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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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Ebekozien O, Fantasia K, Farrokhi F, Sabharwal A, Kerr D. Technology and health inequities in diabetes care: How do we widen access to underserved populations and utilize technology to improve outcomes for all? Diabetes Obes Metab 2024; 26 Suppl 1:3-13. [PMID: 38291977 PMCID: PMC11040507 DOI: 10.1111/dom.15470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 02/01/2024]
Abstract
Digital health technologies are being utilized increasingly in the modern management of diabetes. These include tools such as continuous glucose monitoring systems, connected blood glucose monitoring devices, hybrid closed-loop systems, smart insulin pens, telehealth, and smartphone applications (apps). Although many of these technologies have a solid evidence base, from the perspective of a person living with diabetes, there remain multiple barriers preventing their optimal use, creating a digital divide. In this article, we describe many of the origins of these barriers and offer recommendations on widening access to digital health technologies for underserved populations living with diabetes to improve their health outcomes.
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Affiliation(s)
- Osagie Ebekozien
- T1D Exchange, Boston, Massachusetts, USA
- Department of Population Health, University of Mississippi, Jackson, Mississippi, USA
| | - Kathryn Fantasia
- Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Farnoosh Farrokhi
- Alta Bates Summit Medical Centre, Sutter East Bay Medical Foundation, Oakland, California, USA
| | - Ashutosh Sabharwal
- Department of Electrical and Computer Engineering, Rice University, Houston, Texas, USA
| | - David Kerr
- Centre for Health System Research, Sutter Health, Santa Barbara, California, USA
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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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Eng D, Ospelt E, Miyazaki B, McDonough R, Indyk JA, Wolf R, Lyons S, Neyman A, Fogel NR, Basina M, Gallagher MP, Ebekozien O, Alonso GT, Jones NHY, Lee JM. The Design of the Electronic Health Record in Type 1 Diabetes Centers: Implications for Metrics and Data Availability for a Quality Collaborative. J Diabetes Sci Technol 2024; 18:30-38. [PMID: 37994567 PMCID: PMC10899848 DOI: 10.1177/19322968231214539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Systematic and comprehensive data acquisition from the electronic health record (EHR) is critical to the quality of data used to improve patient care. We described EHR tools, workflows, and data elements that contribute to core quality metrics in the Type 1 Diabetes Exchange Quality Improvement Collaborative (T1DX-QI). METHOD We conducted interviews with quality improvement (QI) representatives at 13 T1DX-QI centers about their EHR tools, clinic workflows, and data elements. RESULTS All centers had access to structured data tools, nine had access to patient questionnaires and two had integration with a device platform. There was significant variability in EHR tools, workflows, and data elements, thus the number of available metrics per center ranged from four to 17 at each site. Thirteen centers had information about glycemic outcomes and diabetes technology use. Seven centers had measurements of additional self-management behaviors. Centers captured patient-reported outcomes including social determinants of health (n = 9), depression (n = 11), transition to adult care (n = 7), and diabetes distress (n = 3). Various stakeholders captured data including health care professionals, educators, medical assistants, and QI coordinators. Centers that had a paired staffing model in clinic encounters distributed the burden of data capture across the health care team and was associated with a higher number of available data elements. CONCLUSIONS The lack of standardization in EHR tools, workflows, and data elements captured resulted in variability in available metrics across centers. Further work is needed to support measurement and subsequent improvement in quality of care for individuals with type 1 diabetes.
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Affiliation(s)
- Donna Eng
- Pediatric Endocrinology, Helen DeVos
Children’s Hospital, Michigan State University College of Human Medicine, Grand
Rapids, MI, USA
| | - Emma Ospelt
- Quality Improvement and Population
Health, T1D Exchange, Boston, MA, USA
| | - Brian Miyazaki
- Center for Endocrinology, Diabetes and
Metabolism, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Ryan McDonough
- Pediatric Endocrinology and Diabetes,
Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Justin A. Indyk
- Division of Endocrinology, The Ohio
State University College of Medicine and Nationwide Children’s Hospital, Columbus,
OH, USA
| | - Risa Wolf
- Department of Pediatrics, Division of
Pediatric Endocrinology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Sarah Lyons
- Department of Diabetes and
Endocrinology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX,
USA
| | - Anna Neyman
- Department of Pediatrics, University
Hospitals Rainbow Babies & Children’s Hospital and Case Western Reserve
University, Cleveland, OH, USA
| | - Naomi R. Fogel
- Division of Pediatric Endocrinology,
Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Marina Basina
- Division of Endocrinology,
Gerontology and Metabolism, Stanford University, Stanford CA, USA
| | - Mary Pat Gallagher
- The Pediatric Diabetes Center,
Hassenfeld Children’s Hospital at NYU Langone, New York, NY, USA
| | - Osagie Ebekozien
- Quality Improvement and Population
Health, T1D Exchange, Boston, MA, USA
- Department of Population Health,
University of Mississippi, Jackson, MS, USA
| | - G. Todd Alonso
- Barbara Davis Center, University of
Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nana-Hawa Yayah Jones
- Division of Endocrinology, Cincinnati
Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Joyce M Lee
- Pediatric Endocrinology, Susan B.
Meister Child Health Evaluation and Research Center, Ann Arbor, MI, USA
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Ebekozien O. Roadmap to Achieving Continuous Glucose Monitoring Equity: Insights From the T1D Exchange Quality Improvement Collaborative. Diabetes Spectr 2023; 36:320-326. [PMID: 37982057 PMCID: PMC10654123 DOI: 10.2337/dsi23-0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
This article describes successful interventions from the T1D Exchange Quality Improvement Collaborative (T1DX-QI) to reduce inequities in access to and use of continuous glucose monitoring (CGM). The author proposes a roadmap with recommendations for different stakeholders to achieve CGM equity using insights from the T1DX-QI experience.
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Affiliation(s)
- Osagie Ebekozien
- T1D Exchange, Boston, MA, and the University of Mississippi School of Population Health, Jackson, MS
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