Variation in practice: should we be standardising diabetes care to improve quality?

Authors

  • Paul S Grant Consultant Physician Diabetes & Endocrinology, Diabetes & Endocrine Day Centre, St. Thomas’ Hospital, Westminster Bridge Road, London, UK

DOI:

https://doi.org/10.15277/bjdvd.2014.006

Abstract

It is recognised that there are highly variable outcome and complication rates for patients with diabetes across the UK. The practice of healthcare professionals has been transformed by a growing evidence base quantifying the benefits and risks of interventions in diabetes and the development of clinical practice guidelines summarising this evidence base. Interventions which target the system of chronic disease management, along with patient mediated quality improvement strategies, are important factors significantly contributing to improvements in diabetes care and outcomes. This article explores this phenomenon and demonstrates some of the key quality improvement work that has been done in this area.

References

NHS Atlas of Variation in Healthcare for People with Diabetes. http://www.rightcare.nhs.uk/index.php/atlas/diabetes/ (Accessed March 2013).

Mathews SC, Pronovost PJ. Physician autonomy and informed decision making: finding the balance for patient safety and quality. JAMA 2008;300:2913-5. http://dx.doi.org/10.1001/jama.2008.846

Tomson, CRV. Van der Veer SN. Learning from practice variation to improve the quality of care. Clin Med 2012;13:19-23. http://dx.doi.org/10.7861/clinmedicine.13-1-19

Tricco AC, Ivers NM, Grimshaw JM, et al. Effectiveness of quality improvement strategies on the management of diabetes: a systematic review and meta-analysis. Lancet 2012;379:2252-61. http://dx.doi.org/10.1016/S0140-6736(12)60480-2

O'Connor P. Quality improvement collaboratives in the age of health informatics—new wine in new wineskins. BMJ Qual Saf 2012;21:891-3. http://dx.doi.org/10.1136/bmjqs-2012-001265

NICE Quality Standard for Diabetes in Adults QS6 March 2011. http://guidance.nice.org.uk/QS6 (accessed March 2013).

Grant P. The New NICE Quality Standards for Diabetes 2011: a critical analysis. Pract Diab Int 2011;28:208. http://dx.doi.org/10.1002/pdi.1594

Hazlehurst JM, Armstrong MJ, Sherlock M, et al. A comparative quality assessment of evidence-based clinical guidelines in endocrinology. Clin Endocrinol 2013;78:183-90. http://dx.doi.org/10.1111/j.1365-2265.2012.04441.x

Atkinson S, Ingham J, Went S, et al. Defining quality and quality improvement. Clin Med 2010;10:537-9. http://dx.doi.org/10.7861/clinmedicine.10-6-537

Echouffo-Tcheugui JB, Dagogo-Jack S. Preventing diabetes mellitus in developing countries. Nat Rev Endocrinol 2012;8:557-62. http://dx.doi.org/10.1038/nrendo.2012.46

Beard EL Jr, Sharkey K. Innovation amidst radical cost containment in health care. Nurs Adm Q 2013;37:116-21. http://dx.doi.org/10.1097/NAQ.0b013e3182869e67

Bombardier C, Mian S. Quality indicators in rheumatoid arthritis care: using measurement to promote quality improvement. Ann Rheum Dis 2013;72:Suppl 2:ii128-ii131. http://dx.doi.org/10.1136/annrheumdis-2012-202259

Hysong SJ, Khan MM, Petersen LA. Passive monitoring versus active assessment of clinical performance: impact on measured quality of care. Med Care 2011;49:883-90. http://dx.doi.org/10.1097/MLR. 0b013e318222a36c

National Diabetes Audit. Health & Social Care Information Centre, http://www.hscic.gov.uk/nda. (Accessed May 2013).

Quality and Outcomes Framework. Online GP practice results database, http://www.qof.ic.nhs.uk/(Accessed June 2013).

Patient Reported Outcome Measures. Health & Social Care Information Centre, http://www.hscic.gov.uk/proms (Accessed June 2013).

UK Renal Registry. The Renal Association, http://www.renalreg.com/Accessed June 2013.

Co-creating health. The Health Foundation, http://www.health.org.uk/areas-ofwork/programmes/co-creating-health/impact/(Accessed June 2013).

Herring R, Caldwell G, Jackson S. Implementation of a considerative checklist to improve productivity and team working on medical wards rounds. Clin Governance 2011;16:129-36. http://dx.doi.org/10.1108/14777271111124482

London Diabetes Footcare Network. NHS Diabetes, http://www.diabetes.nhs.uk/networks/footcare_network/pan_london_diabetic_footcare_network_meeting_sept_2012/(Accessed June 2013).

Safer Patient Initiative. The Health Foundation, http://www. health.org.uk/areas-ofwork/programmes/safer-patients-initiative/(Accessed June 2013).

Grant P, Mustafa O, Malik R. Setting up an insulin safety group – A practical approach. Practical Diabetes 2012;29:160-2. http://dx.doi.org/10.1002/pdi.1682

Beitsch LM, Carretta H, McKeever J, et al. The quantitative story behind the quality improvement storyboards: a synthesis of quality improvement projects conducted by the multi-state learning collaborative. J Public Health Manag Pract 2013;19:330-40. http://dx.doi.org/10.1097/PHH.0b013e3182629054

Surviving Sepsis Campaign Care Bundles, http://www. survivingsepsis.org/Bundles/Pages/default.aspx (Accessed June 2013).

Mate KS, Ngidi WH, Reddy J, et al. A case report of evaluating a large-scale health systems improvement project in an uncontrolled setting: a quality improvement initiative in KwaZulu-Natal, South Africa. BMJ Qual Saf 2013;22(11):891-8.

Williamson M, Cardona-Morrell M, Elliott JD et al. Prescribing Data in General Practice Demonstration (PDGPD) project—a cluster randomised controlled trial of a quality improvement intervention to achieve better prescribing for chronic heart failure and hypertension. BMC Health Serv Res 2012;12:273. http://dx.doi.org/10.1186/1472-6963-12-273.

Brown CA, Lilford RJ. The stepped wedge trial design: a systematic review. BMC Med Res Methodol 2006,6:54. http://dx.doi.org/10.1186/1471-2288-6-54

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Published

2014-04-01

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