Background: Insulin pump therapy in type 1 diabetes (T1D) has been associated with lower hemoglobin A1c than multiple daily injections. In the T1D Exchange, 63% of pediatric patients <18 years old in 2013-14 used pumps. However, pump use at our institution in 2015 was much lower at 39.4% (551 of 1399 patients <18 years old with T1D duration ≥1 year attending clinic at least twice yearly). A multidisciplinary team of pediatric endocrinologists, diabetes educators, and hospital leaders implemented a QI initiative aimed to increase pump use to ≥50%.
Methods: Pump use was extrapolated from diabetes providers’ visits in the electronic medical record (EMR) and tracked via a run chart. A series of plan-do-study-act (PDSA) cycles were implemented, including:
1. Creation of introductory and advanced pump handouts for patients.
2. Quarterly technology sessions for providers and clinic staff to improve pump knowledge.
3. Creation of pump start orders in the EMR.
4. Certification of the clinic’s diabetes educators in all commonly used pumps.
5. Scheduled diabetes educator visits for all patients after pump initiation.
Results: Pump use increased from 39.4% (551 of 1399 patients) in 2015 to 50.6% (730 of 1442 patients) in 2018 (Image 1).
Conclusion: The aim of increasing pump use to ≥50% of our clinic’s population was achieved over 3 years. Building on this success, future direction is to evaluate impact on bolus frequency and association with HbA1c.
S. Lyons: None. N.L. Canada: None. K. Hernandez: None. J.E. Segovia: Consultant; Self; Insulet Corporation. S.K. Bartz: None. D.J. DeSalvo: Consultant; Self; Dexcom, Inc., Insulet Corporation. S. Mckay: None. R. Sonabend: None.
