COAHEC NEAR Virtual Conference - Cristy Geno Rasmussen

Title: Challenges of translating public health research into clinical practice: Autoimmunity Screening for Kids (ASK)

Cristy Geno Rasmussen

Senior Instructor and Project Manager of the Autoimmunity Screening for Kids (ASK) study at the Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus. Adept professional in healthcare leadership, translational research, evaluation, and management. Research interests include chronic disease prevention across the life course, psychosocial health factors, population health, public health policy, health equity, health communication, health literacy, socio-environmental determinants of health, behavior change, dissemination and implementation science, healthcare leadership, coordinated and managed care, community-based participatory research, and qualitative methodologies.

Video Presentation

Other Authors:

Senior Instructor and Project Manager of the Autoimmunity Screening for Kids (ASK) study at the Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus. Adept professional in healthcare leadership, translational research, evaluation, and management. Research interests include chronic disease prevention across the life course, psychosocial health factors, population health, public health policy, health equity, health communication, health literacy, socio-environmental determinants of health, behavior change, dissemination and implementation science, healthcare leadership, coordinated and managed care, community-based participatory research, and qualitative methodologies.

¹Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, USA

²Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, USA

³Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, USA

⁴Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA

^Abstract

Background/Objectives: Early detection through screening can prevent morbidity associated with type 1 diabetes (T1D), including diabetic ketoacidosis (DKA), and celiac disease (CD). The Autoimmunity Screening for Kids (ASK) program explores the feasibility and cost effectiveness of screening for pre-symptomatic T1D and CD in the U.S. general population children aged 1-17 y.

Methods: From January 2017- April 2020, the ASK study screened 25,738 children in Colorado testing for islet (IA) autoantibodies to insulin, GAD, IA-2, and ZnT8 and, for celiac, transglutaminase autoantibodies (TGA). A screening implementation toolkit was tailored to engage providers in varied health care systems, hospitals, and private practices. Incentives to participate included providing screening staff on site, electronic consent kiosks, marketing assistance, and referral programs.

Results: Pre-symptomatic T1D was detected by at least one islet autoantibody in 3.4% including 0.52% with multiple IA and 0.58% high affinity IA, predicting, respectively, a 44% and 29% 5-y risk of clinical T1D. Celiac disease risk was found in 2.7% of participants; 163 were diagnosed. Screening cost per person was $47 (including $15 in lab costs); cost per case detected was $4,700. Screening program considered cost effective if rate of DKA decreased from current 59% to 47%. During study follow-up, 35 children progressed to clinical T1D; only six developed DKA. Challenges to implementing screening program included lack of provider time and commitment, limited space, inconsistent value perspective, and research constraints.

Conclusions/Implications: Prospective follow-up of screening-detected cases and further examination of cost-effectiveness will inform screening program acceptance including cost reimbursement and increased provider engagement. Translation into public health practice may initially require targeted versus universal screening recommendations based on family history and symptomology to build provider momentum.