Background: where we started
In 2020, we launched a new effort called the Rising T1DE Alliance (formerly known as the Rapid Learning Lab), funded by a 3-year, $8.5M grant from The Leona M. & Harry B. Helmsley Charitable Trust. This exciting effort is led by Dr. Mark Clements at Children’s Mercy, in collaboration with Dr. Leonard D’Avolio and his data science team at Cyft, Inc. Dr. Sanjeev Mehta from the Joslin Diabetes Center serves as advisor and Chair of the 12-member Stakeholder Advisory Committee for the project. Dr. Susana Patton from Nemours Children’s Health System, directs intervention development and selection, and Dr. Ryan McDonough from Children’s Mercy directs the quality improvement work. Dr. John Lantos and Emily Hurley direct bioethical and foundational research related to the use of AI in healthcare, respectively. Emily DeWit and Kristi Holmes coordinate the project from Children’s Mercy and Cyft, respectively. Other support from Children’s Mercy includes:
Integrated Care System (Children’s Mercy’s value-based care program) support
Digital strategy support
Innovation Center support
Telehealth Program support
Advanced Research Compute Team support
Space in the new Children’s Mercy Research Institute
Key project support teams include Data Science, QI Leadership, QI Work Groups, the Data and Evidence Generation Team, Bioethical/Formative Research, Health Economics and Dissemination Working Groups.
We are building on our prior foundational work by using those prediction models, paired with novel interventions and guided by implementation science to rapidly innovate and rapidly scale our quality-improvement efforts. The Rising T1DE Alliance (RTA) aims to increase the rate of deployment of successful interventions and innovative therapies in diabetes care. The RTA will start with identifying an outcome to target, develop a predictive model, test interventions, develop a change package plus (i.e., a roadmap for predicting and quality-improving the outcome), and disseminate that change package plus to other diabetes centers and learning health systems.
What's Happening Now
The following publications from our team are being considered for the Journal of Diabetes! Congratulations are in order to not only all of our authors, but to everyone in the department who contributed to the operations and execution of these projects! Way to go!
Schema and Data Validation of T1D Exchange Mapped Data Using Pandera Framework Brent Lockee; Mitchell Barnes; Emily DeWit, MASL; Mark C. Clements MD, Ph.D; Diana Ferro, Ph.D.
Remote Patient Monitoring for Youth with Type 1 Diabetes (T1D) Predicted to Experience a Rise in Hemoglobin A1C (A1c) David D. Williams, MPH; Diana Ferro, PhD; Brent Lockee, BS; Shelby Carrothers, MPH; Mitchell S. Barnes, BS; Emily DeWit, MASL; Sarah Albert, BS; Britaney Spartz, NONE; Ryan McDonough, DO; Mark A. Clements, MD, PhD
Implication of device disengagement on glycemic control and diabetic ketoacidosis in youth with T1D Diana Ferro, PhD; David Williams, MPH; Brent Lockee; Colin Mullaney; Jacob Redel, MD; Lydia Skrabonja; Mark A. Clements MD, PhD; Ryan J. McDonough, DO
Implementation of a Transition Readiness Assessment and Transition Discussion Documentation in a Type 1 Diabetes Clinic Sonalee Ravi, MD; Jaimie Contreras, BSN, RN, CDECS; Julie Kincheloe, BSN, RN, CDECS; Heather Feingold, LSCSW, LCSW; Lydia Sailor BSN, RN, CDECS; Callie Chagas, MS, RD, CDECS; Rebekah Elliott BS, Katelyn Evans, LCSW, LMSW; Diana Ferro, PhD; Emily DeWit, MASL; Ryan McDonough, DO; Mark Clements, MD PhD
Children’s Mercy Hospitals was awarded the 2021 T1D Exchange Best QI Team Award for diverse team roles, good camaraderie, and ability to scale QI work within the organization. This is a fantastic reflection on all of the hard work done by everyone in the department to work towards better diabetes outcomes. The award was presented virtually on Tuesday, November 9, during the 2021 T1D Exchange Learning Session.
Remote Patient Monitoring (RPM)
As of 10/31/2021, 140 families have participated in RPM. We have received fantastic feedback from participants, reflecting on the incredible work the RPM interventionists have put in to make RPM so successful.
“This is a great thing for in-between appointments” -RPM Family, August 2021
“[Interventionist] has been amazing to work with and I feel like she understands our struggles” -RPM family, July 2021
“The weekly one-on-one check-ins are a good idea for helping get my daughter’s diabetes under control. She is not having anywhere near the highs and lows she has been having for months! We appreciate the flexibility of these sessions and that they have been relaxing. My daughter has been a lot more comfortable with these appointments” -RPM Family, May 2021
“I love the video visits, they have helped so much!” -RPM Family, February 2021
We have begun offering Let’s Chat to patients who are eligible for RPM. Let’s Chat allows us to send text messages to patients and has been used to send downloading guides, appointment reminders, and reschedule notifications. If you have ideas for new and unique applications for Let’s Chat, please reach out to Emily DeWit or a member of the QI team.
We are currently working on a manuscript for Remote Patient Monitoring.
Connect to Resources (CORE)
CORE is a new QI intervention designed to screen and identify families in need of socioeconomic support. The CORE survey was added to clinic intake forms on 9/6/2021 so that all patients with Type 1 or Type 2 diabetes and their families can participate. Families who indicate a need for assistance in key areas tied to social determinants of health (food, housing, utilities, transportation, etc.) will receive referrals to free or reduced resources within their community.
As of 2/15/22, 1600 CORE surveys have been filled out as a part of clinic intake forms. 63 of those families have requested assistance and have subsequently received a guide to resources in their area. Families can either opt for self-guidance or can receive aid from a social worker.
All Hands Meeting Updates
New Manuscript Submission: Recent advances of Integrative Bio-Omics Technologies to Improve Type 1 Diabetes (T1D) Care
Congratulations to our authors Nisha Karwal and Megan Rodrigues, Shelby Carrothers, David Williams, Ryan McDonough, and Diana Ferro!
We are excited to introduce the first live dashboard using the new Data Mart! This dashboard takes advantage of the data that Brent and Mitchell have been collecting in the Data Mart and uses PowerBI to provide on-demand summaries of glycemic control for every patient with T1D visiting our clinics
We are preparing to start recruitment for Coin2Dose and Loan2Dose
Expansion of Let’s Chat (provider to patient text messages) through video added to intake forms
KIDDO and QUEST Interventions were just recently submitted to IRB
Stakeholder Advisory Meeting Updates
Dipper Academy Change Package draft is coming soon
Rise in A1c Rising T1DE Report receiving updates
The Data Mart is now importing Cerner Data from Healthy Intent instead of Business Objects, resulting in increased stability and reliability
We are in the beginning stages of the POPs Intervention, currently led by Shelby Carrothers. POPs consists of a blood glucose meters that attaches to the back of a smartphone.
Ryan McDonough is working on Peds Guide Overview app to bridge the gap between inconsistent care and improve frontline care on a national level
Welcome new team members!
Rhiannon Pomerantz graduated from the University of Kansas in May 2021 with a Bachelor of Arts degree in Applied Behavioral Sciences and a focus in basic research, as well as a minor in Jewish Studies. She currently works as an Assistant Clinical Research Coordinator, splitting her time between the QI team and research. She also has a 1- year old Catahoula mix puppy!
Shelby Carrothers graduated from Vanderbilt’s School of Medicine with her Master’s in Public Health in 2019. She recently returned from working in Vienna, Austria for the United Nations’ office of Drug and Crime. Within the Rising T1DE Alliance she splits her time between QI and Data Science Teams. She is currently balancing her free time between pining after a dog, and forcing herself to make more responsible decisions (e.g. resisting canine ownership).
Craig Vandervelden graduated from the University of Kansas in 2016 with a Bachelor of Science degree in Chemical Engineering. He received his PhD in Chemical Engineering in 2021 from the University of California, Santa Barbara after studying data science techniques in the arena of chemical physics. He works as a data scientist and helps create interactive dashboards ranging from quality assurance to intervention effectiveness. He also loves coffee and the science behind espresso preparation!
New Data Insights
During 2020 and most of 2021, the data team emphasized building a modern data infrastructure and integrating our many data sources: Cerner, Redcap, device vendors, and others. Now that much of the work is complete, the team has focused recent efforts on building automated reports and dashboards and delivering insights from the collected data. An operational monitoring dashboard inspired by the T1D Exchange monthly metrics has recently been released for use by Diabetes leadership. In addition, dashboards focused on population health and patient-level continuous blood glucose monitoring are in advanced stages of development. The team also continues to support data reporting and quality efforts for upcoming publications.
We are preparing to start recruitment for Coin2Dose, a study that examines the effects of financial incentive and loss aversion on adherence to diabetes management guidelines.
Nudge and KIDDO have both been resubmitted to the IRB with modifications.
The Structured Eating Study just received IRB approval. This study focuses on establishing a structured way of eating with carb distribution based on individualized needs so that we can test not only if this can lower A1c over time but also how acceptable this form of eating is for participants/families.
We have completed production of educational Dipper Academy videos aimed at caretakers of young children with diabetes. We are currently looking for a host platform for these videos so that they can be shared with our patient population.
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