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

Abstract

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. 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. 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. 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.