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. 2022 Sep 8;7(5):e602.
doi: 10.1097/pq9.0000000000000602. eCollection 2022 Sep-Oct.

Testing an Automated Approach to Identify Variation in Outcomes among Children with Type 1 Diabetes across Multiple Sites

Jessica Addison  1 , Hanieh Razzaghi  2   3 , Charles Bailey  2   3 , Kimberley Dickinson  2   3 , Sarah D Corathers  4   5 , David M Hartley  5   6 , Levon Utidjian  2   3 , Adam C Carle  5   6   7 , Erinn T Rhodes  8   9 , G Todd Alonso  10 , Michael J Haller  11 , Anthony W Gannon  12 , Justin A Indyk  13   14 , Ana Maria Arbeláez  15   16 , Elizabeth Shenkman  17 , Christopher B Forrest  2 , Daniel Eckrich  12 , Brianna Magnusen  15 , Sara Deakyne Davies  10 , Kathleen E Walsh  9   18
Affiliations

Testing an Automated Approach to Identify Variation in Outcomes among Children with Type 1 Diabetes across Multiple Sites

Jessica Addison et al. Pediatr Qual Saf. .

Abstract

Introduction: Efficient methods to obtain and benchmark national data are needed to improve comparative quality assessment for children with type 1 diabetes (T1D). PCORnet is a network of clinical data research networks whose infrastructure includes standardization to a Common Data Model (CDM) incorporating electronic health record (EHR)-derived data across multiple clinical institutions. The study aimed to determine the feasibility of the automated use of EHR data to assess comparative quality for T1D.

Methods: In two PCORnet networks, PEDSnet and OneFlorida, the study assessed measures of glycemic control, diabetic ketoacidosis admissions, and clinic visits in 2016-2018 among youth 0-20 years of age. The study team developed measure EHR-based specifications, identified institution-specific rates using data stored in the CDM, and assessed agreement with manual chart review.

Results: Among 9,740 youth with T1D across 12 institutions, one quarter (26%) had two or more measures of A1c greater than 9% annually (min 5%, max 47%). The median A1c was 8.5% (min site 7.9, max site 10.2). Overall, 4% were hospitalized for diabetic ketoacidosis (min 2%, max 8%). The predictive value of the PCORnet CDM was >75% for all measures and >90% for three measures.

Conclusions: Using EHR-derived data to assess comparative quality for T1D is a valid, efficient, and reliable data collection tool for measuring T1D care and outcomes. Wide variations across institutions were observed, and even the best-performing institutions often failed to achieve the American Diabetes Association HbA1C goals (<7.5%).

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Conflict of interest statement

K.E.W., within the past 36 months, has served as a consultant for Sanofi and Research Triangle Institute. The other authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
Percentage of youth with two or more measures of A1c > 9% and 95% confidence interval bars for each site.
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References

    1. Pettitt DJ, Talton J, Dabelea D, et al. ; SEARCH for Diabetes in Youth Study Group. Prevalence of diabetes in U.S. youth in 2009: the SEARCH for diabetes in youth study. Diabetes Care. 2014;37:402–408. - PMC - PubMed
    1. Meltzer LJ, Johnson SB, Pappachan S, et al. . Blood glucose estimations in adolescents with type 1 diabetes: predictors of accuracy and error. J Pediatr Psychol. 2003;28:203–211. - PubMed
    1. Gagnum V, Stene LC, Jenssen TG, et al. . Causes of death in childhood-onset type 1 diabetes: long-term follow-up. Diabet Med. 2017;34:56–63. - PubMed
    1. Petitti DB, Klingensmith GJ, Bell RA, et al. ; SEARCH for Diabetes in Youth Study Group. Glycemic control in youth with diabetes: the SEARCH for diabetes in youth study. J Pediatr. 2009;155:668–72.e1. - PMC - PubMed
    1. Provost LP, Murray S. The Health Care Data Guide: Learning from Data for Improvement. John Wiley & Sons; 2011.