How Quality Improvement Can Expand Insulin Pump Use and More

How Quality Improvement Can Expand Insulin Pump Use and More 150 150 Mary Bates, PhD

A Q&A with Don Buckingham about the T1D Exchange Quality Improvement Collaborative

Don Buckingham, MBOE, CPHQ, CSSBB, joined Nationwide Children’s Center for Clinical Excellence as a quality strategist eight years ago. In a Q&A, he shares how he leveraged his background in industry and business services improvement in projects for the T1D Exchange Quality Improvement (QI) Collaborative, which was established by the T1D Exchange clinic network to improve care delivery for people with type 1 diabetes.

Q: What is the T1D Exchange QI Collaborative?

The diabetes centers that make up the T1D Exchange clinic network share data on patients, both adults and children, with type 1 diabetes. That information is used by hospitals for benchmarking. The participating centers are also part of a learning collaborative where they work together and learn from each other to determine best practices in managing type 1 diabetes.

All of the folks in the collaborative are trained in the medical area. They are smart and talented and know what they’re doing. But they don’t necessarily know how to implement processes to sustain the improvements that they would like to see. The T1D Exchange is about figuring out how to build infrastructure and support systems and processes around the great work that the medical teams are already doing. We all want to deliver the best patient care and achieve optimal clinical outcomes.

Q: Tell me about the recent initiative from the T1D Exchange QI Collaborative aimed at increasing insulin pump use.

In this project, Nationwide Children’s and four other centers worked at increasing insulin pump use in patients aged 12-26 years with type 1 diabetes. We used the IHI (Institute Healthcare Improvement) model for change, which begins with the question: What is it you want to change? Our aim was to increase the number of patients using insulin pumps from 45% to above 50%. The next step is identifying key drivers, those things that directly contribute to making that aim happen. In this case, the key drivers were getting patients access to insulin pumps, educating patients on effective insulin management and supporting patients in active problem solving for glucose monitoring, insulin management and nutrition education. Then we came up with secondary drivers, or you might call them interventions, to test to see if we could make that change happen. The centers tested different interventions to increase insulin pump use among their patients. And we saw that over 22 months, insulin pump use rates increased from 45% to 58%.

Q: What are some other accomplishments of the T1D Exchange QI Collaborative?

The learning collaborative started in 2016 with 10 centers. Now there are 52 centers, 35 of which are pediatric hospitals. That’s a lot of brain power. In just the last three years, we’ve published 40 peer-reviewed journal articles and given 70 conference presentations. It’s generating quite a large body of work.

We have also built an online QI Portal, where information is available that can be used for data benchmarking and sharing across centers. And we’ve developed the largest real-world electronic medical record data set, with more than 75,000 patients with type 1 diabetes.

Q: Why are collaboratives like the T1D Exchange important?

The last step in the model we use is spread. It’s important to share the fruit of your learning. Sharing helps the spread of improvement science and its ability to impact hospitals.

In many for-profit businesses, knowledge is guarded in order to keep a competitive advantage. But a great thing about health care is that we are collaborative, not competitive. We are all trying to help patients.

When we do our improvement studies, we find information that is likely to be transferable. We can’t say with certainty that if you do exactly what we did in your setting, you’ll get exactly the same results. But you can learn from what we’ve done and use your own expert judgment and apply the same process to come up with solutions that work for you.

Q: What is the collaborative planning next?

Future goals include continued growth in the network to become the foremost source of real-world data and QI best practices in the field. We will also focus on building on the mental health initiatives, which is important for people with diabetes because your blood chemistry affects how you feel and think and behave.

I will be retiring at the end of this year but it has been an enormous privilege to work here at Nationwide Children’s. It has had a life changing impact on me. And even in retirement, I plan to continue to support the T1D Exchange with whatever I can do for them.



Lyons SK, Ebekozien O, Garrity A, Buckingham D, Odugbesan O, Thomas S, Rioles N, Gallagher K, Sonabend RY, Lorincz I, Alonso T, Kamboj M, Lee JM. Increasing insulin pump use among 12- to 26-year-olds with Type 1 Diabetes: Results from the T1D Exchange Quality Improvement Collaborative. Clinical Diabetes. 2021:39(3):272-277.


About the author

Mary a freelance science writer and blogger based in Boston. Her favorite topics include biology, psychology, neuroscience, ecology, and animal behavior. She has a BA in Biology-Psychology with a minor in English from Skidmore College in Saratoga Springs, NY, and a PhD from Brown University, where she researched bat echolocation and bullfrog chorusing.