Modern Roads to Type 1 Diabetes Management in Children: The Guide to Goals Program

Prabhu Shankar
22
Dec

Modern Roads to Type 1 Diabetes Management in Children: The Guide to Goals Program

Background: The goal of this pilot is to share and implement American Diabetic Association (ADA) guidelines-based standard of care and point of care (POC) informatics tools to manage pediatric Type 1 Diabetes Mellitus. T1D affects 2-3/1,000 Americans under age 20, and the prevalence is rising. Implementation of best practices substantially reduces mortality and morbidity, yet 40-80% of children are unable to maintain ideal blood glucose control. The Chronic Care Model (CCM) addresses this shortfall by assembling a multi-disciplinary healthcare team to inform patients and parents, allowing them to establish evidence-based goals for their own treatment. The Standards of Care published by the ADA provide a sound basis for goal-oriented therapy; but, their systematic implementation is cumbersome. We propose a novel electronic guide to pediatric T1D care to: 1) promote goal setting by patients and provider behavior change towards consistent education and 2) expedite the completion and monitoring of 17 items that comprise evidence-based standards of care for pediatric T1D. Method: Guide to Goals (G2G) is a mobile app and an expert alert system (AS), designed for pediatrics. It employs a tablet-based front-end user interface, a backend relational database, and an alert system based on ADA guidelines. The tablet is used for data entry, data retrieval (e.g., questionnaires and laboratory results), and alert notifications. After assigning a secure login upon patient arrival, patients/caretakers will use the tablet to complete questionnaires, historical/clinical updates, lab values, and medication reconciliation. Captured information is stored in a separate database. However, plans include future EHR integration. The AS will take input from the database, and based on the rules engine, will trigger realtime alerts and reports about each patient’s progress, their goals and morbidity and mortality risks. Providers can generate specific alert-based management and educational instructions to improve patient adherence to the ADA standards. The specific innovations proposed in GTG apply modern technology to: i) systematically monitor and prompt responses to meet all evidence-based practice standards, ii) apply standardized instruments (questionnaires) to screen for complex problems that may confound care of T1D (e.g. depression, eating disorders, patient/caretaker sharing of responsibility for care), iii) promote prioritization of patient-centered goals through a collaborative effort of the T1D management team, iv) maximize the time available for problem solving and goal setting at T1D team visits by promoting data entry to GTG by patients/caretakers, and the providers both before and after visits, v) optimize T1D-related communications among the T1D team members, and vi) provide detailed practice-based information that will offer new evidence to help aid patients and providers in decision making. Focus group meetings are planned with end users to gather suggestions for improvement and launch clinical trials with a consortium of 3 pediatric endocrinology academic/private practices in Atlanta that have committed to participate in the trials. GTG will provide the basis for designing a measure of the quality of pediatric T1D care. To our knowledge, there are no validated pediatric-specific applications in the literature.