Title: A system of quality promotion and epidemiology in diabetes care IKED/IPQED/IQED
1A system of quality promotion and epidemiology in
diabetes careIKED/IPQED/IQED
- Noƫmi Debacker, Anouck Billiet, Viviane Van
Casteren
Rue Juliette Wytsmanstraat 14 1050 Brussels
Belgium T 32 2 642 51 11 F 32 2 642 54 10
email info_at_iph.fgov.be http//www.iph.fgov.be
2History IQED (Quality promotion and Epidemiology
for Diabetes)
- Diabetes convention since 1988 (NISII all
Belgian diabetes centres) - Aim
- Prevent or slow down diabetes complications by
- promoting self-monitoring (financial and material
support) - offering multidisciplinary care
- participating to initiative with quality
promoting initiatives - In 2001 Initiative for Quality promotion and
Epidemiology for Diabetes
3Diabetes centre 1
Diabetes centre 2
Diabetes centre n
Scientific Institute of Public Health
Report Pooled results - Public
Feedback Personal
4Specific population characteristics
- Diabetes type 1 and type 2
- Insulin treated patients
- 2 insulin injections/day
- 18 years
-
-
- Population is NOT representative for general
Belgian diabetes population, but for adult type
1diabetes population
5Data collection IQED (1)
- Sample
- Random sample of 10 of patients, minimum 50 pts
- Cross-sectional study
- Every 18 months (at start every 12 months)
- Participation
- obliged (convention)
6Data collection (2)
New sampling procedure
DC 1
DC 2
DC 3
DC 4
DC 5
DiabCare
ACCESS registration tool
7Data collection (3)
- Demographic data
- Metabolic control
- Cardiovascular risk
- Microvascular complication
- Macrovascular complications
- Screening for complications
- Hypoglycaemic treatment
- Additional treatment
8Data collection (4)
9Population
10Feedback per type of diabetes
- 3 process indicators
- Examination of eyes, kidneys, feet
- 9 intermediate outcome indicators
- Smoking status, blood lipids, BMI, Blood
pressure, HbA1c - 7 final outcome indicators
- Stroke, MI, nephropathy, end stage renal disease,
Amputation, Foot ulcer, Diabetic eye disease,
blindness
11Feedback
Per centre (not public)
12Feedback Percentile tables
13Feedback
- Addition of radar graphs (Excel)
- Advantage
- Global evaluation of care
Centre result
14Quality improvement initiatives in diabetes
centres
- Survey in 2004
- Quality improvement initiatives in min 50 of
diabetes centres - Initiatives on quality promotion and improvement
in several overlapping domains - Need for more interaction between health care
providers in diabetes care
15Yearly eye examination (Process)
16Yearly foot examination (Process)
17HbA1c (outcome)
18Blood pressure (outcome)
19Blood lipids LDL-cholesterol (outcome)
20BMI (outcome)
21Results (1)
- Diabetes not only a problem of sugar
- Hypoglycaemic treatment HbA1c
- Screening and early treatment of
- CV-risk
- microvascular complications
- Studied population ill population
- Overt CVD 8 and 31 (DM1 and DM2)
- Microvascular complications 47 and 67 (DM1 and
DM2) - Need for multidisciplinary care
22PROCESS
- Better organised medical record?
- Better registration?
- More examinations?
- Probably a combination
23OUTCOME
- Improvement of
- Blood lipids
- Blood pressure
- HbA1c (last 2 years)
- Deterioration BMI
IQED?
24Utility of IQED
- Excellent tool to evaluate quality of care and
stimulate local quality promoting initiatives - Excellent tool to follow-up effect of changes of
organisation of care - Obligatory participation
- Workload
25IQED-FOOT
- Convention NISII 22 diabetic foot clinics
(2005) - Sample
- 52 patients meeting the convention criteria
- Intake data
- Follow-up during 12 months
- Participation
- obliged (convention)