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Abstract
Introduction T1DM is a common condition which continues to pose a serious health risk with devastating long-term complications. Compared to comparable countries, the UK has a higher mortality rate and significant variation in paediatric diabetes health outcomes are evident. In 2012 a Best Practice Tariff (BPT) was introduced in the UK and a National Peer Review Quality Assurance Programme was developed by the Diabetes Quality Improvement Network System (DQUiNS). Both national initiatives were developed to drive improvements in diabetes care.
Aim To explore trends in paediatric diabetes care in the North West Diabetes Network and assess impact of BPT and DQUiNS
Staffing levels before and after BPT and DQUiNs
Trends in HbA1C by PDU
HbA1C outcomes
Method Data was collected from each paediatric diabetes unit (PDU) in the region for staffing levels and extracted from the National Paediatric Diabetic Audit (NDPA) for HbA1C values for 2010–2014. We compared staffing levels before and after BPT and DQUiNS and compared values for mean HbA1C and percentage of patients with HbA1C <58 mmol/mol. Data was analysed using student T-test for continuous variables.
Results Data was received from all 28 PDUs for staffing levels before and after BPT and DQUiNs. There was a significant increase in staffing levels for admin staff (p < 0.01), consultants (p = 0.05), dieticians (p < 0.01), specialist diabetes nurses (p < 0.01) and psychologists (p < 0.01) across the network (Figure 1). Data was extracted from the NPDA for the years 2010–11, 2011–12, 2012–13 and 2013–14. Five units were excluded from HbA1C analysis due to incomplete data. There was a statistically significant improvement in percentage of patients with HbA1C <58 mmol/mol when compared both year on year and to 2010–11. The mean HbA1C was significantly improved for each year compared to 2010–11 prior to the national initiatives (Table 1 and Figure 2)
Conclusion There has been significant increases in staffing dedicated to care of children with diabetes across the North West units following DQUiNs peer review and the BPT, as well as significant improvement seen in HbA1c values. Set standards for paediatric diabetes care and appropriate staffing levels are critical to delivering good service and improving health outcomes.