title: Health-system-based interventions to improve care in pediatric and adolescent type 1 diabetes.
abstract: Despite significant advances in pharmacology and technology, glycemic targets are difficult to achieve for patients with type 1 diabetes (T1D) and management remains burdensome for patients and their families. Quality improvement (QI) science offers a methodology to identify an aim, evaluate complex contributors to the goal, and test potential interventions to achieve outcomes of interest. Day-to-day management of diabetes is often an iterative process but interventions exist at all care levels: individual patient and family, clinic, and larger population and health system. This article reviews current literature and proposes novel QI interventions for enhancing health outcomes, with attention to essential determinants or drivers of improved glycemic control and patient experience for pediatric T1D in the context of the Chronic Care Model. In-depth consideration of key drivers of successful T1D care, including self-management and integration of technology, are explored, and examples of larger health systems with improved outcomes, including Learning Health Systems are highlighted.
authors.affiliation: Divisions of Endocrinology, Cincinnati Children's Hospital Medical Center, University of Cincinnati Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA. Sarah.Corathers@cchmc.org.
authors.forename: Sarah D
authors.initials: SD
authors.lastname: Corathers
authors.affiliation: James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA. Pam.Schoettker@cchmc.org.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Schoettker
authors.affiliation: Pediatric Clinical Research Unit, Endocrine Clinical Research, University of Missouri-Kansas City, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO, 64108, USA. maclements@cmh.edu.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Clements
authors.affiliation: Xavier University, 3800 Victory Parkway, Cincinnati, OH, 45207-7351, USA. betsy.list@gmail.com.
authors.forename: Betsy A
authors.initials: BA
authors.lastname: List
authors.affiliation: International Diabetes Center, 3800 Park Nicollet Blvd, IDC 6N, St. Louis Park, MN, 55416, USA. deborah.mullen@parknicollet.com.
authors.forename: Deborah
authors.initials: D
authors.lastname: Mullen
authors.affiliation: Naturally Sweet Sisters, 9573 Tree Top Court, Pinckney, MI, 48169, USA. naturallysweetsisters@gmail.com.
authors.forename: Amy
authors.initials: A
authors.lastname: Ohmer
authors.affiliation: Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, G-313 Medical Center, MC 5208, Stanford, CA, 94305-5208, USA. avnishah@stanford.edu.
authors.forename: Avni
authors.initials: A
authors.lastname: Shah
authors.affiliation: Pediatric Endocrinology, Child Health Evaluation and Research Unit, University of Michigan, 300 NIB, Room 6E14, Campus Box 5456, Ann Arbor, MI, 48109-5456, USA. joyclee@umich.edu.
authors.forename: Joyce
authors.initials: J
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D010353:Patient Education as Topic; D058996:Quality Improvement; D012648:Self Care; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose
keywords: Chronic Care Model; Learning Health Systems; Quality improvement; Type 1 diabetes