Background: Youth with type 1 diabetes (T1D) are at increased risk for comorbid autoimmune conditions and long-term complications. To help with early identification of these complications, the American Diabetes Association (ADA) has published evidence-based screening guidelines. The aim of our quality improvement intervention was to improve and sustain adherence to the ADA recommended screening guidelines to >90% for youth with T1D in the Texas Children’s Hospital (TCH) Diabetes Center by utilizing best practice alerts (BPA) within the electronic medical record (EMR).

Methods: In accordance with the ADA Standards of Care screening guidelines for youth with T1D, we analyzed the database of TCH patients to obtain the following baseline percentages: 1) urine microalbumin-to-creatinine ratio, 2) thyroid function screen, 3) lipid panel, and 4) retinopathy screen. In the TCH EMR, we developed BPAs to alert providers and provide decision support on ADA-based screening recommendations at each clinic encounter. Comparisons were made to screening rates for each category pre- and post-intervention.

Results: In the four years following the BPA build, the screening percentage for each category improved from a baseline of 90%, which has been maintained for three consecutive fiscal years.

Conclusions: The use of EMR-based BPAs to alert providers of the need for evidenced-based screening is effective in increasing adherence to standard of care guidelines. With this quality improvement intervention, we achieved our goal of >90% for each category. Similar tools for decision support may be effectively utilized for evidence-based screening in other disease states.