Patient-Centered Decision Support to Improve Diabetes Management in Pre-Teens and Adolescents with Type 1 Diabetes

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Management strategies and concomitant technologies for improving glycemic control in patients with type 1 diabetes (T1D) continue to evolve; yet the majority of adolescents with diabetes have glycosylated hemoglobin (HbA1c) values above the recommended range. Moreover, inequities in care delivery occur including differences in providers’ knowledge/adherence to guidelines, variability in access to providers, and socioeconomic inequities. The American Diabetes Association (ADA) Strategies for Improving Care in 2016 states that “patient-centeredness, including a patient-centered communication style that incorporates patient preferences, assesses literacy and numeracy, and addresses barriers to care should be used”. Further, advancing technology to enable timely, evidence-based treatment decisions tailored to individual patient preferences, prognoses, and comorbid conditions is recommended. Unfortunately, these types of generalizable tools currently do not exist in pediatric diabetes care. To address this gap, we propose to study an intervention that will provide patient-centered, automated decision support to diabetes providers with the ultimate goal of improving health outcomes. We will implement ADA recommendations of care using a CDSS developed by our research group – the Child Health Improvement through Computer Automation (CHICA) system. The greatest strengths of CHICA include its ability to implement evidence-based recommendations from authoritative sources, like the ADA, in a format that integrates easily into routine care, and to screen for and alert providers about patient-centered concerns. To ensure that we design the most effective CDSS intervention we will partner with adolescents, parents, and other stakeholders in a way that exceeds standard expectations for the engagement of these parties in research. This truly innovative approach will offer improved technology-based support systems for diabetes management along with attention to patient-centered goals using co-designed interventions for diabetes self-management. Specifically, the study aims are to: (1) Utilize a human-centered design approach to engage stakeholders in refinement of our previously developed patient-centered diabetes management plan for implementation within a CDSS; (2) Expand and modify CHICA to provide patient- centered, automated decision support to diabetes providers caring for youth (>=12 years of age) with T1D that incorporates the findings from Aim 1 and prompts the provision of care according to ADA recommendations; and (3) Demonstrate the feasibility and effectiveness of the CHICA T1D prototype, to improve a) clinical care measures (e.g., HbA1c), b) process of care measures (e.g., provider adherence to standards of care), and c) patient-centered outcomes. During Aim 3 we will conduct three cycles of stakeholder refinement to ensure we that we have designed the most optimal intervention. By study end, the finalized CHICA T1D system should be safe, feasible to implement, effective, acceptable in our target population, and ready to test in a larger, randomized controlled trial.