1149-P: Expanding Access to Continuous Glucose Monitoring in Medicare Patients through Quality Improvement

Introduction and Objective: In 2023, Medicare expanded coverage for continuous glucose monitoring (CGM) to include all patients with diabetes using insulin, but this update has been slow to disseminate to providers. This quality improvement project aimed to improve access to CGM for Medicare patients with type 2 diabetes on insulin at our subspecialty diabetes clinic.Methods: Patients meeting Medicare CGM coverage criteria were identified from the clinic registry. Clinical data extracted from the electronic health record included age, self-reported race and ethnicity, sex, preferred language, and education level. Several interventions were trialed, including provider lists of eligible patients not on CGM, patient flyers, an updated formulary guide with insurance requirements, and a technology support guide. CGM usage pre- and post-intervention was identified through review of diabetes clinic notes. Monthly CGM orders were extracted from the electronic durable medical equipment ordering system. Statistical process control was used to analyze change in monthly CGM orders over time. Logistic regression was used to identify factors associated with CGM use and assess disparities in prescribing practices.Results: In this open cohort of Medicare patients with type 2 diabetes on insulin, CGM use increased from 49.6% (420/847) to 62.6% (632/1009) over eight months of interventions. Median monthly CGM orders increased from 34 to 60 and the change met IHI criteria for special cause variation. Both pre- and post-intervention, patients using CGM were younger (p<0.01) and had lower A1c (p<0.05). There were no differences in racial, ethnic, or socioeconomic factors between the groups (p>0.05 for all).Conclusion: Through clinic-wide interventions, CGM orders for Medicare patients increased without creating disparities in care. Quality improvement efforts can help translate policy change to practice change and improve access to standard of care diabetes technologies.

K.L. Flint: None. T. Ting: None. K.D. Smead Rivera: None. P. Tamang: None. C.A. Colling: Advisory Panel; DocGo. J.H. Li: None. M.S. Putman: Consultant; Anagram Therapeutics. Research Support; Dexcom, Inc. Other Relationship; Vertex Pharmaceuticals Incorporated.

National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007028); Center of Expertise grant support from the Mass General Brigham Office of Graduate Medical Education



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