Abstract: Understanding facilitators and barriers to clinic-wide implementation of a population-based tool to identify patients with type 1 diabetes (T1D) at high risk for suboptimal glycemic outcomes
Emily L. DeWit1, Katie Noland1, Sophie MacColl1, Franziska Bishop2, Mark Clements1
1Children's Mercy Kansas City, 2Stanford School of Medicine
Background/Objective: To gain insights from clinicians to inform clinic-wide implementation of a CGM-based population health management tool (Ferstad et al, 2021) that identifies patients in need of support due to the presence of suboptimal glycemic outcomes.
Methods: We recruited diabetes clinicians (physicians, nurses, dieticians, a fellow and a social worker) at a pediatric hospital in the Midwestern United States to participate in QUEST, a qualitative study designed to gather input to inform design and implementation of patient and provider-facing care delivery interventions. Clinician experience ranged from 2 months to 25 years (average 6 years) in their current role, and clinicians were naive to the tool. Participants completed an electronic survey that included a video introduction to the Timely Interventions for Diabetes Excellence (TIDE) platform, followed by 34 Likert scale, multiple choice, and free text response questions. The Capability, Opportunity, Motivation, and Behavior (COM-B) model and Organizational Readiness for Implementing Change (ORIC) scale provided the framework for these questions.
Results: Fifty-six clinicians received study information; 20 consented to participate. Participants perceived that the platform could serve as a proactive tool to support youth to improve glycemic management. Clinicians scored on average 45/60 on the ORIC scale, suggesting an overall readiness for implementing this change. Clinicians endorsed lack of time and training as barriers to implementing the tool. They identified that de-implementing ineffective clinical practices could address time as a barrier.
Conclusion: Results will guide implementation of the TIDE platform in new organizations.
Keywords: continuous glucose monitoring, glycemic management, implementation, population health