Improving the Recognition and Management of Elevated Blood Pressure among Youth with Type 1 Diabetes

• Published in: Diabetes (New York, N.Y.) Vol. 67; no. Supplement_1
• Main Authors: GANDHI, KAJAL, BUCKINGHAM, DON A., HEHMEYER, JESSICA, KRAMER, ALYSSA M., OBRYNBA, KATHRYN, INDYK, JUSTIN A., KAMBOJ, MANMOHAN K.
• Format: Journal Article
• Language: English
• Published: 01-07-2018
• ISSN: 0012-1797; 1939-327X
• DOI: 10.2337/db18-1307-P

Background: Studies show that youth with type 1 diabetes (T1D) harbor cardiovascular risk factors and exhibit clinical signs suggestive of cardiovascular disease. ADA and ISPAD guidelines promote regular blood pressure screening to reduce cardiovascular risk, and strategies should involve effective screening and management. The diabetes clinic previously had limited measures in place to manage T1D youth with elevated blood pressure.
Objective: The aim of this quality improvement (QI) project was to increase provider recognition and follow-up of TID patients with elevated blood pressure readings ≥ 95%tile for age/gender/height, from 0% to 50%, by 12/31/17 and sustain through 12/31/2018.
Methods: After the QI team clarified project goals, a Key Driver Diagram (KDD) and elevated blood pressure process map was established. This algorithm aided to clarify the care process to efficiently recognize and manage youth with T1D who presented with elevated blood pressure in the outpatient diabetes clinic. A “Best Practice Alert” (BPA) was created within the electronic medical record, which alerted the diabetes care team of the presence of elevated blood pressure among T1D patients in clinic. This allowed the provider to choose electronically tracked care options in the medical record to manage elevated blood pressure among T1D patients and coordinate care among subspecialties that manage elevated blood pressure. Data reports were compiled to track utilization of the blood pressure BPA from May 2017 (initiation date) to December 2017 with ongoing data collection.
Results: Upon BPA creation, process mean of the utilization and management of elevated blood pressure BPA among T1D youth increased to 73% over a 7 month period.
Conclusions: This project successfully improved screening and management of T1D youth with elevated blood pressure in the outpatient setting. This project builds on comprehensive diabetes care, with the hope of reducing future cardiovascular burden for youth with T1D.