Best Practice Advisories to Reduce Inequities in Technology Use for People With Type 1 Diabetes
Implementing Best Practice Advisories to Reduce Inequities in Technology Use for People With Type 1 Diabetes
1 other identifier
interventional
1,178
1 country
2
Brief Summary
The overall goal of the study is to create a standardized, stakeholder-informed system within EMRs, that will enable an equitable and regular prescription and documentation of advanced diabetes technologies. This will reduce racial disparities and generate an understanding of the reasons behind prescription decisions. The study will highlight the development and implementation an EMR-based Best Practice Advisory (BPA). The study will answer whether the EMR-based BPA can effectively reduce disparities. Additionally, it will explore why providers may not prescribe advanced diabetes technologies. Patients will also be surveyed to understand their perspectives on developing the EMR-based BPA.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for not_applicable
Started Aug 2024
Typical duration for not_applicable
2 active sites
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
Study Start
First participant enrolled
August 13, 2024
CompletedFirst Submitted
Initial submission to the registry
September 9, 2024
CompletedFirst Posted
Study publicly available on registry
April 17, 2025
CompletedPrimary Completion
Last participant's last visit for primary outcome
July 30, 2027
ExpectedStudy Completion
Last participant's last visit for all outcomes
July 30, 2027
April 17, 2025
June 1, 2024
3 years
September 9, 2024
April 15, 2025
Conditions
Keywords
Outcome Measures
Primary Outcomes (1)
Progression of Advanced Diabetes Technology use
Defined as positive for an individual if: • MDI/smartpen + no CGM begins using CGM * MDI/smartpen + CGM begins using insulin pump * Insulin pump + no CGM begins using CGM * Insulin pump + CGM (without AID) begins using AID
12 months
Study Arms (2)
ADT use following Best Practice Advisory among non- Hispanic Black and Hispanic Patients with T1D
EXPERIMENTALADT use following a BPA intervention among non-Hispanic Black and Hispanic PwT1D receiving care at 6 T1DX-QI centers will be assessed. The EMR-based BPA will be designed to recommend ADT prescription to patients not already using some type of ADT using a rule-based algorithm. ADT will include CGM, insulin pumps, and AID systems. We will work with each of the 6 centers to implement the BPA as part of the Epic EMR. The function will generate a BPA if patient is not utilizing a CGM or pump/AID. If the patient is not on a CGM, pump or AID system (if already using CGM and pump), the BPA will suggest discussing and/or prescribing CGM (or pump/AID) to the provider. The provider will answer in the affirmative or say, "not discussed" or "patient declined." If the provider chooses to opt out of prescribing, they will be forced to provide a reason for not prescribing to advance the screen. Providers in each intervention center will be trained on the BPA process prior to implementation.
ADT use among non- Hispanic Black and Hispanic Patients with T1D
PLACEBO COMPARATORThe arm will comprise of a matched control non-Hispanic Black and Hispanic PwT1D receiving care at a center over a 12-month period. Participants will be matched on the basis of Age categories, biological sex, Insurance status, Area deprivation index, Baseline Technology use, Duration of T1D bins, and Baseline HbA1c.
Interventions
Advanced Diabetes Technologies including AIDs, insulin pumps and CGMs will be prescribed to patients after an EMR-based BPA implementation at six centers.
Advanced Diabetes Technologies including AIDs, insulin pumps and CGMs will be prescribed to patients after an EMR-based system without BPA at the implementation at six centers.
Eligibility Criteria
You may qualify if:
- non-Hispanic Black and Hispanic individuals
You may not qualify if:
- PwT1D with evidence of use of AID at baseline
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (2)
T1D Exchange
Boston, Massachusetts, 02110, United States
T1D Exchange
Boston, Massachusetts, 02111, United States
Related Publications (4)
Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ. 2005 Apr 2;330(7494):765. doi: 10.1136/bmj.38398.500764.8F. Epub 2005 Mar 14.
PMID: 15767266BACKGROUNDFlores EJ, Jue JJ, Giradi G, Schoelles K, Mull NK, Umscheid CA. AHRQ EPC Series on Improving Translation of Evidence: Use of a Clinical Pathway for C. Difficile Treatment to Facilitate the Translation of Research Findings into Practice. Jt Comm J Qual Patient Saf. 2019 Dec;45(12):822-828. doi: 10.1016/j.jcjq.2019.10.002. Epub 2019 Oct 28.
PMID: 31672660BACKGROUNDEbekozien O, Mungmode A, Buckingham D, Greenfield M, Talib R, Steenkamp D, Haw JS, Odugbesan O, Harris M, Mathias P, Dickinson JK, Agarwal S. Achieving Equity in Diabetes Research: Borrowing From the Field of Quality Improvement Using a Practical Framework and Improvement Tools. Diabetes Spectr. 2022 Summer;35(3):304-312. doi: 10.2337/dsi22-0002. Epub 2022 Aug 15.
PMID: 36072814BACKGROUNDMathioudakis N, Wolf R, Choudhary A, Davis G, Gallagher MP, Gupta M, Kamboj M, Rioles N, Ospelt E, Thapa S, Weinstock RS, Wright T, Ebekozien O. Implementation and Evaluation of a Best Practice Advisory to Reduce Inequities in Technology Use for People With Type 1 Diabetes: Protocol for a Mixed Methods, Nonrandomized Controlled Trial. JMIR Res Protoc. 2025 May 28;14:e71038. doi: 10.2196/71038.
PMID: 40434817DERIVED
Related Links
- Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success
- AHRQ EPC Series on Improving Translation of Evidence: Use of a Clinical Pathway for C. Difficile Treatment to Facilitate the Translation of Research Findings into Practice
- Achieving Equity in Diabetes Research: Borrowing From the Field of Quality Improvement Using a Practical Framework and Improvement Tools
MeSH Terms
Conditions
Condition Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Osagie Ebekozien
T1DExchange
- STUDY DIRECTOR
Nestoras Mathioudakis
Johns Hopkins University
- STUDY DIRECTOR
Risa Wolf
Johns Hopkins Pediatrics
Central Study Contacts
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- NON RANDOMIZED
- Masking
- NONE
- Purpose
- HEALTH SERVICES RESEARCH
- Intervention Model
- PARALLEL
- Sponsor Type
- OTHER
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- MD,
Study Record Dates
First Submitted
September 9, 2024
First Posted
April 17, 2025
Study Start
August 13, 2024
Primary Completion (Estimated)
July 30, 2027
Study Completion (Estimated)
July 30, 2027
Last Updated
April 17, 2025
Record last verified: 2024-06
Data Sharing
- IPD Sharing
- Will not share
There will be no Individual Participant data collection.