299 - Embedding Pre-Symptomatic Type 1 Diabetes Screening into an Economically and Culturally Diverse Federally Qualified Health Center

Publication Number: 299.4855

Honora Quinn. Burnett, Department of Pediatrics, Denver Health Medical Center & University of Colorado School of Medicine, Denver, CO, United States; Sonja O'Leary, University of Colorado School of Medicine, Denver, CO, United States; Cristy Geno, Barbara Davis Center for Diabetes, Denver, CO, United States; Marian J. Rewers, University of Colorado School or Medicine, Aurora, CO, United States; Rachel Miller, Denver Health and Hospital Authority, Denver, CO, United States; Crystal Silva, University of Colorado School of Medicine, Denver, CO, United States; Gottlieb Yael, Denver Health, Denver, CO, United States; Thomas Gray, Denver Health and Hospital Authority, Denver, CO, United States; Holly M. Frost, Intermountain Health and University of Utah, Arvada, CO, United States

Background: General population type 1 diabetes mellitus (T1D) screening occurs in Colorado through Autoimmunity Screening for Kids (ASK). ASK can identify 80-90% of children with pre-symptomatic stage 1 or stage 2 T1D. With early identification, children are eligible for treatment to delay the onset of T1D, monitoring and education – all of which can reduce diabetic ketoacidosis at diagnosis by 90%.

Objective: To describe the implementation of embedding general population T1D screening into well child care (WCC) to improve access for historically marginalized patients.

Design/Methods: We used Practical and Robust Implementation Model (PRISM) to guide methods to embed the study into WCC and constructs of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to look at implementation outcomes. The project took place at Denver Health’s Westside Pediatric Clinic (WC), a Federally Qualified Health Center (FQHC) serving a large population of minoritized patients. Embedded clinical screening for T1D autoantibodies was offered with lead/CBC screening at 12 & 24-month WCC. In the pre-implementation phase, electronic health record (EHR) data was used to evaluate the potential reach of the program. Focus groups of providers and patients were conducted to assess facilitators and barriers to T1D screening. Feedback was used to adapt implementation roadmap (Figure 1) and improve process flow mapping (Figure 2). The study was approved by the Colorado Multiple Institute Review Board.

Results: From 11/1/23-7/1/24, eligible WC patients were offered imbedded ASK. Patients completed an online consent form and went to the in-clinic lab. Results were communicated to patient and ordering provider by the tertiary care Barbara Davis Center for Diabetes (BDC). If positive, patients were brought to BDC for confirmation, education, and monitoring. Baseline EHR data indicated WC had ~135 eligible patients/month, ~50% completed lead/CBC labs and would be eligible for ASK labs. 5 families and 5 clinicians participated in focus groups, to guide implementation. All 22 WC clinicians were ASK trained. In total, 419 patients (of 795 eligible) were offered screening, 86 completed a consent and were screened. Specific patient demographics, and ASK completion rates, can be found in Figure 3.

Conclusion(s): Using implementation science strategies to embed T1D research screening into an economically and culturally diverse FQHC setting can lead to greater access, effectiveness, acceptability, and sustainability. Lessons learned can be applied to other similar health systems.

Figure 1 Integration Roadmap
Figure 1 Integration Roadmap

Figure 2 Process Flow Map for ASK Screening at WC
Figure 2 Process Flow Map for ASK Screening at WC

Figure 3 ASK Patient Demographics & Completion Rates
Figure 3 ASK Patient Demographics & Completion Rates