Co-design, implementation, and evaluation of a nested diabetes model of care for adults with cystic fibrosis: a mixed...

Cystic fibrosis (CF) is a genetic disease with increasing life expectancy due to advances in treatment. However, this increased life expectancy has led to new health challenges, especially diabetes. Nearly 25% of adults with CF develop diabetes, but only a minority receive endocrinology care.

This study aimed to co-design, implement, and evaluate a nested diabetes model of care (MOC) for adults with CF and diabetes in a single tertiary adult CF center in Australia.

We used several implementation frameworks to co-design the MOC with consumer and provider end-users. Following MOC implementation, we used database-driven analytics to evaluate changes in the primary clinical outcome (HbA1c) pre and post study at 1 year. A mixed methods approach was used to evaluate secondary clinical and non-clinical outcomes.

The MOC promoted multidisciplinary collaboration and streamlined patient journeys, leading to high engagement. Thus, 76.7% of the entire CF cohort with confirmed diabetes was reviewed within the first year of operationalization. Engagement with the MOC was associated with a statistically significant decline in HbA1c (-0.54% vs +0.33%, p- value 0.004) and a 0.22% [95% CI 0.19 -0.32] per month increment in percent predicted forced expiratory volume (ppFEV1).

Our co-designed MOC demonstrated high engagement as well as improving glycemic management and lung function in adults with CF and diabetes. Our approach to CF diabetes care may reduce the treatment burden in the order of initiating a new diabetes medication while concurrently enhancing end-user experiences of health care.

http://links.lww.com/IJEBH/A473.