Improving Multidisciplinary Care in Pediatric Diabetes Clinic

Abstract

Background: A team-based approach facilitates comprehensive assessment and individualized care plan for diabetes patients. The ADA recommends diabetes patients see a Certified Diabetes Educator (CDE), Registered Dietician (RD) and Social Worker (SW) at least once yearly. Prior to this QI project there was no structured process in our pediatric diabetes clinic for these visits, leading to low rates of multidisciplinary patient care. Objectives: Our goal was to improve the proportion of diabetes patients receiving evidenced-based multidisciplinary care for enhanced education and social support. Specifically, we aimed to improve the percentage of diabetes patients (<21yo) with CDE visits from baseline of 59% in FY2014 to ≥75% in FY2017, RD visits from baseline of 33% in FY2014 to ≥75% in FY2017, and SW visits from baseline of 24% in FY2014 to ≥75% in FY2017. Methods: Fish bone and key driver diagrams were deployed to identify strategies for improvement. Our intervention established a policy of Annual Visits for multidisciplinary care with a model to ensure optimal communication. PDSA1: Use birthdays as a mechanism to trigger Annual Visit with CDE, RD, SW; PDSA2: Develop and utilize sustainable pre-visit planning document; PDSA3: Staff call patients scheduled for Annual Visit the day prior; PDSA4: Multidisciplinary pre-clinic huddle to discuss daily clinic procedure; PDSA5: Utilization of EMR diabetes patient registry to identify gaps in care; PDSA6: Utilize a Nurse Coordinator to ensure patients receive required services Results: The rates of patients seen by multidisciplinary staff increased from baseline for all 3 groups in FY2017: CDE-79.4%, RD-64.3% and SW-83.9%. Thus, the goal of ≥75% was achieved for CDE and SW, but not RD visits (primarily due to staffing). Conclusions: This QI project resulted in improved transparency, organization and accountability within the clinic. Increasing CDE, RD, and SW support for diabetes patients could impact quality of care delivery, value to the patient, and clinical outcomes. Disclosure D.J. DeSalvo: Consultant; Self; Dexcom, Inc.. Speaker's Bureau; Self; Insulet Corporation. S.K. Bartz: None. C. Yee: None. R. Sonabend: None.