579-P: ADA Diabetes Medical Management Plan Implementation—Barriers and Opportunities

Introduction & Objective: The ADA’s Diabetes Medical Management Plan (DMMP), revised in 2021, provides medical orders for diabetes care in schools. The objective was to assess multistakeholder experiences with the revised DMMP, barriers to uptake, and potential strategies to enhance usability.

Methods: We conducted a national survey of diabetes providers and school nurses with the ADA Safe at School Working Group, National Association of School Nurses, and other professional organizations. Questions addressed processes for DMMP integration, perceived barriers, and recommendations.

Results: We received responses from 507 school nurses and 79 providers representing all US regions. Of these, 57% of school nurses and 62% of the providers had used the DMMP. Views of the DMMP were generally favorable; 100% of providers and 92% of nurses agreed that the DMMP was comprehensive and >60% felt it was the right length. The DMMP was usually completed on a computer by providers (82%), though only 31% could share the form electronically with schools. Common barriers reported by school nurses included delays in receiving the DMMP (57%) including updates (64%) and alternative forms from providers (41%); for providers, barriers included lack of health record integration (72%) and time required to complete the DMMP (50%). Both groups endorsed difficulty with parent engagement with DMMP completion (37% nurses, 44% providers). Over 750 comments suggested modifications to enhance usability; themes included fostering parent and provider input for all sections, streamlining references to accommodations, and providing more flexible formats to customize based on local practices.

Conclusion: Barriers at the health system level interfere with uptake of the DMMP. Multi-stakeholder input can co-create medical orders and school resources which can be customized to meet the needs of local centers. Electronic systems for bidirectional information transfer between schools and diabetes centers would facilitate adoption.