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:

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