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G474 Variation in patient experience across paediatric diabetes units (pdus) in england and wales and association with glycaemic outcomes
  1. D Charalampopoulos1,
  2. R Amin1,
  3. R Viner1,
  4. J Warner2,
  5. J Edge3,
  6. F Campbell4,
  7. T Stephenson1
  1. 1Institute of Child Health, University College London, London, UK
  2. 2Department of Paediatric Endocrinology, University Hospital of Wales, Cardiff, UK
  3. 3Department of Paediatric Endocrinology and Diabetes, Oxford Children’s Hospital, Oxford, UK
  4. 4Leeds Children’s Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK

Abstract

Patient Reported Experience Measures (PREMs) are increasingly recognised as an important indicator of healthcare quality. We investigated variation in patient experience across Paediatric Diabetes Units (PDUs) in England and Wales and explored links between PREMs and glycaemic outcomes.

Methods An aggregate analysis of linked PREM and glycaemic data for each PDU collected as part of the 2012–2013 National Paediatric Diabetes Audit (NPDA) was conducted. The percentage of patients/carers who reported a high level of satisfaction (scores 9 or 10/10) in the friends and family recommendation test was used as a quality indicator of diabetes care. A funnel plot of the above indicator was constructed and the 95% and 99.8% control limits around the mean were used to distinguish between common–cause (units lying within the control limits) and special-cause variation (units lying outside the control limits). A linear regression model was also fitted for the relationship between mean satisfaction score and mean HbA1c at PDU level.

Results Percentage of patients who reported high satisfaction showed a 2.9-fold variation (range 35% to 100%) across PDUs with 60/170 (35.3%) and 33/170 (19.4%) units falling outside the 95% and the 99.8% control limits respectively. Of the 170 PDUs, 21 (12.4%) lay below the lower 99.8% control limit (Figure 1). Linear regression showed a significant negative association between mean HbA1c (mmol/mol) and average satisfaction score for each PDU (regression coefficient= –2.9, 95% CI: –4.7 to –1.1, p = 0.002) (Figure 2).

Abstract G474(P) Figure 1

Funnel plot of the% of children and young people/carers reporting high satisfaction (scores 9–10/10) in the friends and family recommendation test across 170 PDUs in England and Wales,2012–201

Abstract G474(P) Figure 2

Scatterplot with regression line for the association between mean satisfaction and mean HbA1c at PDU level (2012–2013 NPDA data for England and Wales)

Conclusion Patient satisfaction varied considerably across PDUs with one in three units exhibiting more variation than expected by chance. At aggregate level, clinics with higher mean satisfaction had better average glycaemic control. Individual-level analyses allowing for nested sources of variation (patients within clinics) are needed to confirm these clinic-level analyses. Further work should also adjust for “case-mix variation” i.e. correct for differences in the sociodemographic and disease profile of children served by different clinics.

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