A gradual reduction of national median HbA1c levels in England and Wales since 2009 can be attributed to development of a network approach to care supported by the National Paediatric Diabetes Audit (NPDA) and a Best Practice Tariff in England, introduced by the Department of Health in 2012. This delivery of a co-ordinated national programme of support for 173 multi-disciplinary teams distributed across over 140 NHS Trusts and Health Boards, has been at risk of plateauing in recent years. To maintain the momentum towards achieving improvements comparable to international results, a new way to engage teams and their host organisations was required.
Evidence from Sweden, which has reduced its HbA1c levels markedly in recent years, demonstrates the impact that a programme of Quality Improvement can have on stimulating units to improve outcomes. In 2017, a Quality Improvement Collaborative model was developed in partnership with colleagues from Linkoping University Hospital in Sweden. 16 teams applied to participate in a pilot Quality Improvement Collaborative with ten ultimately chosen to begin a 9-month programme of training from November 2017. All members of the 10 successful MDTs were expected to attend the programme of training together; comprising 2 residential weekends and 2 one-day events, lunchtime webinars for team champions and access to a secure online platform to share resources and ideas between events.
The ethos of the programme was to provide teams with the QI methodology to identify, design and analyse their own interventions specific to their teams and to the needs of the children and young people and their families that they care for. Each of the 10 teams highlighted very individual areas of focus ranging from the newly-diagnosed patient pathway, self-management resources in the community, Diasend download education and access, support for patients on pumps and the outpatient clinic experience.
Initial run-chart data has shown up to 10% reduction in mean and median HbA1c post-pilot. As part of the new National Children and Young People's Diabetes Quality Programme that includes annual self-assessment and a peer review process, the pilot Quality Improvement Collaborative model has now been adapted for rollout to over 100 units across England and Wales. It is our hope that this will be the stimulus to drive sustainable development of paediatric diabetes services in England and Wales and help bring transformative improvements to the care of children and young people with diabetes and their families in the future.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology