623 - Effects of a Quality Improvement Project and the "2023 AAP Clinical Practice Guideline for the Evaluation and Treatment of Obesity" on Type 2 Diabetes Screening Rates in an Academic Institution

Poster Number: 623
Publication Number: 623.3289

Background: Pediatric type 2 diabetes (T2D) prevalence is increasing and disproportionately affects children in marginalized demographic groups. On January 9, 2023, the American Academy of Pediatrics (AAP) released its “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity (CPG)” which includes recommendations for T2D screening.

Objective: Evaluate the effect of the AAP’s CPG on T2D screening and of quality improvement efforts to improve T2D screening rates.

Design/Methods: The frequency of qualifying visits with T2D screening were evaluated using electronic health record data at 3 academic pediatric clinics (intervention clinics, [IC]) and 27 community clinics (comparison clinics, [CC]) in 2 phases. Visits qualified for screening for patients age ≥ 10 years with prior elevated HgbA1c without timely follow-up, defined as follow-up at ≤ 1 y for HgbA1c 5.6%-5.9% or ≤ 6 mo for HgbA1c 6.0% to < 6.5%, or additional criteria based on BMI and race. In phase 1 (Jul 1, 2022 – Jan 8, 2023), IC had provider education with an internal care process model; visits qualified for patients who had BMI ≥ 85th percentile and belonged to a high-risk racial/ethnic group (Asian/Pacific Islander, Black, American Indian and Alaska Native, or Hispanic/Latino).
In phase 2 (Jan 9, 2023 – Oct 15, 2023), IC had CPG education beginning Jan 9, 2023, and monthly audit and feedback cycles beginning March 28, 2023. Visits qualified for patients with (1) BMI ≥ 85th to < 95th percentile and belonged to a high-risk racial/ethnic group or (2) BMI ≥ 95th percentile regardless of racial/ethnic group. Repeat screening criteria was increased to 2 y for visits without high-risk race/ethnicity with normal prior HgbA1c May 1, 2023.
Differences in screening between phases and clinic group were analyzed using statistical process control (SPC) p-charts, χ2 tests, and interrupted time series (ITS).

Results: There were 3599 qualifying visits (intervention, 692; comparison, 2907). χ2 test showed a 17.2% increase in frequency of screening in IC (P = .02) and no change in CC (P = .076) in phase 2 (Table 1). IC SPC p-chart showed special cause variation in phase 1 but not phase 2 (Figure 1). Phase 2 ITS (Fig. 2) showed a positive trend in percentage of screening in IC (1.02%/2 wk [P = .011]), but no significant trend in CC (0.06%/2 wk [P = .806]). There was a difference in trends between clinics groups in phase 2 (P = .047).

Conclusion(s): There was a significant increase in phase 2 T2D screening in intervention clinics after CPG release, audit and feedback cycles, and education.