Using Stakeholder Input to Develop a Best Practice Advisory (BPA) to Increase Prescribing of Automated Insulin Delivery (AID) Systems for People With Type 1 Diabetes (PwT1D).
Emma Ospelt, Trevon Wright, Justin Indyk, Nicole Rioles, Susan Thapa, Asher Beckwitt, Osagie Ebekozien, Rachel Hopkins, Joseph Erardi, Abha Choudhary, Meenal Gupta, Mary Pat Gallagher, Jeniece Ilkowitz, Georgia Davis, Nestoras Mathioudakis, Risa M Wolf
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Abstract
Background: Diabetes technology use is increasing, yet disparities remain in adoption among people with type 1 diabetes (PwT1D). The Best Practice Advisories to Reduce Inequities in Technology Use ("BPA-TECH") study is a multi-site quality improvement (QI) initiative that seeks to develop, deploy, and evaluate a BPA aimed at standardizing prescribing of diabetes technologies.
Methods: This mixed-methods study sought feedback from PwT1D, their care partners, and diabetes clinicians through the T1D Exchange QI Collaborative (T1DX-QI) using electronic surveys, interviews, and focus groups to develop and refine the BPA.
Results: The T1DX annual survey with general BPA questions was completed by 56 participating centers (38 pediatric and 18 adult), and 31 diabetes care clinicians from eight T1DX-QI centers (five pediatric and three adult) participated in focus groups. An online survey was completed by 101 PwT1D and/or their care partners, followed by structured interviews with nine adult PwT1D and ten care partners. In response to the annual survey, 48% of pediatric and 28% of adult centers thought a BPA would be useful for increasing automated insulin delivery (AID) use. During focus groups, clinicians expressed concerns about workflow integration and alert fatigue. On surveys, most PwT1D and care partner stakeholder groups (96%) said a BPA would help remind diabetes clinicians to discuss technology with patients, and 77% agreed that a BPA could help PwT1D use these technologies, recommending a cadence of every three months.
Conclusions: Successful BPA development and implementation requires addressing clinician concerns about workflow and alert fatigue, while aligning with PwT1D and care partners' expectations for the cadence of conversations on AID systems.
期刊介绍：
The Journal of Diabetes Science and Technology (JDST) is a bi-monthly, peer-reviewed scientific journal published by the Diabetes Technology Society. JDST covers scientific and clinical aspects of diabetes technology including glucose monitoring, insulin and metabolic peptide delivery, the artificial pancreas, digital health, precision medicine, social media, cybersecurity, software for modeling, physiologic monitoring, technology for managing obesity, and diagnostic tests of glycation. The journal also covers the development and use of mobile applications and wireless communication, as well as bioengineered tools such as MEMS, new biomaterials, and nanotechnology to develop new sensors. Articles in JDST cover both basic research and clinical applications of technologies being developed to help people with diabetes.
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