P3.218: Transition of Care: Type 1 Diabetes Mellitus

Purpose/Objectives: The transition from pediatric to adult care is a critical time for patients with type 1 diabetes. Poor transition practices can lead to uncontrolled hyperglycemia, diabetic ketoacidosis, and hypoglycemia.

This quality improvement project implements a transition of care (TOC) program for patients with type 1 diabetes. The primary goal is to reduce the time between the last pediatric appointment and the first adult appointment with an endocrinologist.

Design/Methods: This quality improvement project included the following stakeholders: pediatric and adult endocrinologists, certified diabetes educators (CDEs), and administrative staff. The pre-intervention group transitioned to adult care before May 13, 2024, and the post-intervention group transitioned after. Patients aged 20 to 25 with type 1 diabetes were included.

A detailed email outlining a TOC protocol instructed the pediatric endocrinologists to message adult administrative staff via the electronic medical record to facilitate scheduling a first visit appointment with an adult endocrinologist. The pediatric endocrine team was also instructed to refer patients over 18 years old to adult CDEs for diabetes education.

Reviewed charts to obtain the date of the patient’s last pediatric visit and the date of their first adult visit. The pre-intervention group consisted of 20 patients and the post-intervention group consisted of 15 patients. The Wilcoxon rank-sum test was used to evaluate if this intervention created a significant difference in time between appointments.

Results: The average time between appointments was 395 days pre-intervention and 223 days post-intervention. Given the pre group was normally distributed (Shapiro-Wilk test statistic = 0.953, p-value = 0.414) and the post group was not normally distributed (Shapiro-Wilk test statistic = 0.770, p-value = 0.00157), a Wilcoxon-Mann-Whitney test was completed to compare the two groups. The Wilcoxon rank-sum test (W = 215.5, p = 0.03) showed a statistically significant difference.

Conclusion/Discussion: Implementing a TOC protocol at Stony Brook reduced the time between pediatric and adult appointments. As more patients transition, the sample size will grow. Future goals include reducing transition time to three months, tracking CDE appointments, and implementing TOC educational packets for patients and providers. The limitations of these data include analysis of only patients who stayed within the hospital system, which may introduce bias.