Patient-Centered Decision Support to Improve Diabetes Management in Pre-Teens and Adolescents With Type 1 Diabetes

Investigators propose to study an intervention that will provide patient-centered, automated
decision support to diabetes providers with the goals of improving adherence to medical
recommendations (both patients and providers), improving self-management, and ultimately
improving health outcomes. Computer decision support systems (CDSS) have scientifically
demonstrated advantages for improving care, and the potential to revolutionize diabetes care
because they allow for increased reactive and proactive contact with the health care team,
real-time adherence support, and intensification of treatment. In this study,investigators
will implement the ADA recommended standards of care using a CDSS developed by the research
group - the Child Health Improvement through Computer Automation (CHICA) system.9 One of the
greatest strengths of the CHICA system is its ability to implement evidence-based
recommendations from authoritative sources, in this case the ADA, in a format that integrates
easily into routine care. A second strength of the CHICA system is its ability to screen for
patient-centered concerns, including barriers to optimal care such as literacy, socioeconomic
issues (i.e., food insecurity, housing insecurity, etc.), and mental health issues (i.e.,
depression). The provider is alerted, and safety mechanisms are set in motion (i.e., referral
to mental health provider, etc.) to address identified issues. In order to ensure that we
design the most effective CDSS intervention possible, the study team, in collaboration with
the Patient Engagement Core (PEC) of the Indiana Clinical and Translational Science
Institute, will partner with adolescents, parents, and other stakeholders in a way that
exceeds standard expectations for the engagement of these parties in research. Investigators
have experience working directly with patients to elucidate patient-centered outcomes,
identify determinants of adherence, and to co-design interventions that are inherently more
patient-centered.10-14 By combining a patient-centered design approach along with CDSS
investigators will be able to individually tailor recommendations to meet the real needs of
patients, taking into account the adolescent patient's perspective and input. This truly
innovative approach will offer improved technology-based support systems for diabetes
management along with attention to patient-centered goals using co-designed interventions for
diabetes self-management.

Inclusion Criteria:

1. Adolescents with type 1 diabetes

2. Parents of adolescents with type 1 diabetes

3. Friends/siblings of adolescents with type 1 diabetes

4. Community partners who work with adolescents with type 1 diabetes

5. Diabetes care providers

Exclusion Criteria: