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T1D Monitoring Project meeting minutes 4/26/24

JDRF T1D Monitoring Project meeting 4/26/24 1:00 PM ET

Participants: Dr. Carla Demeterco-Berggren; Dr. Laura Jacobsen; Dr. Osagie Ebekozien; Ann Mungmode; Don Buckingham

Agenda:

Time Item Lead(s)
2:00-2:10 (10’) Welcome

·       Updates to Qualtrics and QI Portal

Ann Mungmode
2:10-2:30 (20’) Failure Mode and Effects Analysis

·       Anticipating and accounting for failures in process development

Don Buckingham

 

 

 

2:30-3:00 (30’) QI Project Updates

·       Process maps

·       PDSA cycles

·       Data submissions – Qualtrics

Dr. Carla Demeterco-Berggren

Dr. Laura Jacobsen


Minutes:

Welcome and Updates:

  • Updated Qualtrics survey; both teams have started uploading surveys
  • Some suggested edits:
    • Include Insulin AA in multiple AA option (currently in single AA)
    • Remove Tyrosine Phosphate (a type of Anti-IA2 which we collect already)
    • T1DX team to update Qualtrics
    • Laura and Carla to continue survey entry
  • Reviewed QI Portal projects
    • Can document monitoring projects using “Other” à “T1D Screening and Monitoring” metric
    • Laura and Carla to update QI Portal with monitoring projects

Failure Mode and Effects Analysis:

  • Why a FMEA tool?
    • Document our methods and QI story
    • Identify ‘what could go wrong’ and prepare for it before the process is established
  • FMEA background
    • We use a Fishbone diagram to identify root causes which stand in the way, which help us determine interventions that ARE the way
    • Things that we may discover (which severely interrupt process) on the back end of implementation:
      • Risk to patient/provider
      • Technology failure
      • Missing materials
    • When this happens, hospitals will often do a root cause analysis
    • If the effects of the failure are severe, we will benefit from identifying and incorporating around them in the ‘design’ process
    • The magnitude of the risk informs the extend of the FMEA process to go through
      • If we experienced a patient death, for example, extensive FMEA would be appropriate
      • A supply chain disruption would be a different process
    • FMEA components
      • Identify the failure modes – what could go wrong
      • Indicators tell how how we know if the process failed
        • We can rate based on severity
      • The intervention would help relieve this failure in the future
    • FMEA and this project
      • Laura and Carla can decide if this tool is appropriate for this content area
      • We brainstormed some potential failures
        • Misdiagnosis
        • Billing failures
        • Mishandling of samples
        • Patients decline monitoring options
      • As we work on a process, we may have a higher rate of success bias
        • Using an FMEA may help with this bias by challenging us to ask how this could fail and how we could mitigate that from happening
        • Especially in a high-risk and high reward scenario

QI Project Analyses Updates:

  • University of Florida updates:
    • Updated process map
    • 17 people screened, 8 entered into Qualtrics
    • Positivity rate is 50% but probably won’t stay this high
    • 7% positivity in relatives
  • Rady Children’s updates:
    • Updated process map
    • Monitor screening inbox
    • Offer counseling for every family; seen within two weeks
    • Two junior faculty joining this project and working to scale up
      • Eventually to general pediatricians
      • Providing academic instruction
      • Understanding with receiving referrals to endos and sharing flyers
    • EMR documentation
      • Using family history, or
      • Z-code for AA (GAD AA+)

Meeting Recording: T1DX-QI JDRF Monitoring project check-in-20240209_140208-Meeting Recording.mp4

T1DX-QI

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