Screening to early detection of type 1 diabetes (STEP T1D): co-selection of implementation strategies with primary care pediatricians using the rapid assessment process

Screening for early-stage type 1 diabetes and monitoring for disease progression has been recommended since 2023 to prevent severe complications at diagnosis and provide pathways to disease modifying therapies. Yet, screening is limited to academic diabetes centers. Recent guidance supports screening in primary care; however, evidence to support optimal approaches for screening in this context is limited. The objective of this study was to identify pediatrician-informed strategies to implement type 1 diabetes screening in primary care for children with a family history. We used the rapid assessment process to conduct a pre-implementation study with pediatric primary care providers (PCPs). We conducted 5 visits with PCP practices representing diverse environments. Data collection at each visit included 60-minute facilitated group discussions and provider surveys. During group discussions, PCPs reflected on how screening would be integrated into practice, focusing on possible solutions. The survey consisted of 18 established implementation strategies, which PCPs rated on a 1–5 Likert type response scale from “very unhelpful” to “very helpful.” Detailed field notes were analyzed using a taxonomic approach to identify how strategies may address organizational barriers and facilitators to screening. Strategies with mean scores > 4.5/5 were considered highly prioritized by PCPs. Group discussions with 29 PCPs yielded three facilitators, including high general support for screening as in their scope of practice, existing referral systems to pediatric endocrinology, and practice-based support to follow test results. Barriers focused on identifying who to screen, ease of testing, PCP counseling, and access to follow up care for families with high social needs. Highly prioritized strategies focused on (1) creating order sets for antibodies with embedded diagnosis codes, (2) step-by-step protocols, (3) electronic health record customizations such as prompts and documentation templates, (4) quick reference guide for common terms, and (5) support from endocrinology. Field notes from facilitated discussions of proposed strategies aligned and expanded on these. Strategies to implement type 1 diabetes screening in primary care should focus on clinical decision support tools with access to expert consultation. Future research should evaluate the impact of these strategies on uptake of screening and long-term sustainability. n/a.