Developing and evaluating an EMR-based Best Practice Advisory to standardize prescribing of advanced diabetes technologies and reduce racial inequities in their use.
Continuous advancements in diabetes technologies have improved self-management for people with type 1 diabetes (PwT1D). Continuous glucose monitors (CGM) and automated insulin delivery (AID) systems have enhanced quality of life and glycemic outcomes while reducing severe hypoglycemia and diabetes ketoacidosis (DKA) hospitalizations. Despite these benefits, racial inequities in the use of advanced diabetes technology (ADT) persist.
Aim 1: To develop and implement an EMR-based BPA using stakeholder feedback to standardize the approach for prescribing and documentation of advanced diabetes technologies (ADT) — CGM, insulin pump, AID — among adult and pediatric PwT1D.
Aim 2: To determine the effectiveness of an EMR-based BPA in reducing racial inequities in ADT.
Primary Objective: Compare the proportion of non-white (non-Hispanic Black and Hispanic) PwT1D with progression in ADT use at 6 T1DX-QI centers (4 pediatric and 2 adult) where the BPA intervention is implemented, with matched control non-white PwT1D at T1DX-QI centers not receiving the intervention over a 12-month period — adjusting for baseline level of ADT use and other confounders.
Secondary Objective: Assess the difference in ADT use between White and non-white PwT1D receiving care at the intervention centers compared with the racial difference in ADT use in matched control PwT1D.
Aim 3: Explore the reasons identified for providers' decision not to prescribe ADT and whether they were patient or provider led, and the association between the reason provided and the patient's race/ethnicity.
