Using Stakeholder Input to Develop a Best Practice Advisory (BPA) to Increase Prescribing of Automated Insulin Delivery (AID) Systems for People With Type 1 Diabetes (PwT1D)

Background: Diabetes technology use is increasing, yet disparities remain in adoption among people with type 1 diabetes (PwT1D). The Best Practice Advisories to Reduce Inequities in Technology Use (“BPA-TECH”) study is a multi-site quality improvement (QI) initiative that seeks to develop, deploy, and evaluate a BPA aimed at standardizing prescribing of diabetes technologies. Methods: This mixed-methods study sought feedback from PwT1D, their care partners, and diabetes clinicians through the T1D Exchange QI Collaborative (T1DX-QI) using electronic surveys, interviews, and focus groups to develop and refine the BPA. Results: The T1DX annual survey with general BPA questions was completed by 56 participating centers (38 pediatric and 18 adult), and 31 diabetes care clinicians from eight T1DX-QI centers (five pediatric and three adult) participated in focus groups. An online survey was completed by 101 PwT1D and/or their care partners, followed by structured interviews with nine adult PwT1D and ten care partners. In response to the annual survey, 48% of pediatric and 28% of adult centers thought a BPA would be useful for increasing automated insulin delivery (AID) use. During focus groups, clinicians expressed concerns about workflow integration and alert fatigue. On surveys, most PwT1D and care partner stakeholder groups (96%) said a BPA would help remind diabetes clinicians to discuss technology with patients, and 77% agreed that a BPA could help PwT1D use these technologies, recommending a cadence of every three months. Conclusions: Successful BPA development and implementation requires addressing clinician concerns about workflow and alert fatigue, while aligning with PwT1D and care partners’ expectations for the cadence of conversations on AID systems.