Evaluating the utility of texting in the ambulatory care of paediatric patients with type 1 diabetes: a quality improvement report
Bibliographic record
Abstract
INTRODUCTION: Type 1 diabetes (T1D) is a chronic and costly disease that is often diagnosed in childhood. Achieving excellent glycaemic control during this period requires attention to multiple factors. Advances in technology now allow clients (patients/family members) to fine-tune their insulin delivery, necessitating support from highly skilled nurses, dietitians and physicians (clinicians). Despite quarterly team-based appointments, interim issues and questions often arise, and families may not always reach out for support. The incidence of T1D is rising, and yet barriers exist to expanding the clinical team. Additionally, clinicians are not necessarily colocated, making timely and efficient communication challenging. We postulated that offering texting as a communication modality would increase client interactions by 20%, and that clients and clinicians would find it a desirable tool in the delivery of efficient and timely ambulatory care. METHODS: A prospective interventional quality improvement project was conducted between July 2022 and August 2023. Baseline data were obtained for the number of interactions. Parents, caregivers and age-appropriate patients were then registered onto the texting platform (N=125) and received a weekly check-in message. The number of interactions and clinical time spent texting and providing care because of a text interaction were collected. RESULTS: There were approximately 30 interactions per week, an increase of >2300%. The average additional clinical time required was 56 min per week (average of 30 s/interaction). Qualitatively, 100% of our clients expressed a desire to continue texting with the team. 97% of clients felt that texting was an important way for them to contact their diabetes team. Our clinicians also wished to continue texting, valuing the improved efficiency of communication and experiencing a greater degree of connection with their clients. CONCLUSIONS: Texting is a welcome modality of communication between clients and their clinical care team in the setting of ambulatory T1D care, resulting in increased engagement.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.033 | 0.064 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".