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Health-System-Based Interventions to Improve Care in Pediatric and Adolescent Type 1 Diabetes

  • Health Care Delivery Systems and Implementation in Diabetes (EB Morton-Eggleston, Section Editor)
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Abstract

Despite significant advances in pharmacology and technology, glycemic targets are difficult to achieve for patients with type 1 diabetes (T1D) and management remains burdensome for patients and their families. Quality improvement (QI) science offers a methodology to identify an aim, evaluate complex contributors to the goal, and test potential interventions to achieve outcomes of interest. Day-to-day management of diabetes is often an iterative process but interventions exist at all care levels: individual patient and family, clinic, and larger population and health system. This article reviews current literature and proposes novel QI interventions for enhancing health outcomes, with attention to essential determinants or drivers of improved glycemic control and patient experience for pediatric T1D in the context of the Chronic Care Model. In-depth consideration of key drivers of successful T1D care, including self-management and integration of technology, are explored, and examples of larger health systems with improved outcomes, including Learning Health Systems are highlighted.

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Acknowledgments

The authors would like to acknowledge the contribution of a larger design team consisting of patients, caregivers, clinicians, researchers, and diabetes stakeholders working together to produce a framework document, “A collaborative chronic care network for type 1 diabetes—Design and Development of a Learning Health System” for presentation to the T1D Exchange and Helmsley Charitable Trust. Dr. Corathers and Dr. Lee received funding from the Helmsley Charitable Trust.

Compliance with Ethics Guidelines

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Conflict of Interest

Sarah D. Corathers, Pamela J. Schoettker, Mark A. Clements, Betsy A. List, Deborah Mullen, Amy Ohmer, Avni Shah, and Joyce Lee declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Divisions of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA

    Sarah D. Corathers

  2. James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA

    Pamela J. Schoettker

  3. Pediatric Clinical Research Unit, Endocrine Clinical Research, University of Missouri-Kansas City, Children’s Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Mark A. Clements

  4. Xavier University, 3800 Victory Parkway, Cincinnati, OH, 45207-7351, USA

    Betsy A. List

  5. International Diabetes Center, 3800 Park Nicollet Blvd, IDC 6N, St. Louis Park, MN, 55416, USA

    Deborah Mullen

  6. Naturally Sweet Sisters, 9573 Tree Top Court, Pinckney, MI, 48169, USA

    Amy Ohmer

  7. Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, G-313 Medical Center, MC 5208, Stanford, CA, 94305-5208, USA

    Avni Shah

  8. Pediatric Endocrinology, Child Health Evaluation and Research Unit, University of Michigan, 300 NIB, Room 6E14, Campus Box 5456, Ann Arbor, MI, 48109-5456, USA

    Joyce Lee

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  1. Sarah D. Corathers
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  2. Pamela J. Schoettker
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  3. Mark A. Clements
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  4. Betsy A. List
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  5. Deborah Mullen
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  6. Amy Ohmer
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  7. Avni Shah
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  8. Joyce Lee
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Correspondence to Sarah D. Corathers.

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This article is part of the Topical Collection on Health Care Delivery Systems and Implementation in Diabetes

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Corathers, S.D., Schoettker, P.J., Clements, M.A. et al. Health-System-Based Interventions to Improve Care in Pediatric and Adolescent Type 1 Diabetes. Curr Diab Rep 15, 91 (2015). https://doi.org/10.1007/s11892-015-0664-8

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