Using Metrics to Improve the Delivery of Optimal Care for Children With Type 1 Diabetes

Kathryn Obrynba, MD

Kathryn Obrynba, MD, pediatric endocrinologist at Nationwide Children’s Hospital

US News Badge Diabetes and EndocrinologyUS News Badge Honor RollPediatric type 1 diabetes (T1D) necessitates a coordinated, multidisciplinary effort to deliver optimal standards of diabetes care, as outlined by the American Diabetes Association (ADA) and International Society for Pediatric and Adolescent Diabetes (ISPAD).

Tracking care delivery can identify shortfalls and encourage specific interventions to improve delivery of quality care.

Kathryn Obrynba, MD, a pediatric endocrinologist at Nationwide Children’s Hospital, and her research team designed a novel T1D care index (T1DCI) to track the delivery of optimal T1D care within the hospital’s diabetes program.

“An overall improvement was observed by tracking the index,” Dr. Obrynba says, “meaning there were fewer missed opportunities to deliver care.”


Using ADA and ISPAD guidelines, Dr. Obrynba and her team first identified 11 elements of optimal diabetes care, then grouped the elements into three categories: patient-centered multidisciplinary care, monitoring for co-morbidities/preventive screening and psychosocial support.

For the study’s baseline period (January to December 2017), the research team reviewed the electronic medical records (EMR) of patients with T1D to tally the number of missed opportunities to deliver optimal diabetes care. During the intervention period (January to December 2018), the cumulative number of missed opportunities was tallied for each care element each month.

By the end of the intervention period, there was a 26% overall reduction in the number of missed care opportunities.

“Tracking opened our eyes to how care processes were being implemented to provide optimal care,” Dr. Obrynba says.

Several care elements demonstrated marked reductions during the intervention period. The largest reduction (74%) was observed with clinic accessibility, attributed to automatically scheduling follow-up appointments at check-in. The second-largest reduction (53%) was observed with the after-clinic summary, attributed to autopopulating the summary in the EMR.

Some missed opportunities increased during this period, however. For example, missed opportunities for depression screenings increased by 129% because of a shortage of social workers to perform the screenings.

“Near the end of intervention period, we instituted a process change to flag when patients were due for their depression screenings,” Dr. Obrynba says.

These patients completed the screening at check-in, independent of a social worker. Several high-level changes were also implemented such as an electronic dashboard within each patient’s EMR to track delivery of care.

Although not all 11 care elements demonstrated a reduction in missed opportunities, Dr. Obrynba says that the index’s real success was the ability to track delivery of care and identify these missed opportunities.

Obrynba KS, Indyk JA, Gandhi KK, Buckingham D, Kamboj MK. The diabetes care index: A novel metric to assess delivery of optimal type 1 diabetes care. Pediatric Diabetes. 2020;21:637–643.

A Decade of Remarkable Transformation: Endocrinology

Over the last 10 years, Endocrinology has expanded to provide comprehensive programs for pediatric and adolescent endocrine care including Prader Willi disease, fertility, gender diversity, and difference of sex development. The division has also become a national leader in diabetes quality improvement initiatives by joining the T1D Exchange Quality Improvement Collaborative.

  • 2013: Developed Diabetes Calculator for Kids — First-of-Its-Kind Electronic Tool
  • 2014: New THRIVE Program Specializes in Care for Differences of Sexual Development, Complex Urological Problems and Gender Concerns
  • 2015: Juan Sotos, MD, Honored for Dedication and Vast Contributions to the Field of Pediatric Endocrinology
  • 2018: Nationwide Children’s Joins T1D Exchange Quality Improvement Collaborative
  • 2019: Manmohan Kamboj, MD, Named Division Chief