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Published on: June 11, 2012
Improving the Insulin Pump Initiation Process for Pediatric Patients with Type 1 Diabetes through Application of Lean
G Todd Alonso1, Raquel Hink2, Michael R De Georgeo3
1Assistant Professor at the Anschutz Medical Campus Barbara Davis Center at the University of Colorado at Denver in Aurora. guy.alonso@ucdenver.edu.
Insights
Streamlining insulin pump initiation for type 1 diabetes patients significantly reduced wait times. This improvement in the diabetes technology onboarding process enhances patient care and access to essential treatments.
Area of Science:
- Pediatric Endocrinology
- Diabetes Management Technology
- Healthcare Process Improvement
Background:
- Inefficient onboarding processes for insulin pump therapy at a pediatric diabetes center led to prolonged lead times for type 1 diabetes patients.
- Over 250 patients initiated insulin pump therapy in 2014, highlighting the need for optimized patient support.
Purpose of the Study:
- To decrease the median lead time for new insulin pump users from 132.5 days to under 110 days within five months.
- To improve the efficiency of the insulin pump initiation process for pediatric patients with type 1 diabetes.
Main Methods:
- The Define, Measure, Analyze, Improve, Control (DMAIC) methodology was employed to address process inefficiencies.
- Key changes included shortening training classes, increasing class frequency and capacity, clarifying metrics, developing a reporting dashboard, cross-training staff, and standardizing communication templates.
Main Results:
- Median lead time for insulin pump initiation decreased from 132.5 to 98.5 days (p = 0.007).
- The proportion of patients with a lead time under 110 days increased from 37% to 60% (p = 0.001).
- No significant difference in pump nonstarter rates was observed between groups, though nonstarters had longer diabetes duration.
Conclusions:
- The project successfully met its goal of reducing lead time for insulin pump initiation.
- A significant proportion of patients did not initiate pump therapy, independent of the process improvements, indicating a need for further investigation.
- Sustained improvements were achieved through ongoing process monitoring and implementation of further changes.
Context:
Our pediatric diabetes center initiated insulin pump therapy for more than 250 patients with type 1 diabetes in 2014, but onboarding was inefficient.
Objective:
To decrease time from the decision to initiate pump therapy to the ambulatory encounter after pump start (lead time) for new pump users from 132.5 days to less than 110 days within 5 months.
Design:
Define, Measure, Analyze, Improve, Control method. We identified key problems: Long wait for training classes, unclear metrics, complicated scheduling, and nonstandardized processes. We then implemented 17 changes, including shortened classes, increased class offerings and space, clarified metrics, built a reporting dashboard, designated and cross-trained staff, created appeals letter templates, and educated clinicians. At project conclusion, we established a reaction plan if the processes were not performing as designed.
Main Outcome Measures:
Outcomes of pump orders placed before and after improvements were implemented.
Results:
During this project, 229 patients initiated the pump start process. Median lead time decreased from 132.5 to 98.5 days (p = 0.007). Patients with lead time under 110 days increased from 37% to 60% (p = 0.001). There were 31 pump nonstarters, with no significant association between group and whether the patient was a starter or nonstarter (p = 0.58). Nonstarters had a longer diabetes duration (median = 3.43 vs 2.05 years, p = 0.001).
Conclusion:
Project goals were met. A high proportion of patients not starting pump therapy was discovered, but this was not affected by the project. We implemented further changes and a process-monitoring system.
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