MON-584 - Understanding and Improving the Integration of Continuous Glucose Monitors as Part of Routine Care Plans to Eligible Patients in Subspecialty and Primary Care Clinics

Introduction and

Objective: Continuous glucose monitors (CGMs) are an integral component of modern diabetes management. However, in practice, CGM implementation faces operational challenges. Therefore, a process improvement project was conducted to understand the clinical context for CGM use, identify barriers, and propose solutions.

Methods: Interviews and subsequent mapping were conducted in 2025 at Northwestern Medicine and were grounded in the SEIPs model (Systems Engineering Initiative for Patient Safety). A process map for CGMs in clinics (primary care and endocrinology) was constructed, starting from identifying eligible patients for a CGM and ending with a provider making medical decisions from CGM data. A modified thematic analysis was performed to identify barriers and facilitators at the various steps in the process map. Solutions for the barriers were then generated from the ideas of the interviewees and the research team.

Results: The ten interviewees included one endocrinologist, four endocrinology nurses, one pharmacist, one diabetes educator, two internal medicine (IM) physicians, and one IM nurse practitioner. The process map includes numerous decision branch points to depict how medical professionals of different specialties interact longitudinally. Barriers included the primary care provider’s (PCP’s) unawareness of CGM indications, difficulties with ordering CGMs, lack of infrastructure to assist with navigating insurance coverage, difficulty in providing timely diabetes education after CGM receipt, and PCP interpretation and clinical processing utilization of CGM data. Facilitators include structures that allow multiple clinical roles to prescribe CGMs, CGM order sets, and continued training on CGM care pathways (e.g. training in their insurance coverage). Proposed solutions involve changes at the individual, institutional, and extra-institutional levels and then were subsequently mapped to the Systems Engineering Initiative for Patient Safety (SEIPS) domains. Institutional solutions at the level of tools and technology include creating a dot phrase for CGM indications, establishing a central directory of CGM company resources, and utilizing a toolkit to facilitate a conversation between providers and eligible patients about the use of CGMs as part of their treatment plan.

Conclusion: Numerous obstacles and the coordination of multiple care pathways make it difficult to effectively utilize CGM in academic clinics. This project mapped this complex process, allowing for solutions to be generated at stakeholders’ pain points in the process. Future work needs to be performed to validate the effectiveness of the proposed solutions and study barriers and facilitators at non-academic centers and assess the applicability of proposed solutions in that context.

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