Improving psychosocial care to decrease diabetic ketoacidosis in a population with type 1 diabetes: A series of quality improvement interventions
Background/Objective: Psychosocial factors play an important role in the care and management of type 1 diabetes (T1D) in children and adolescents. Youth with T1D who experience general and diabetes-specific psychosocial distress are more likely to experience difficulties with self-management and have suboptimal glycemic control, which can contribute to recurrent diabetic ketoacidosis (DKA) and diabetes-related complications. We aimed to decrease DKA events to <5% in our T1D population through multiple, ongoing PDSA cycles geared toward improving psychosocial care.
Methods: Data regarding medical outcomes such as DKA events were extracted from the EMR database. PDSA cycles to achieve our aim included (a) creation of an extra-care cohort of patients at high risk for recurrent DKA events, with a dedicated social worker for this cohort; (b) increasing patient access to dedicated psychologists with diabetes-specific expertise; (c) initiating yearly PHQ-9A depression screenings; (d) development of a diabetes specific psychosocial assessment tool to identify and address barriers to diabetes care; and (e) development of a risk score to identify patients at high risk for DKA.
Results: The overall DKA percentage reduced from 9.5% (baseline) in 2015 to 6.02% in 2020.
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