May 15, 2023

T1D Exchange Quality Improvement Collaborative 

May Strategy Session 2023 

Diabetes Distress working group 

Link to Recording 

Discussion Questions 

1. Start with open discussion of interested PIs. 

1. Each group to select 2 volunteer leads (one adult and one peds) 

1. Choose deliverables, SMART aims, and timelines. Each group can decide 

1. Plan interventions that tie to the KDD 

1. Plan for organization and visualization of data (e.g. run charts) 

1. Progress report due by the November meeting 

Minutes 

• Participants 

• Dr. Devin Steenkamp 
• Dr. Liz Mann 

• Dr. Mary Scott 
• Dr. Caleb Schmid 
• Dr. Anna Neyman (Dr. Tamara Hannon to take over) 
• Dr. Alissa Roberts 
• Ann Mungmode 

• Emma Ospelt 

• Previous experience 

• Seattle Children’s has used the Paid-T Diabetes distress tool (Seattle) 

• Alissa is happy to share their past publications 

• Diabetes Distress – collaborate to develop a structured implementation program and model to address diabetes distress in routine clinical practice 

• Boston Medical Center invited Larry Fisher to facilitate a session on diabetes distress scale 

• What is practical in a clinical space and supporting diabetologists in asking these important questions  
• How do we respond to screening? Composite score, or individual questions? 
• The lessons we learn about how to do this in practice would be great to share out 
• How to make DDS transformed from a research tool to a practical clinical tool 

• Be careful with mental health diagnoses; there are implications to a diagnosis (employment) 

• OHSU has an ICD-10 code that they use for psychological events in T1D 
• We want those people to receive the care they need to improve psychologically 

• Leading this workgroup 

• Liz is interested, unsure about bandwidth 

• Alissa would be happy to doing together and supporting wherever possible 

• If we only wanted one pediatric PI 

• T1DX-QI will support with administrative tasks (like scheduling meetings) 
• Meeting frequency 
  • Monthly would be good 
  • Would be helpful to have the next meeting soon to keep momentum going 
  • Get an email train started
  • Monday afternoons work well 

• Plan for next meeting 
  • Suggestion that every member share 
  • What is your current process, what tools do you use 
  • Liz can share out a ‘survey’ to enhance our discussion next time 
  • 10 minutes sharing 

 

Potential outcomes/deliverables 

• Identify preferred distress tools to use (in peds and adults) 
• Coding for providers to use 
• Processes for clinical If a patient scores highly in total or in specific areas 

• • If not feeling listened to, trigger something to improve communication between provider and patients 

• It was easier to implement diabetes distress compared to PHQ-9 because not the same kind of acuity (suicidal ideation) – difficult hurdle due to the safety risk 

• The measures (building into EHR) may be one of the most challenging 

• • May need to consider paper options 

• Our recommendations on distress tools for members of the T1DX-QI 
• How to capture teens who are not distressed but parents are (and similarly, adult patients with partners) 
• How to measure the impact of diabetes distress on families as opposed to individuals 

• There are different types of distress  

• Differing interventions 

• • Psychology 
  • Social workers 
  • Support