The Mayo Clinic Diabetes Technology Clinic
A story of continuous improvement with focus on outcomes important for patients and stakeholder feedback
Clinical care of patients using diabetes technologies such as insulin pumps and continuous glucose monitors is often poorly standardized. The American Diabetes Association's insulin pump standards of care, published in Diabetes Care, emphasize the importance of skilled, consistent providers to care for patients who utilize diabetes technologies to manage their diabetes.
Recognizing the need for a unique clinic that focused on people with diabetes who use technology to effectively manage the disease, Mayo Clinic in Rochester, Minnesota, founded the Diabetes Technology Clinic (DTC) in 2006. The clinic continues to grow and is now staffed by five physicians, two nurse practitioners and four certified diabetes educators that care for patients who currently use or are interested in using an insulin pump, a continuous glucose monitor, or a combined insulin pump and continuous glucose monitor.
Yogish C. Kudva, M.B.B.S., an endocrinology consultant at Mayo Clinic's campus in Rochester, Minnesota, says: "In 2010, an estimated 400,000 people were using insulin pumps. The estimate for 2015 is that 525,000 people are using insulin pumps, according to statistics shared by Halozyme Therapeutics during the J.P. Morgan 29th Healthcare Conference in 2011.
"More sophisticated diabetes technologies continue to emerge, including sensor-augmented insulin pumps and low-glucose insulin suspend models, the latter representing the first step of a closed-loop glucose insulin control system."
With the goal of better meeting the needs of an anticipated increasing number of patients using diabetes technologies, the Mayo Clinic DTC partnered with a health systems engineer from Mayo Clinic Systems and Procedures to complete several voice-of-the-customer exercises to better understand the needs of DTC patients.
Dr. Kudva explains: "These needs were solicited utilizing several tools. Internal stakeholders such as DTC staff — nurses, nurse practitioners, physician assistants, physicians, desk staff and others — as well as referring providers were interviewed to learn about their experiences with the DTC. Patient and patient family input was solicited via a satisfaction survey."
Patient feedback was centered on the following themes:
Survey respondents expressed a strong desire to continue to learn more about the diabetes technology they currently use as well as new developments. Education was sufficient when they were new to the technology, but respondents felt there was much they could learn about using the technology more efficiently and expressed interest in continuing education. There was also interest in additional education on topics such as exercise and pregnancy.
Survey respondents appreciated advance notice when tests were required and clearly understandable test results.
Visit frequency and appointment access
Patients want to understand the expectations for follow-up care and visit frequency and were concerned that appointment access was insufficient.
Patients stated a preference to see the same provider at each DTC visit.
There was a desire to clearly understand the contact information and process for care required between visits to the DTC.
As a result of patient feedback, several DTC enhancements were implemented, including:
- An increase in the number of providers focused on meeting the needs of patients and ensuring sufficient training for them, to meet expectations and practice growth
- Creation of additional patient education materials specific to diabetes technology on topics such as diabetes technology and exercise, diabetes technology and pregnancy, traveling with an insulin pump, and uploading insulin pumps at home
- Expansion of DTC appointment access to five days a week to ensure patient appointment availability
- Implementation of the DTC provider of the day role to ensure access to a diabetes technology-focused provider, to support patient needs between visits and respond to referring provider questions
- Development of an education assessment to be completed by the certified diabetes educator at each patient visit to identify knowledge gaps and inform the DTC team of potential patient education needs
- Development of a model of caring for community patients currently using or interested in using diabetic technologies in partnership with primary care providers
- Creation of a DTC overview video to provide an overview of the clinic for new patients, posted to YouTube and the Mayo Clinic Medical Professionals Video Center
Dr. Kudva adds: "Improvement efforts also included developing a standard patient visit process to ensure a consistent patient experience. At each patient visit, the DTC care team reviews the patient's medical history to understand the patient's health and diabetes management concerns.
"The DTC team develops a plan with the patient to effectively and safely manage his or her devices. This plan may include working with a certified diabetes educator, a dietitian or both to address specific concerns the patient may have. If the patient already uses diabetes technology, the team will review device download information, determine if the device settings require adjustment and answer any questions the patient may have. The patient and DTC care team partner to determine DTC visit frequency."
Dr. Kudva concludes: "The care of patients who currently use or have an interest in using technology to manage their diabetes is a field that continues to evolve based on advances in available technologies. The Mayo Clinic DTC continues to identify opportunities to best meet the needs of this patient population."
For more information
Heinemann L, et al. Insulin pump risks and benefits: A clinical appraisal of pump safety standards, adverse event reporting, and research needs. A joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group. Diabetes Care. 2015;38:716.
Frost GI. Halozyme Therapeutics presentation. Presentation at: J.P. Morgan 29th Annual Healthcare Conference; 2011; San Francisco, Calif.
Kudva YC. Insulin Pumps and Sensors: Treating Diabetes with Technology at Mayo Clinic. Medical Professional Video Center. Mayo Clinic. 2015.