Using Quality Improvement to Reduce Loss to Follow-Up in Pediatric Patients With Type 1 Diabetes

Area of Science:

• Pediatric Endocrinology
• Quality Improvement Science
• Diabetes Management

Background:

• Quarterly clinic visits are standard for pediatric type 1 diabetes (T1D) management.
• Lower visit attendance correlates with elevated hemoglobin A1c (HbA1c) levels.
• The study aimed to decrease the proportion of T1D patients (under 18) lost to follow-up (LTFU) from 38% to 20% within 18 months.

Purpose of the Study:

• To reduce the rate of pediatric patients with type 1 diabetes who are lost to follow-up.
• To improve clinic visit attendance and adherence to recommended care schedules.
• To ensure quality improvement efforts do not exacerbate existing health disparities.

Main Methods:

• A multidisciplinary team utilized a driver diagram and Plan-Do-Study-Act (PDSA) cycles for quality improvement.
• Interventions included same-day scheduling, online patient portal scheduling, and targeted outreach to LTFU patients.
• Lost to follow-up (LTFU) was defined as no clinic visit within 6 months; monthly analysis used statistical process control charts.

Main Results:

• The proportion of LTFU pediatric T1D patients decreased from 38% to 15% within 18 months, sustained at 27 months.
• Improvements in reducing LTFU were observed across diverse patient demographics (age, sex, race, ethnicity, language, insurance).
• Reductions in LTFU were also noted across different HbA1c categories (<7%, 7%-9%, ≥9%), indicating reduced disparities.

Conclusions:

• A Plan-Do-Study-Act (PDSA) quality improvement framework effectively reduced LTFU in pediatric T1D patients.
• Simplifying the clinic visit scheduling process through iterative changes was key to improving patient retention.
• The implemented strategies successfully decreased the proportion of pediatric patients with T1D lost to follow-up.