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| Name | Class |
|---|---|
| Canadian Institutes of Health Research (CIHR) | OTHER_GOV |
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Adolescents with type 1 diabetes face particular challenges related to having a chronic illness that requires daily intensive self-management and medical follow-up during a period when their social, developmental, educational, and family situations are in flux. When transitioning from pediatric to adult care, over a third of youth have a care gap of >6 months. During this vulnerable period youth are at risk for acute life-threatening complications such as diabetic ketoacidosis, and for poor glycemic control, which confers an increased risk of chronic diabetes complications. Gaps in care may be a result of deficiencies in transition processes causing some young people to be poorly prepared for adult care and dissatisfied with the transition process. Ineffective transition can lead to decreased frequency of diabetes visits and an increased risk of adverse events in young adulthood. Further, risk factors such as psychiatric comorbidity and behavioural problems in adolescents with type 1 diabetes are associated with poor outcomes in early adulthood. Quality improvement initiatives can be designed to optimize care processes such as referral systems to adult diabetes providers.
Our overall objective is to optimize care and outcomes for youth with diabetes as they transition to adult care.
Specific Aim 1: To improve glycemic control in youth around the time of transition from pediatric to adult diabetes care Specific Aim 2: To evaluate the fidelity and quality of a quality improvement intervention designed to improve transition care processes and to identify contextual factors associated with variation in outcomes.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Pre-intervention | No Intervention | Those whose last pediatric visit was in the year before the intervention (2018). Medical record data abstracted from patient charts at the time of the final pediatric visit. | |
| Early Intervention | Other | Those whose last pediatric visit was in the year immediately after the start of the intervention (2019). The intervention will begin on Jan 1, 2019 and includes the following :
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| Post-Intervention | Other | Those whose last pediatric visit was in the second year after the intervention (2020). The intervention includes the following :
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Data platform +Quality Performance feedback reports | Behavioral | Teams from each of the participating sites will attend the webinars. Each site will share an example of a QI initiative that they are executing and describe the success and challenges. |
| Measure | Description | Time Frame |
|---|---|---|
| HbA1c | Hemoglobin A1c | HbA1c value up to 12 months after the final pediatric visit. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Diabetes-related admissions, ED visits, death | The occurrence of at least one diabetes-related admissions or emergency department visit or death | number of occurrences up to12 months after the final pediatric visit. |
| Time from the final pediatric visit to the first adult diabetes visit |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Rayzel Shulman, Md, PhD | The Hospital for Sick Children | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| McMaster Children's Hospital | Hamilton | Ontario | Canada | |||
| Children's Hospital, London Health Sciences Centre |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38500183 | Derived | Ahmad SZ, Ivers N, Zenlea I, Parsons JA, Shah BR, Mukerji G, Punthakee Z, Shulman R. An assessment of adaptation and fidelity in the implementation of an audit and feedback-based intervention to improve transition to adult type 1 diabetes care in Ontario, Canada. Implement Sci Commun. 2024 Mar 18;5(1):25. doi: 10.1186/s43058-024-00563-2. | |
| 31766999 |
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An intervention with integrated components
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identified using physician service claims and defined as the first diabetes office visit by an adult endocrinologist, internist, or family physician |
| Time in months up to 12 months after the final pediatric visit |
| London |
| Ontario |
| N6A 5W9 |
| Canada |
| Markham Stouffville Hospital, Clinic 4 | Markham | Ontario | L3P 7P7 | Canada |
| Trillium Health Partners | Mississauga | Ontario | Canada |
| The Hospital for Sick Children | Toronto | Ontario | M5G1X8 | Canada |
| Shulman R, Zenlea I, Shah BR, Clarson C, Harrington J, Landry A, Punthakee Z, Palmert MR, Mukerji G, Austin PC, Parsons J, Ivers N. Testing an audit and feedback-based intervention to improve glycemic control after transfer to adult diabetes care: protocol for a quasi-experimental pre-post design with a control group. BMC Health Serv Res. 2019 Nov 25;19(1):885. doi: 10.1186/s12913-019-4690-0. |