Establishment of the Type 1 Diabetes Exchange QI Learning Collaborative (T1DX-LC)

Background: The proportion of patients with type 1 diabetes (T1D) who meet recommended HbA1c targets remains suboptimal, with little improvement over the last two decades. A Learning Collaborative (LC) is a multi-clinic learning and sharing quality improvement (QI) process known to accelerate improvement in chronic conditions. We created the T1DX-LC to spread learning to improve health outcomes of individuals living with T1D.

Methods: In 2014, a design process engaged clinicians, researchers, patient advocates, and QI leaders to develop a roadmap for improvement, based on the Chronic Care Model. The T1DX-LC launched in 2016 with 7 pediatric and 3 adult diabetes practices, coordinated by the T1D Exchange (Boston, MA). Over 18 months, we established a LC foundation: teams representing each clinic, governance, QI training and capability, online collaboration space, standard measures, and population data systems. Teams selected clinical tests of change to pilot for depression screening, pre-visit planning, and patient-centered clinic design.

Results: Teams completed formal QI coursework and collaborated via monthly calls, emails, an online collaboration space, and 3 in-person learning sessions. Six teams increased depression screening, 5 teams adopted multiple change ideas for pre-visit-planning, and 5 teams shared patient-centered tools and practices. A QI capability assessment survey was established and showed proficiency for all teams. We established a HIPAA-compliant data repository, data formatting specifications, data extraction/transmission standards, and a prototype data visualization dashboard. Two sites demonstrated the ability to extract and transmit EHR data to the central database.

Conclusions: The T1DX-LC demonstrated broad engagement, improved QI capability, advanced 3 focus areas, and developed a data exchange infrastructure. Our next steps are to build upon these efforts to accelerate improvement of outcomes in high-risk patients with T1D defined by HbA1c >9%.