Implementation of Diabetes Care Coordination in Schools Across Pediatric Centers in the T1D Exchange Quality Improvement Collaborative.

OBJECTIVE

To characterize barriers and facilitators in implementing evidence-based care coordination for type 1 diabetes in K-12 schools among diabetes centers in the U.S.

RESEARCH DESIGN AND

METHODS

We conducted a mixed-methods study with diabetes centers in the T1D Exchange Quality Improvement Collaborative who deliver pediatric care. A representative from each center participated in a survey and optional semistructured interview. Questions were situated within an implementation science framework and asked about processes for communication, education, and clinical care related to in-school diabetes support; the interview probed deeper on barriers and solutions. Surveys were analyzed descriptively. Interviews were transcribed and coded by two reviewers using a thematic analysis.

RESULTS

Surveys were returned by 38 predominantly academic pediatric centers representing different U.S. regions and patient volumes (range 600 to >3,000, 93% response rate). Most respondents (58%) were somewhat satisfied with current processes for communicating with schools and providing medical orders, with <25% being extremely satisfied. Centers identified problematic barriers: insufficient clinician time (74% of respondents), school call volume (78%), and inefficient communication methods (71%). Less than 5% of centers billed for care coordination activities. Qualitative themes expanded upon center and school-level barriers. Desired solutions focused on technology or intermediary roles (e.g., nurse navigators) for coordination. Although school-partnered interventions were viewed favorably, scalability and sustainability were concerns.

CONCLUSIONS

Diabetes care coordination between K-12 schools and diabetes centers is variably implemented because of challenges within both institutions. Further research is needed to test implementation strategies that can overcome barriers and augment evidence-based care.