles N, Ebekozien O, Bernal-Mizrachi E, Vendrame F. Connecting From Afar: Implementation of Remote Data-Sharing for Patients With Type 1 Diabetes on Insulin Pump Therapy. Clin Diabetes 2023; 41:442-445. [PMID: 37456094 PMCID: PMC10338273 DOI: 10.2337/cd22-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes an effort to improve the remote collection of insulin pump data in an academic center in South Florida.
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Affiliation(s)
- Monica Grimaldi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Lisania Cardenas
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Aleida Maria Saenz
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Maddison Saalinger
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Ori Odugbesan
- T1D Exchange, Quality Improvement and Population Health Department, Boston, MA
| | - Nicole Rioles
- T1D Exchange, Quality Improvement and Population Health Department, Boston, MA
| | - Osagie Ebekozien
- T1D Exchange, Quality Improvement and Population Health Department, Boston, MA
| | - Ernesto Bernal-Mizrachi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Francesco Vendrame
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
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8
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Noor N, Kamboj MK, Triolo T, Polsky S, McDonough RJ, Demeterco-Berggren C, Jacobsen L, Sonabend R, Ebekozien O, DeSalvo DJ. Hybrid Closed-Loop Systems and Glycemic Outcomes in Children and Adults With Type 1 Diabetes: Real-World Evidence From a U.S.-Based Multicenter Collaborative. Diabetes Care 2022; 45:e118-e119. [PMID: 35708494 PMCID: PMC9490446 DOI: 10.2337/dc22-0329] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/25/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Nudrat Noor
- T1D Exchange, Boston, MA.,Aga Khan University, Karachi, Pakistan
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9
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Prahalad P, Rioles N, Noor N, Rapaport R, Weinstock RS, Ebekozien O. T1D exchange quality improvement collaborative: Accelerating change through benchmarking and improvement science for people with type 1 diabetes. J Diabetes 2022; 14:83-87. [PMID: 34854232 PMCID: PMC9060055 DOI: 10.1111/1753-0407.13234] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/17/2022] Open
Affiliation(s)
- Priya Prahalad
- Pediatric EndocrinologyStanford UniversityStanfordCaliforniaUSA
| | | | | | - Robert Rapaport
- Mount Sinai Kravis Childrenʼs Hospital, Icahn School of MedicineNew YorkNew YorkUSA
| | | | - Osagie Ebekozien
- T1D ExchangeBostonMassachusettsUSA
- Division of Population HealthUniversity of Mississippi School of Population HealthJacksonMississippiUSA
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10
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Ebekozien O, Mungmode A, Odugbesan O, Majidi S, Prahalad P, Noor N, Rioles N, Agarwal S, Weinstock RS, Rapaport R, Kamboj M. Addressing type 1 diabetes health inequities in the United States: Approaches from the T1D Exchange QI Collaborative. J Diabetes 2022; 14:79-82. [PMID: 34874109 PMCID: PMC9060069 DOI: 10.1111/1753-0407.13235] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 01/05/2023] Open
Affiliation(s)
- Osagie Ebekozien
- T1D ExchangeBostonMassachusettsUSA
- University of Mississippi School of Population HealthJacksonMississippiUSA
| | | | | | | | | | | | | | | | | | - Robert Rapaport
- Mount Sinai Kravis Children's HospitalIcahn School of MedicineNew YorkNew YorkUSA
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11
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Marks BE, Mungmode A, Neyman A, Levin L, Rioles N, Eng D, Lee JM, Basina M, Hawah-Jones N, Mann E, O’Malley G, Wilkes M, Steenkamp D, Aleppo G, Accacha S, Ebekozien O. Baseline Quality Improvement Capacity of 33 Endocrinology Centers Participating in the T1D Exchange Quality Improvement Collaborative. Clin Diabetes 2022; 41:35-44. [PMID: 36714248 PMCID: PMC9845085 DOI: 10.2337/cd22-0071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This article describes the evolution of the Type 1 Diabetes Exchange Quality Improvement Collaborative (T1DX-QI) and provides insight into the development and growth of a successful type 1 diabetes quality improvement (QI) program. Since its inception 8 years ago, the collaborative has expanded to include centers across the United States with varying levels of QI experience, while simultaneously achieving many tangible improvements in type 1 diabetes care. These successes underscore the importance of learning health systems, data-sharing, benchmarking, and peer collaboration as drivers for continuous QI. Future efforts will include recruiting additional small- to medium-sized centers focused on adult care and underserved communities to further the goal of improving care and outcomes for all people living with type 1 diabetes.
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Affiliation(s)
- Brynn E. Marks
- Children’s National Hospital, Washington, DC
- Children’s Hospital of Philadelphia, Philadelphia, PA
- Corresponding author: Brynn E. Marks,
| | | | - Anna Neyman
- Riley Children’s Hospital, Indiana University School of Medicine, Indianapolis, IN
| | - Laura Levin
- Ann and Robert H. Lurie Children Hospital, Chicago, IL
| | | | - Donna Eng
- Helen DeVos Children’s Hospital, Grand Rapids, MI
| | - Joyce M. Lee
- C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI
| | | | | | - Elizabeth Mann
- UW Health Kids, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | | | | | | | | | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
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12
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Albanese-O'Neill A, Grimsmann JM, Svensson AM, Miller KM, Raile K, Akesson K, Calhoun P, Biesenbach B, Eeg-Olofsson K, Holl RW, Maahs DM, Hanas R. Changes in HbA1c Between 2011 and 2017 in Germany/Austria, Sweden, and the United States: A Lifespan Perspective. Diabetes Technol Ther 2022; 24:32-41. [PMID: 34524026 DOI: 10.1089/dia.2021.0225] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aims: This study assessed hemoglobin A1c (HbA1c) across the lifespan in people with type 1 diabetes (T1D) in Germany/Austria, Sweden, and the United States between 2011 and 2017 to ascertain temporal and age-related trends. Methods: Data from the Diabetes-Patienten-Verlaufsdokumentation (DPV) (n = 25,651 in 2011, n = 29,442 in 2017); Swedish Pediatric Diabetes Quality Registry (SWEDIABKIDS)/National Diabetes Register (NDR), (n = 44,474 in 2011, n = 53,690 in 2017); and T1D Exchange (n = 16,198 in 2011, n = 17,087 in 2017) registries were analyzed by linear regression to compare mean HbA1c overall and by age group. Results: Controlling for age, sex, and T1D duration, HbA1c increased in the United States between 2011 and 2017, decreased in Sweden, and did not change in Germany/Austria. Controlling for sex and T1D duration, mean HbA1c decreased between 2011 and 2017 in all age cohorts in Sweden (P < 0.001). In the United States, HbA1c stayed the same for participants <6 years and 45 to <65 years and increased in all other age groups (P < 0.05). In Germany/Austria, HbA1c stayed the same for participants <6 to <13 years and 18 to <25 years; decreased for participants ages 13 to <18 years (P < 0.01); and increased for participants ≥25 years (P < 0.05). Conclusions: The comparison of international trends in HbA1c makes it possible to identify differences, explore underlying causes, and share quality improvement processes. National quality improvement initiatives are well accepted in Europe but have yet to be implemented systematically in the United States. However, disparities created by the lack of universal access to health care coverage, unequal access to diabetes technologies (e.g., continuous glucose monitoring) regardless of insurance status, and high out-of-pocket cost for the underinsured ultimately limit the potential of quality improvement initiatives.
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Affiliation(s)
| | - Julia M Grimsmann
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Ann-Marie Svensson
- Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Klemens Raile
- Department of Pediatric Endocrinology and Diabetes, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Karin Akesson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Paediatrics, County Hospital Ryhov, Jönköping, Sweden
| | - Peter Calhoun
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Beate Biesenbach
- Department of Pediatrics, University Hospital Linz, Kepler University, Linz, Austria
| | - Katarina Eeg-Olofsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - David M Maahs
- Division of Pediatric Endocrinology, Stanford Diabetes Research Center, Stanford, California, USA
- Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California, USA
| | - Ragnar Hanas
- Department of Pediatrics, NU Hospital Group, Uddevalla, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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13
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Mungmode A, Noor N, Weinstock RS, Izquierdo R, Indyk JA, DeSalvo DJ, Corathers S, Demeterco-Berggen C, Hsieh S, Jacobsen LM, Mekhoubad A, Akturk HK, Wirsch A, Scott ML, Chao LC, Miyazaki B, Malik FS, Ebekozien O, Clements M, Alonso GT. Making Diabetes Electronic Medical Record Data Actionable: Promoting Benchmarking and Population Health Improvement Using the T1D Exchange Quality Improvement Portal. Clin Diabetes 2022; 41:45-55. [PMID: 36714251 PMCID: PMC9845086 DOI: 10.2337/cd22-0072] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This article describes how the T1D Exchange Quality Improvement Collaborative leverages an innovative web platform, the QI Portal, to gather and store electronic medical record (EMR) data to promote benchmarking and population health improvement in a type 1 diabetes learning health system. The authors explain the value of the QI Portal, the process for mapping center-level data from EMRs using standardized data specifications, and the QI Portal's unique features for advancing population health.
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Affiliation(s)
- Ann Mungmode
- T1D Exchange, Boston, MA
- Corresponding author: Ann Mungmode,
| | | | | | | | - Justin A. Indyk
- Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH
| | | | - Sarah Corathers
- Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, Cincinnati, OH
| | | | | | | | | | - Halis Kaan Akturk
- Barbara Davis Center for Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | | | | | - Lily C. Chao
- Children’s Hospital Los Angeles, Los Angeles, CA
| | | | - Faisal S. Malik
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
| | - Mark Clements
- Children's Mercy – Kansas City, University of Missouri, Kansas City, MO
| | - G. Todd Alonso
- Barbara Davis Center for Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO
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14
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Ospelt E, Noor N, Sanchez J, Nelson G, Rioles N, Malik FS, Basina M, Indyk J, Vendrame F, Schmitt J, Scott ML, Ebekozien O. Facilitators and Barriers to Smart Insulin Pen Use: A Mixed-Method Study of Multidisciplinary Stakeholders From Diabetes Teams in the United States. Clin Diabetes 2022; 41:56-67. [PMID: 36714258 PMCID: PMC9845084 DOI: 10.2337/cd22-0068] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study sought to identify barriers and facilitators to successful smart insulin pen (SIP) use and gauge prescribing practices and integration into clinical practice by assessing provider and care team perspectives at participating endocrinology clinics within the T1D Exchange Quality Improvement Collaborative. The identified provider-related, patient-related, and clinic- and operational-level barriers and facilitators varied based on clinic knowledge, capacity, and resources. High-impact barriers included insurance coverage and prescribing processes; high-impact facilitators included improved diabetes clinic visit quality and use of SIPs as an alternative to insulin pump therapy. Findings indicated the need for provider and care team education and training on proper SIP features, use, and prescribing.
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Affiliation(s)
- Emma Ospelt
- T1D Exchange, Boston, MA
- Corresponding author: Emma Ospelt,
| | | | - Janine Sanchez
- University of Miami Miller School of Medicine, Miami, FL
| | | | | | | | | | | | | | | | | | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
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15
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Ebekozien O, Mungmode A, Buckingham D, Greenfield M, Talib R, Steenkamp D, Haw JS, Odugbesan O, Harris M, Mathias P, Dickinson JK, Agarwal S. Achieving Equity in Diabetes Research: Borrowing From the Field of Quality Improvement Using a Practical Framework and Improvement Tools. Diabetes Spectr 2022; 35:304-312. [PMID: 36072814 PMCID: PMC9396719 DOI: 10.2337/dsi22-0002] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
There are limited tools to address equity in diabetes research and clinical trials. The T1D Exchange has established a 10-step equity framework to advance equity in diabetes research. Herein, the authors outline this approach and expand on its practical application.
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Affiliation(s)
- Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
- Corresponding author: Osagie Ebekozien,
| | | | | | | | | | | | - J. Sonya Haw
- Grady Memorial Hospital, Emory University, Atlanta, GA
| | | | | | - Priyanka Mathias
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | | | - Shivani Agarwal
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
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