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Pathways the Diabetes Dashboard Gillian Kinstrie Diabetes - - PowerPoint PPT Presentation
Pathways the Diabetes Dashboard Gillian Kinstrie Diabetes - - PowerPoint PPT Presentation
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
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SCI-Diabetes Data Flows
Retinopathy Screening Master Patient Index Laboratory Results Primary Care Systems Inpatient Linkage Ambulance Service Point of Care Blood Glucose Testing Audit & Reporting Patient Access Scottish Diabetes Research Network Digital Dictation Electronic Document Transfer Clinical Portal Inpatient Linkage
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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
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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
SCI-Diabetes
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Reviewing Diabetes Care in Scotland
Diabetes Improvement Plan 2014 sets out the
priorities to improve the experience and clinical
- utcomes 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
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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
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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
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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
- r amputations. Trend indicated eg decreasing % is
positive
Patient data available to identify/contact those who
could benefit from further support
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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
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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
- verall patient population.
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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)
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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
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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
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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
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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.
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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.
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