Adult Diabetes Control & 1. ADCM 2008/09 progress report - PDF document

Scope of Presentation Adult Diabetes Control & 1. ADCM 2008/09 progress report Management (ADCM) 2. Current challenges Use of data • Progress Report Dissemination of information-Publication • 3. Future direction Current challenge & Future direction Dr Mastura Ismail MBBS, Master Fam Med (UM) Fellow in Non-Communicable Disease, Monash Uni Chairperson, ADCM/FMS Klinik Kesihatan Ampangan INTRODUCTION INTRODUCTION Introduction The Adult Diabetes Control and Management audit (ADCM) � � Prevalence of diabetes has increased from was first established in May 2008. 8.3% (NHMS II,1996) to 14.9% (NHMS Initially, this registry was called ADCM but subsequently the III,2006) � plan is to change to National Diabetes Registry (NDR) as it was deemed to be more appropriate. � Poor diabetes controlled leads to higher rate of morbidity and mortality CRF was initially simplified from the DICARE CRF as well � as taking consideration the NCD Division, MOH QAP of � Precise estimate on the incidence and Diabetes in Primary Care. prevalence of diabetes in Malaysia is lacking � It started off as a pilot project involving centers with health clinics and hospitals within the Ministry of Health Malaysia in Negeri Sembilan. 1

Initial Steering Committee Objectives of ADCM Dr. Mastura Ismail, Ampangan Health Clinic � Determine the demographic of the diabetic 1. Dr. Wan Shaariah mohd Yusuf, Clinical Research Centre, Hospital � patients attending the MOH health Seremban clinics/hospital Dr. Zanariah Hussein, Medical Department, Hospital Putrajaya � Dr. Hjh. Fatanah Ismail, Disease Control Division, MOH, Putrajaya Determine the diabetic health educational � 2. Dr. Feisul Idzwan Musthapa, Disease Control Division, MOH, Putrajaya � and preventive program among patients Dr. Inderjeet Kaur Gill, Medical Development Department, Putrajaya � attending their regular follow-up in MOH Dr. G.R. Letchumanan a/k Ramanathan, Medical Department, � health clinics/hospitals Hospital Taiping Dr. Sri Wahyu Taher, Simpang Kuala Health Clinic � Determine the diabetic complications 3. workload in health clinics/hospitals KKM Objectives.. cont Determine the demographic of the diabetic 4. Vision patients attending the MOH health clinics/hospital because of diabetes complications Determine the diabetic treatment outcome in 5. patients attending the MOH health clinics/hospital To facilitate service improvements by providing 6. An Accessible Diabetes Health robust nationally comparable data for diabetic care. Information System Stimulate and facilitate diabetic research activities 7. using this database. 2

Organization chart ADCM Registry-www.acrm.org.my/adcm Steering Committee Advisor; Dr. Lim Teck Onn Chairperson: Mastura Ismail Members: Wan Shaariah, Zanariah, jamaiyah, Fatanah, Feisul, sri Wahyu, Letchumanan Launch 1.5.2008 Governance Sub committee/expert panels /Advisory Board (MOH, public, university • Registry PI/Co-PI Registry Coordinating Centre • Independent data monitoring Public health ophthalmologist / epidemiologist • Outcome evaluation Clinical Registry manager (Miss Tee ) Research Assistant (Akma, Nurafiqah) • Data access & Publication IT personnel • Medical writing Statistician Users – e.g. MOH, Universities Source Data Producers Heads of Department (Site Co-Investigator) Doctor in charge Site Coordinator Activities in 2008 3 Steering committee meetings , 1 publication 1 SDP management meeting-present annual reports, Method- web based registry Materials and Methods Online web application Age 18 and above years old � Centres 1. Data collection & � Type 1 and Type 2 Diabetes seen in any of the participating entry ��������������� sites. - at participating site ���������������� Old and newly diagnosed cases � internet Open for health clinics and hospital �������������������� � 2 Data analysis Center need to register with ADCM � ���������������������� Registry - real time Centre Participation Self Reply Form � � ���������������� -virtual - automated ������������ � Authorization Form Information Security Policy/User Agreement � internet � Upon receiving these documents, the centre shall be 3. Online report to users registered and each of the users of the ADCM shall be notified and data providers via their e-mail address. Users /Public 3

Progress report Uses of Registry data Conventional Expansion Cases Reported by SDP (As of 25 March 2009) Epidemiology � Public health service planning � Trending and tracking � � Outcome assessment Benchmarking � Standard of care � � Quality assurance Quality Assurance � eKPI � � Performance monitoring Research eCUSUM � � Apply in clinical practice or effect change in Presentation at meetings Healthcare Policy Data Information Wisdom Cases Reported by SDP 4

Cases Reported by SDP Cases Reported by SDP Cases Reported by SDP Cases Reported by SDP 5

Current Challenges / Ways to overcome Publication ! Invite private centre as SDP � Participation – MOH only, not � national data Data collection -Need to incorporate into � routine work flow and need to maintain Reasons to publish � Data ascertainment – not 100% alertness of staff Unethical to conduct study and do not report 1. � Data quality Data Quality (accountable to study subjects (patients) and sponsors � At system – must fill, accuracy � missing values � ( public $) check, range check ,pop up wrong values message � Sharing of information to wider medical practitioners as it is web based with real � At SDP sites : 2. � time report, data cleaning at Training /awareness-doctor � Want to progress scientific thoughts and improve health RCC is difficult 3. � Eyeball CRF before data entry - site coordinator outcomes ( saving life) Use of data on NDR web – not yet � HOD- encourage use of data at Give credibility to research team � 4. widely used and present or � CME/CNE published Sense of achievement and pride Dept audit 5. � Publication/ presentation at � Add credibility to your reputation Change of staff lead to problem in 6. � scientific meetings data collection. Seek other means – e-KPI/e-CUSUM � Improve chance of promotion 7. Funding – special registry grant – More likely to obtain research grants � 8. stop by 2011 Activities….. Publications and Presentations SC meeting: 20th February 2008 and 5th June 2008 1. Protocol development: The final version was released on 2. 30Oct 2008 (Protocol Number: NMRR ID: 08-12-1167) 1. One paper (special registry issue, MREC submission: The ADCM obtained its approval from MJM,volume 63 Supplement September 3. MREC on Dec 2008 2008) CRF development: Latest version is version 1.2 which was 4. 2. One Poster presentations at CREATE released on 1 st Apr 2008 meeting 20-23 Oct 2008 Web application for ADCM was released in May 2008 5. User training : 6. 3hb Julai 2008 (Hospital Seremban), 25th July 2008 (PKD Gombak), 19th August 2008 (KK Teluk Datok), 13th November 2008 (JKNNS K.Terengganu) 6

Future Direction Critical Success factors Recruiting more SDPs: Participation of all diabetes care providers � Promotional activities, more training and website design � � Commitment � Establish medical writing committee- publish more papers � Endurance � Cohort (systematic random sampling) – too many pts � Team work � Expansion of NDR � Appreciation Link Tele Diab. retinopathy screening data � Link with National Nephropathy Screening data � Pulling data from TPC � Link To Hypertension Registry � “Research is sacred.” On-line registration � “It is a sin if we do not use applicable research findings in improving health care practice.” � NDR widen its scope e-KPI � � Quote:Dr.Mariam Ismail � Sponsorship/Funding Discussion Conclusion ADCM provides sound evidence for Public Health Actions – 1. Service & training R egistry provides information essential for public health Users can then put effort to meet the unmet needs 2. advocacy Use of ADCM data for Healthcare Provider 3. Plan for diabetes services � e -registry- Make it easy Outcome of treatment � � Economic burden of treatment Research databases � R esearch into action - improve public diabetes care e-KPI � F uture direction –NDR to widen scope 4. Use of ADCM data by policy makers to ensure good health is Accessible � – e valuating quality, cost effectiveness and accessorily Affordable � of health care � Provided with equity 7

Acknowledgement We wish to thank CRC network director:Dr.Lim TO � ADCM advisor: � ADCM Steering committee members � Principal investigators of registries � HODs as site co-investigators � SDP Doctors in charge � SDP Site coordinators � All the staff of Hospital and health clinics, MOH � Registry Coordinating Unit :Miss Tee, Akma � Manager CRC H. Tuanku Jaafar : � 8