180 - Risk-based Quality Improvement for Type 2 Diabetes Screening in Primary Care

Type 2 diabetes (T2D) screening guidelines in youth vary and are inconsistent, leading to underscreening, particularly in marginalized, at-risk groups.

Objective:

To evaluate the effect of a 2-phase intervention for T2D screening on provider adherence to guidelines and screening rates in at-risk groups.

Design/Methods:

Phase 1, June 2020 to May 2021: A multidisciplinary care process model (CPM) based on American Diabetes Association T2D screening guidelines in youth was created. Patients qualified for screening if they were aged ≥ 10 years, had body mass index ≥ 85^th percentile, and identified as belonging to a high-risk racial/ethnic group (Asian/Pacific Islander, Black, American Indian and Alaska Native, or Hispanic/Latino) or had a prior elevated hemoglobin A_1c level without timely follow-up (5.6%-5.9%, ≤ 1 y; 6.0% to < 6.5%, ≤ 6 mo). University of Utah Health well child visit baseline screening rates were analyzed at 3 intervention clinics (academic pediatric centers) and 27 comparison clinics (primary care clinics).

Phase 2, June 2021 to November 2022: Links to the CPM were implemented as electronic health record (EHR) clinical decision support (CDS) within well-child structured templates and endocrine referrals. Intervention clinics received educational presentations. Frequency of qualifying visits with screening in phase 1 vs phase 2 were analyzed using chi-square test, statistical process control (SPC) p-charts, and interrupted time series (ITS).

Results: There were 2486 qualifying visits (intervention, 796; comparison, 1690). In phase 2, the frequency  of qualifying visits with screening increased in intervention clinics by 20% (P = .003) and comparison clinics by 10% (P = .043) (Table 1, Figure 1). In phase 1, ITS showed an increase in qualifying visits with screening in intervention (2.4%/month; 95% CI, 1.8 – 3.0; P= .000) and comparison clinics (1.3%/month; 95% CI, 0.5 – 2.1; P=.001). In phase 2, ITS showed no significant increase in qualifying visits with screening in intervention (0.3%/month; 95% CI, -0.6 – 1.3; P = .46) or comparison clinics (0.1%/month; 95% CI, -0.4 – 0.7; P = .55)  (Fig 1).

Conclusion(s): A risk-based T2D CPM integrated into EHR CDS increased screening frequency in at-risk youth. Despite phase 2 educational presentations in intervention clinics, screening trends were similar between groups.