bluuebunny/crossref_metadata_2025_split huggingface dataset:
1176-P: The Value of Quality Improvement Programs in Diabetes Care: Experience from the Prime Program
Authors: MITRI JOANNA , CHARLOT WANNA , ZANGER BRANDY L. , MILLAN-FERRO ANDREINA 
Published: June 2020

The quality of diabetes care is suboptimal worldwide. The Joslin PRIME program assists healthcare professionals (HCPs) with improving diabetes outcomes using scalable quality improvement (QI) methodology. We present findings from a large-scale PRIME implementation focused on A1c reduction. An invitation was sent to 29 HCPs within a large multi-specialty medical group in Springfield, IL. Seventeen HCPs enrolled in the program. Each HCP identified a medical assistant or nurse within the practice to serve as the Diabetes Care Coordinator (DCC) and assist with leading QI activities. Following a live QI workshop, each team (HCP and DCC) learned how to create plan-do-study-act (PDSA) cycles, received a diabetes registry on patients with diabetes and established a plan to decrease the proportion of patients with A1c&gt;9%. Teams were offered online CME, weekly support calls and guidance to implement QI activities using PDSA cycles. De-identified data including clinical metrics on all patients with diabetes, based on ICD-10 codes, cared for by 17 enrolled HCPs (EG) and 12 unenrolled HCPs (UG) were evaluated before and 5 months after institution of the program. Differences in proportion of patients with A1c&gt;9% before the program (P1) and at 5 months (P2) were compared using Chi-square. Twelve participants completed at least one PDSA cycle and saw 39% of their patients with diabetes in 5 months, compared to 21% in the remaining participants. In the EG, P1 was 12% and P2 was 10% (p=0.037). In the UG, P1 was 11% and P2 was 10%, (p=0.136). The odds ratio of having A1c&gt;9% was 0.79 (95% CI 0.63-0.99, p=0.037) in the EG and 0.86 (95% CI 0.71-1.05, p=0.136) in the UG. The proportion of patients with A1c&gt;9% in the EG was significantly lower 5 months after institution of the program. Based on these preliminary data, the PRIME QI program, which is mostly delivered remotely, has the potential to assist HCPs to enhance the quality of diabetes care if applied at a larger scale.

Disclosure
J. Mitri: Consultant; Spouse/Partner; Janssen Pharmaceuticals, Inc., kymera. Consultant; Self; national dairy council/local dairy council. Research Support; Spouse/Partner; AbbVie Inc., beigene, Janssen Pharmaceuticals, Inc. Research Support; Self; Kowa Pharmaceuticals America, Inc., national dairy council. Research Support; Spouse/Partner; pharma cyclic, TG therapeutics. W. Charlot: None. B.L. Zanger: None. A. Millan-Ferro: None.
1178-P: Multicomponent Integrated Care Program Benefits on Cardiovascular Risk Factors for Adults with Diabetes and High Cardiovascular Risk: The DIABEMPIC Program
Authors: SILVA-TINOCO RUBÉN , CUATECONTZI ENEDINA TERESA C. , DELATORRE-SALDAÑA VIRIDIANA , GUZMAN EILEEN B. , CABRERA-GERARDO DOLORES , PRADA DIDDIER , VILLA-CORTÉS ANDREA , LEÓN-GARCÍA ENRIQUE , SEGOVIA-VELAZQUILLO ALMA , ZARATE CLAUDIA , ROMERO-IBARGUENGOITIA MARIA ELENA , GONZALEZ-CANTU ARNULFO 
Published: June 2020

Cardiovascular disease (CVD) is a major cause of death/disability in people with diabetes, this impact could be even greater in low- middle-income countries, where large gaps exist in achieving diabetes care goals. We examined a quality initiative Multicomponent Integrated Care (MIC) program (DIABEMPIC, DIABetes EMPowerment and Improvement of Care) on diabetes care goals in persons with type 2 diabetes (PwT2D) implemented in a public primary care specialized diabetes clinic in Mexico City/Iztapalapa. DIABEMPIC is a 5-months empowerment-based program with the following components: interdisciplinary case management team, diabetes self-management education and support, individual/group sessions, shared medical appointments, patient-centered approach, audit and feedback, and guaranteed supply of medications. We evaluated the effect of the intervention on the improvement in diabetes care goals using a ’before and after’ design in participants with a high CV risk.
Results: total PwT2D were 610, of which 375 (61.1%) had high CV risk (10-year risk of cardiovascular disease ≥10% with Globorisk lab score). The mean (SD) age of this subgroup was 59.3 (9.4) years, 66% female, 56% had elementary or less education, 73% had medium-low or lower socioeconomic status. Mean diabetes duration was 13 (8) years, 21.8% with current smoking status, 61% with hypertension diagnosis. After the intervention systolic and diastolic blood pressure (-12, -4 mmHg respectively), A1c (-2.4%), triglycerides (-40 mg/dl), and non-HDL cholesterol (-36 mg/dl) decreased significantly (p&lt;0.0001).
Conclusions: We found a high prevalence of high risk for CVD in primary care. This quality of care initiative had a valuable effect on CV-related diabetes care goals in a real-world setting. MIC strategies may play an important role to mitigate CVD burden in high-risk populations. We suggest further replications of this intervention.

Disclosure
R. Silva-Tinoco: Speaker’s Bureau; Self; Novo Nordisk Inc. E.C. Cuatecontzi: None. V. delaTorre-Saldaña: None. E.B. Guzman: None. D. Cabrera-Gerardo: None. D. Prada: None. A. Villa-Cortés: None. E. León-García: None. A. Segovia-Velazquillo: None. C. Zarate: None. M. Romero-Ibarguengoitia: None. A. Gonzalez-Cantu: None.
1179-P: Differences in Chronic Kidney Disease Management in Patients with and without Diabetes in a Large Care Delivery System
Authors: SPERL-HILLEN JOANN M. , CRAIN A. LAUREN , DESILVA MALINI B. , CHUMBA LILIAN 
Published: June 2020

Background: Evidence-based chronic kidney disease (CKD) care can slow progression and avert complications. We evaluated evidence-based care gaps for stage 3 and 4 CKD in patients with and without diabetes (DM).
Methods: All patients age 18-75 with a primary care encounter between April and October 2019 in any of 32 clinics in a large Midwestern care system were evaluated for stage 3 or 4 CKD based on laboratory evidence of GFR 15-59 ml/min/1.73 m2 on 2 consecutive tests. Using programmed algorithms they were further assessed for CKD care gaps and classified as DM or no DM.
Results: Out of 5,336 patients with stage 3 or 4 CKD, 41% had DM. Patients with DM had a mean A1C of 7.5%, mean systolic BP 134, and 28.6% had A1C ≥8%. Compared to patients without DM, those with DM were slightly older (65.6, 66.2 years, p&lt;.001), more likely to be male (41.9%, 47.9%, p&lt;.001), African American (6.5%, 11.9%, p&lt;.001) and have either stage 3b (19.9%, 30.6%, p&lt;.001) or Stage 4 CKD (5.2%, 9.4%, p&lt;.001).
Conclusion: CKD care for those with DM is better than for those without DM for most care elements, although large care caps remain for both groups. Of note, 28% of patients with DM had an A1C over 8%, and 15.3% of patients with DM had more advanced CKD with no evidence of seeing a nephrologist in the last year. Better care delivery strategies are needed for optimal CKD management including timely nephrology consultation.

Disclosure
J.M. Sperl-Hillen: None. A. Crain: None. M.B. DeSilva: None. L. Chumba: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R18DK118463)
1190-P: Pharmacist-Led Clinical Interventions to Encourage Adherence to ADA Diabetes Guidelines and Improve Quality of Care
Authors: BANKS JENNIFER M. , TADDEI-ALLEN PATTY 
Published: June 2020

Background: In addition to lifestyle modifications, pharmacotherapy is often required to achieve glycemic goals. In clinical practice, optimal treatment is not consistently implemented, often due to inadequate adherence to recommended guidelines.
Objective: To demonstrate the impact of a pharmacist-led diabetes clinical intervention program.
Methods: A retrospective analysis using collected diabetes program clinical interventions from July 1, 2019 through December 31, 2019 was performed. Members at least 18 years of age enrolled in a prescription plan administered by the pharmacy benefit manager with the pharmacist-led diabetes program who attempted to obtain diabetes medications were included in the analysis. A diabetes specialist reviewed members that did not meet previously established clinical algorithm programmed into the adjudication platform. Total number of clinical interventions and type of clinical intervention were described using descriptive statistics.
Results: The diabetes specialist pharmacist reviewed a total of 85 interventions. Out of these interventions, approximately 34% did not require additional clinical information from the provider and the medication adjudicated. Of the remaining interventions, providers accepted 75% of the recommendations: 30% “Medication changed to cost-effective therapeutic equivalent”, 27% “Medication discontinued”, 9% “New medication initiated”, and the remaining categories included “Medication dose decreased”, “Medication dose increased”, and “Medication dosing interval increased.”
Conclusion: The diabetes specialist pharmacist intervened to promote adherence to ADA guidelines and educate providers on patient specific factors such as medication adherence, polypharmacy, gaps-in-care, and financial considerations. Providers accepted recommendations 75% of the time, demonstrating willingness to collaborate with other clinicians to ensure optimal patient care.

Disclosure
J.M. Banks: None. P. Taddei-Allen: Advisory Panel; Self; Novo Nordisk A/S.
1193-P: “TechQuity” in Diabetes: Does Digital Health Technology Improve Equity?
Authors: CRAIG KELLY JEAN , RHEE KYU B. 
Published: June 2020

Introduction: Higher diabetes mellitus (DM) burden and disparities in healthcare have been linked to factors including race/ethnicity, low socioeconomic status (SES), and geographic location.
Objective: To identify digital health interventions (DHIs) that improve health and healthcare delivery outcomes in populations disproportionately affected by DM.
Methods: A systematic scoping review evaluated DHIs to address global health disparities in cardiovascular (CV)-related diseases/disorders or cardiovascular disease (CVD). A subgroup analysis was performed to identify the impact of DHIs in DM populations. Pre-post DM-specific health (clinical/intermediate and patient-reported) and healthcare delivery outcomes (quality, utilization, and access to care including DHI technical evaluations) were abstracted.
Results: In the subgroup analysis, 21 of the 58 included studies (out of 4,298 relevant citations) examined DM populations. DM-specific health data were obtained from 13 of those studies examining primary (e.g., weight loss), secondary (e.g., diabetic retinopathy screening), tertiary (e.g., glucose control), or quaternary (e.g., overmedicalization) preventive DHIs. DHIs primarily targeted Black (29%), Hispanic (24%), low SES (62%), and/or rural (52%) populations in the United States (52%). DHIs commonly used electronic health records (28%) and decision support systems (19%). Eleven (85%) studies showed DHIs significantly improved outcomes, nine (70%) studies had no effect, and seven (54%) studies negatively impacted disparity populations. Eight (62%) studies were high-quality (e.g., RCTs). No trends could be identified to find associations of DHI type nor disparity group with preventive intervention success.
Conclusions: Preventive DHIs improved both health and healthcare delivery outcomes in DM-specific disparities identified in racial/ethnic groups and low SES populations in both rural and urban geographies globally.

Disclosure
K. Craig: Other Relationship; Self; Medtronic. K.B. Rhee: Employee; Self; IBM.
1195-P: Improving Diabetes Self-Management with a Mobile App: Results of a Pilot Program at a Safety Net Hospital System
Authors: MARCELLO ROOPA KALYANARAMAN , DOLLE JOHANNA , KAUR SHARANJIT , PATTERSON SAWKIA R. , DAVIS NICHOLA 
Published: June 2020

For patients with type 2 diabetes, self-management remains a significant challenge. In recent years, the use of digital health technologies (DHTs) for chronic disease management has increased, with some facilitating improvements in diabetes outcomes. Historically, safety net systems have been slow to adopt DHTs, in part due to assumptions about literacy and the use of technology among low-income or non-English speaking patients. Additionally, the use of DHTs among diverse, low-income patient populations has not been well studied. NYC Health + Hospitals (H+H) is the largest safety net healthcare system in the nation. H+H launched a pilot program of BlueStar, an FDA-approved mobile app for diabetes self-management, among patients with poorly controlled type 2 diabetes at two of its acute care hospitals. The app was provided to patients in English and Spanish. Participants were able to record and receive feedback on their medications, blood glucose, blood pressure, and meals. Key aims of this pilot program were to: 1) increase patient education and support for diabetes self-management; 2) test the use of technology adaptation in a vulnerable patient population; and 3) improve diabetes outcomes as measured by reductions in A1c. Two hundred ninety-nine patients received the app, and 137 (46%) used the app at least once. Of these 137 patients, 52% used the app at least once per week; recording blood glucose and medication were the most frequently used features (82% and 62%, respectively). Among the first 196 patients enrolled, the mean reduction in A1c from baseline to six months post enrollment was 0.7 at hospital A (n=97) and 1.6 at hospital B (n=97). As compared to matched control patients at non-participating facilities, participants experienced a greater reduction in A1c of 0.1 (p=0.61) at hospital A and 0.7 (p=0.02) at hospital B. Results from the final analysis of all 299 participants as well as key themes from semi-structured interviews with patients will be presented.

Disclosure
R. Kalyanaraman Marcello: None. J. Dolle: None. S. Kaur: None. S.R. Patterson: None. N. Davis: None.

Funding
National Institutes of Health (UL1TR001445)
1197-P: Low-Cost, High-Impact Interventions in Diabetes: Social Determinants of Health Screening in Routine Diabetes Care
Authors: MANAVALAN ANJALI , LEE DONNA , JANG ALYSSA , AGARWAL SHIVANI 
Published: June 2020

Background: Social determinants of health (SDH) are known to negatively influence medical outcomes and are prevalent among people with diabetes, but systematic screening and use in routine diabetes care remains limited.
Methods: We used quality improvement methodology to pilot a SDH screening protocol in our diabetes center in an underserved community, and included new adult diabetes patients of 2 providers from October to December 2019. We used a standardized SDH screen offered by the EPIC electronic health record system, which included 10 questions on transportation issues, food security, affordability of medication, housing stability, personal safety, and financial strain, among others. We performed iterative tests of the algorithm to improve reliability. Completion of the screen and responses were tracked electronically. Feasibility and acceptability were assessed with brief interviews of clinic staff and patients after each screen cycle.
Results: Following implementation of the SDH screen protocol, 50 out of 53 (94%) eligible patients were screened (mean age 30, 53% female, 72% Medicaid). Patients who did not complete screens refused due to privacy concerns or were unable to respond due to developmental delay. One-third of patients (n= 17, 32%) reported at least 1 SDH. The most common SDH noted were lack of transportation to visits and food insecurity. Participants who reported SDH and desired assistance were referred to a care coordinator trained to address social needs. In brief post-screen interviews, staff and patients alike expressed high feasibility and acceptability of the SDH screen.
Conclusions: Screening for SDH is important, uncovering social needs that are relevant and impactful for diabetes outcomes, while still maintaining high staff and patient acceptability. Given potential for linkage to future payment, SDH screening should be incorporated into routine diabetes care.

Disclosure
A. Manavalan: None. D. Lee: None. A. Jang: None. S. Agarwal: None.
1207-P: Positioning the Role of the Graduate of the Advanced Course in Diabetes in Primary Care Clinics by Diabetes Nurse Specialist
Authors: WAIZINGER ORIT 
Published: June 2020

There are 70,942 people with diabetes in Haifa- Galil District of Clalit Health services, most are treated in primary care clinics. 10.7% have an HbA1c above 9% and 14.7% of the Arab patients. The HMO is in a process of reallocating and redistributing personnel to better meet the needs. The nursing staff and specifically the graduates of the advanced diabetes course (GADC) are an important asset that needs to be maximally utilized to meet this end. There are 24 nurses who are GADC, 19 work in primary care setting.
Aims: Improvement of metabolic control by enhancing intervention by the GADC. Positioning the role of the GADC in primary care clinics.
Methods: Initiating a quality forum for the graduates led by the diabetes nurse specialist (DNS) coordinator and the head of nursing services to launch a targeted plan of intervention in the 18 community clinics in which they work. The 19 nurses make the intervention in their clinics - 7,800 patient with diabetes in total: invite them for assessment of adherence to therapy, patient education, intensification of therapy and follow-up until getting to target. Support, empowerment, supervision and ongoing assessment of the process by the District DNS.
Results: Improvement in the implementation of performance measures in the clinic from 81.7 to 88.4 (6.6) % in the total population and from 74.9 to 83.5 (8.6) % in the Arab sector. Improvement in the overall metabolic control from 77.9 to 86 (8) % and from 68.9 to 79 (10.1) % respectively. Decrease in HbA1c in those above 9% by -2.3% and -3.3% respectively.
Conclusions: A DNS led structured intervention by GADC as part of the policy of the District nursing administration, maximizes their abilities and professional authority of the graduates. The knowledge and skills provided by the GADC significantly improves performance measures as well as metabolic control. Continue the integration of future graduates into the framework at the community clinic level.

Disclosure
O. Waizinger: None.
1215-P: Qualitative Assessment of a Novel Intervention to Reduce Hospital Readmission Risk among Patients with Diabetes
Authors: TANNER SAMUEL , BRZANA EMILY , DEAK ANDREW , RECCO DOMINIC , TIVON MADELINE , DILLARD FELICIA R. , WATTS SAMANTHA , KONDAMURI NEIL , ALBURY BONNIE S. , ALLEN SHANEISHA , IWAMAYE AMY , VAZ CHERIE LISA , RUBIN DANIEL J. 
Published: June 2020

Patients with diabetes (DM) are at higher risk of hospital readmission within 30 days of discharge (30dRe) than patients without DM. We previously reported quantitative results of a pilot RCT testing a novel intervention, the Diabetes Transition of Hospital Care (DiaTOHC) Program, designed to reduce readmission risk. The current study qualitatively assessed the intervention.
We identified 115 hospitalized patients with DM at high risk for 30dRe using the Diabetes Early Readmission Risk Indicator (DERRITM). A total of 58 patients were randomized to the DiaTOHC Program, which consisted of program-specific inpatient DM education, coordination of care, telephonic post-discharge support by a nurse (Navigator), and an A1c-based algorithm to adjust DM therapy. At 5 to 12 weeks post-discharge, intervention patients were interviewed until saturation, resulting in 22 interviews. Study staff were also interviewed. We performed thematic analysis of the interviews.
We identified 5 themes: (1) the intervention increased agency over DM self-management, (2) Navigator phone calls reinforced patient education and provided subjects with accountability, (3) it was difficult for patients to engage in DM education in the hospital, (4) perceived lack of control was associated with readmission, and (5) most patients were unable to correctly interpret their A1c level. Patients with baseline A1c &gt;8% were less likely to review the educational materials, had more difficulty adhering to discharge instructions, and reported more extreme blood glucose levels. However, this subgroup also reported making more improvements in diet and medication adherence due to the intervention.
The DiaTOHC intervention may instill a sense of personal responsibility for DM management after hospital discharge. Patients and staff valued the combination of education, care coordination, and follow up. All 3 components may interact synergistically with medical management to reduce readmission risk.

Disclosure
S. Tanner: None. E. Brzana: None. A. Deak: None. D. Recco: None. M. Tivon: None. F.R. Dillard: None. S. Watts: None. N. Kondamuri: None. B.S. Albury: None. S. Allen: None. A. Iwamaye: None. C. Vaz: None. D.J. Rubin: None.

Funding
National Institutes of Health (K23DK102963)
1236-P: Perceptions of People with Early-Onset Type 2 Diabetes Mellitus about Diabetes and Exercise
Authors: GU YU , HARMER ALISON , WONG JENCIA , GAULD AMANDA , CONSTANTINO MARIA I. , MUNOZ PHILLIP A. , DENNIS SARAH 
Published: June 2020

Background: The prevalence of early-onset type 2 diabetes (EOT2D, diagnosed with T2DM under the age 40) is increasing. There is limited research on the perceptions and knowledge about diabetes and its management. The aim of the study was to explore the insights on diabetes and exercise among this cohort.
Method: Twelve participants who underwent an 8-week, supervised, high-intensity intermittent training (HIIT) program were invited to participate in a semi-structured interview. The interview explored exercise history, perception of EOT2D, knowledge of EOT2D management and complications, feedback on HIIT, and barriers and facilitators to regular exercise. Inductive thematic analysis was used.
Results: Eight males and four females aged between 20-44 years were interviewed. Four themes emerged from analysis: (i) The diagnosis of T2DM was often unexpected. Participants reported the sense of “loss control” at diagnosis. This motivated people to exercise, but regular and structured exercise was rarely maintained: “didn’t continue after a few months.” (ii) Participants had varying levels of knowledge about diabetes, its management and complications: “⋯didn’t really understand how T2DM works and how exercise could affect it.” Most participants did not monitor blood glucose levels regularly: “monitoring sugar regularly to me is obsessive behaviour.” (iii) Financial and time commitments were the two most common barriers to exercise, especially for people with young children. (iv) HIIT was well-tolerated. Participants valued the individual supervision - “having the supervision gives you structure and a commitment.” However, participants were unlikely to continue with the HIIT program independently or unsupervised.
Clinical implication: Although diagnosis of EOT2D can be an impetus for behaviour change, diabetes management in this cohort was not prioritised over work and family commitments. Diabetes management and education in this young cohort needs to have tailored approaches.

Disclosure
Y. Gu: None. A. Harmer: None. J. Wong: Advisory Panel; Self; Sanofi. Speaker’s Bureau; Self; AstraZeneca, Merck & Co., Inc. A. Gauld: None. M.I. Constantino: None. P.A. Munoz: None. S. Dennis: None.

Funding
Diabetes Australia; Sydney Local Health District