Simulating Screening for Risk of Childhood Diabetes: The Collaborative Open Outcomes tooL (COOL).

The Collaborative Open Outcomes tooL (COOL) is a novel, highly configurable application to simulate, evaluate and compare potential population-level screening schedules. Its first application is type 1 diabetes (T1D) screening, where known biomarkers for risk exist but clinical application lags behind. COOL was developed with the T1DI Study Group, in order to assess screening schedules for islet autoimmunity development based on existing datasets. This work shows clinical research utility, but the tool can be applied in other contexts. COOL helps the user define and evaluate a domain knowledge-driven screening schedule, which can be further refined with data-driven insights. COOL can also compare performance of alternative schedules using adjusted sensitivity, specificity, PPV and NPV metrics. Insights from COOL may support a variety of needs in disease screening and surveillance.