OBJECTIVE Diabetes technology, including insulin pumps, is associated with improved outcomes in youth with type 1 diabetes (T1D). However, youth with public insurance consistently demonstrate lower use. In 2022, we launched a quality improvement (QI) initiative to address disparities in insulin pump use among publicly insured youth with T1D. Our initial aim was to increase pump use from 30% to 40% within 15 months. We now report sustained and expanded outcomes, with pump use reaching 73% by December 2025. RESEARCH DESIGN AND METHODS Using a T1D-specific dashboard embedded within the electronic health record (EHR), we tracked monthly insulin pump use among publicly insured patients seen in our outpatient diabetes clinic. A multidisciplinary team designed and tested interventions through iterative plan-do-study-act cycles. Interventions included multilingual virtual and in-person insulin pump education classes, individualized one-on-one education sessions, Spanish-language educational materials, expanded class availability, targeted care navigation outreach to support scheduling and follow-up, provider implicit bias training, integration of pump screening questions into clinic intake workflows, and systematic collection of patient and family feedback through post–insulin pump class evaluations. RESULTS Insulin pump use increased from 30% in April 2022 to 42% by June 2023, and further to 73% by December 2025, reflecting sustained improvement and successful scale-up over a 44-month period. CONCLUSIONS An equity-centered, EHR-informed QI approach led to durable improvements in insulin pump use among publicly insured youth with T1D. These results demonstrate the potential for scalable, systems-based interventions to reduce disparities in diabetes technology access.
Cymbaluk et al. (Thu,) studied this question.