O-39: Determinants, implementation strategies, and mechanisms of the 4t program
M Y Lee, N Rioles, F K Bishop, S Rompicherla, V Ritter, M Desai, P Prahalad, D M Maahs, M P McGovernAbstract
Introduction
The Teamwork, Targets, and Technology for Tight Glycemia (4T) Program is an innovative pediatric diabetes management program that demonstrated effectiveness in early use of continuous glucose monitoring with remote patient monitoring (RPM) among three diverse cohorts of youth with new onset type 1 diabetes (T1D, n=451). Based on promising data from a single health system, we now plan to scale the 4T Program to the T1D Exchange Quality Improvement Collaborative.
Objectives
The purpose of this implementation evaluation is to guide a more precisely designed 4T Program scaling.
Methods
We used the Simplified Implementation Logic Model to identify contextual determinants of implementation success. Then, we described the connections between the implementation support strategies used in 4T to address the contextual determinants and barriers to program reach to youth with T1D and provider adoption. We hypothesize mechanisms linking barriers and strategies to effectiveness and implementation outcomes.
Results
Limited clinician time was identified as a major barrier to program success. Several targeted strategies were used to address this, including the creation of the Timely Interventions for Diabetes Excellence (TIDE) clinical decision support tool early in the program and ongoing refinement of the TIDE tool. After clinical effectiveness of the 4T Program was established, the next phase focused on further allocating clinician RPM review to participants who would benefit the most (e.g. those with frequent hypoglycemia). Additionally, cost to the family participants, cost to the clinic, and stakeholder engagement were other determinants addressed by the program strategies.
Conclusions
This retrospective process informs connections between determinants, support strategies, mechanisms, and outcomes of the 4T Program. This enables a more precise design in preparation to scale the program across a national network of pediatric diabetes clinics in the T1D Exchange.