141-LB: Targeting Workflow Inefficienes to Improve Continuous Glucose Monitor (CGM) Prescription Rates in Type 1 Diabetes (T1D)

Background: Racial/ethnic disparities exist in CGM prescription rates for people with T1D, and are associated with disparities in glycemic outcomes. We identified healthcare system inefficiencies that may be contributing to inequity and targeted interventions to improve prescription workflow.

Methods: At our large urban diabetes center, we used quality improvement (QI) methodology to implement and test changes in our CGM prescription workflow and examined effect on CGM prescription rates. Since October 2021, we collaborated with a specialty pharmacy to simplify CGM e-prescription for providers to improve device access for patients. We conducted PDSA cycles to add new office workflows for insurance prior authorization, standardize documentation, train support staff, and created change packages for spread across our diabetes practice sites. We examined effects by extracting monthly aggregate CGM prescription data from the electronic medical record and compared CGM prescription rates before and after initiation of the workflow.

Results: We included 717 people with T1D [mean age 38 years; 42.3% Hispanic (n=303) , 29% non-Hispanic Black (n=208) , 14.5% non-Hispanic White (n=104) , 14.3% other (n=102) ; 69% publicly insured]. In the five months since the introduction of the workflow, CGM prescriptions increased by 9.0% (49.4% to 58.4%) . CGM prescription rates in Hispanic and non-Hispanic Black patients were equivalent to White.

Conclusion: Simple, trackable, and iterative changes to CGM prescription workflows are feasible and can effectively increase CGM prescription rates in a short period of time. Further changes to clinic processes using QI methodology may result in meaningful improvements in outcomes.