Using Data To Improve Care Pathways – the Diabetes Dashboard Gillian Kinstrie Diabetes Improvement Lead Scottish Government
SCI-Diabetes Provides a shared electronic patient record to support treatment of people with diabetes in Scotland Web-based access to the shared record Data captured from multiple sources Real-time data-entry and update Supports multidisciplinary team-working Support for specialty groups eg DSNs, Podiatry, Dietetics Clinically relevant tools and views on data Clinically led and driven Local, regional and national reporting
SCI-Diabetes Data Flows Audit & Reporting Laboratory Results Master Patient Index Retinopathy Screening Primary Care Systems Patient Access Clinical Portal Scottish Diabetes Research Network Inpatient Linkage Inpatient Linkage Electronic Document Transfer Digital Dictation Ambulance Service Point of Care Blood Glucose Testing
SCI-Diabetes How often do you use it? What do you find helpful? Some useful features: Prescribing Timeline Foot Screening Tool Processes of Care Direct Link to new GP IT Systems will support use in primary care
SCI-Diabetes Domains of Care allow groups of patients to be allocated to different populations Patients are aligned to one or more domains eg GP Practice and clinic domain Patients will have a Main Domain of Care identified where their main care is provided Ghost domains can be set up to cater for patients who are disengaged from services
Reviewing Diabetes Care in Scotland Diabetes Improvement Plan 2014 sets out the priorities to improve the experience and clinical outcomes for patients living with diabetes across Scotland Scottish Diabetes Survey provides a view on diabetes care across the whole population of Scotland annually SCI-Diabetes provide reports on health board performance against the 12 quality improvement and outcome measures quarterly SCI-Diabetes provide reports on HbA1c levels at GP Cluster level and Diabetes Centre level quarterly
Aim of the Diabetes Dashboard Provide information on meaningful outcome measures linked to the diabetes pathways of care Easy to interpret local data available at individual practice/centre level Format that supports improvement in care in real time Performance against measures highlighted with nationally agreed Red, Amber, Green (RAG) and trend status Allow for comparisons to be made across Scotland
Diabetes Dashboard Available to all SCI-Diabetes users on their home page Data available at population level for GP practice/GP Cluster/HSCP/Diabetes Clinic/Board Drill down ability (as per SCI access) supports individual care at a practice/centre level Separate report views available (Type 1 adults, Type 2 adults, Under 18s with diabetes, Regional Comparison) Measures and RAG status specific to population/age group being viewed. Demographic information now available
Diabetes Dashboard – Information Available Run rate and trend status available RAG shows performance of your patient population and comparison against GP Cluster/HSCP/Clinic/HB Clinical agreement that RAG status was not appropriate for % people who have active foot ulcers or amputations. Trend indicated eg decreasing % is positive Patient data available to identify/contact those who could benefit from further support
Type 1/Type 2 Diabetes Pathways of Care Glycaemic Control Range of measures available eg HbA1c recorded, glycaemic control at one year diagnosis and overall glycaemic control RAG shows performance of your patient population and comparison against Cluster/HSCP/Health board Patient data available to identify/contact those who could benefit from further support
Type 1/Type 2 Diabetes Pathways of Care Cardiovascular Health Are measures of care undertaken? Blood pressure measure of <130/80 Statin use in over 50s – there is opportunity to code if statin not appropriate, contraindicated or declined to exclude these people from the measure. Frailty exclusions being considered – some measures may allow for people who need less stringent targets to be excluded without excluding them from the overall patient population.
Type 1/Type 2 Diabetes Pathways of Care Kidney Health Is regular screening taking place? Who has microalbuminuria? Are people on the right treatment i.e. ACEI or AT2RB? Measures identify people with microalbuminuria who also have - high blood pressure (SBP>130mmHg) - poor glycaemic control (HbA1c >75mmol/mol)
Type 1/Type 2 Diabetes Pathways of Care Eye Health – retinal screening in required timescale? - retinopathy and poor glycaemic control - retinopathy and high BP Foot Health - foot screening recorded? - ulcer management - amputations Lifestyle/Service Engagement - disengaged from services - weight management - self management - smoking
Type 1 Diabetes Diabetes Technologies - Flash Glucose Monitoring - Pump Therapy - Timely access to pump therapy - Pump Users with HbA1c > 75mmol/mol - Continuous Glucose Monitoring Clinical agreement that RAG status was not appropriate for % people using technologies
Diabetes Care Regional Summary Allows the user to compare the performance across a number of domains for different diabetes types/populations. At health board level it allows for data to be displayed in one view for specific groupings: • HSCPs • GP Clusters • GP Practices • Clinic Clusters • Domains of Care
Diabetes Dashboard – Future Developments Refine existing dashboards based on user feedback Inclusion of additional pathways of care eg diabetes prevention, pregnancy and inpatient care Refinement of demographic data and possibility of interrogating data using this eg SIMD Consideration of specific cases eg frailty Portable dashboard extracts for sharing with teams etc Further promotion of dashboard and evaluation to take place.
Diabetes Dashboard - Video User Guides A series of short videos are now available to support people using the dashboard by clicking on the help link.
Thank You For further information on the Diabetes Dashboard or if you have any feedback please get in touch. Gillian Kinstrie Diabetes Improvement Lead Gillian.Kinstrie@gov.scot
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