ESPE2022 Poster Category 1 Diabetes and Insulin (86 abstracts)
A Continuous Quality Improvement Effort Implemented by The Italian Network of Pediatric Diabetes Clinics
Stefano Zucchini 1 , Riccardo Bonfanti 2 , Fortunato Lombardo 3 , Antonio Nicolucci 4 , Ivana Rabbone 5 , Riccardo Schiaffini 6 , Giacomo Vespasiani 7 , Maria Chiara Rossi 4 & on behalf of ISPEDcard members 8
1Pediatric Endocrine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; 2Pediatric Diabetology Unit, Diabetes Research Institute, Istituto Scientifico San Raffaele, Milan, Italy; 3Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy; 4CORESEARCH - Center for Outcomes Research and Clinical Epidemiology srl, Pescara, Italy; 5Department of Health and Science, University of Piemonte Orientale, Novara, Italy; 6Diabetes Unit, Pediatric Hospital Bambino Gesù, Rome, Italy; 7METEDA Srl, Rome, Italy; 8ISPED, Turin, Italy
Pediatric diabetes management extends beyond glycemic control. A gap between guidelines and actual care exists. Standardized performance measures represent a key strategy to improve quality of care. In Italy, a non-profit initiative of continuous monitoring and quality improvement of diabetes care is in place since 2018, promoted by the ISPEDCARD association and involving the Society for Pediatric Endocrinology and diabetology (ISPED). Aim of the present work is to report the state-of-art of the initiative.
Materials and methods: A predefined set of descriptive, process and outcome indicators was identified to assess strengths and weaknesses of the current care. All participating centres share the same electronic medical records system (EMR) and a software for the standardized data extraction. Participation is voluntary, anonymous, and free.
Results: Data on 3,638 patients with type 1 diabetes seen during 2019 were obtained from 18 pediatric diabetes clinics (representing 1/3 of all Italian clinics). Table shows ISPEDCARD indicators by age class.
| Age classes (years) | |||||
| Descriptive | 0-6 | 6.1-12 | 12,1-18 | ||
| N (%) | 311 (8.5) | 1354 (37.2) | 1973 | ||
| Males (%) | 54.3 | 54.4 | 53.1 | ||
| Mean visits/yr | 3.4±1.7 | 3.1±1.4 | 2.8±1.2 | ||
| First accessed (%) | 10.9 | 6.4 | 1.9 | ||
| New diagnosis (%) | 26.7 | 12.7 | 6.0 | ||
| Insulin Regimen (%) | CSII | 48.6 | 39.2 | 34.8 | |
| MDI | 48.9 | 57.5 | 61.7 | ||
| Other | 2.5 | 3.2 | 3.6 | ||
| Process | Patients monitored during the year for: HbA1c | 1 test | 13.8 | 10 | 11 |
| >= 2 tests | 80.7 | 87.2 | 87.1 | ||
| Obesity (%) | BMI | 75.2 | 65.4 | 64.9 | |
| BMI and waist c | 21.2 | 32.8 | 33.0 | ||
| Lipid profile (%) | 47.3 | 46.2 | 44.6 | ||
| Blood Pressure (%) | 49.5 | 66.8 | 74.5 | ||
| Albuminuria (%) | 21.9 | 37.0 | 40.8 | ||
| Eye examination (>=11yr) | - | 8.3 | 13.4 | ||
| Outcome | HbA1c % (mean±SD) | 7.7±1.4 | 7.5±1.2 | 7.7±1.4 | |
| LDL-cholesterol > 100 mg/dl (%) | 27.2 | 28.3 | 27.4 | ||
| Blood pressure > 140/70 mmHg (%) | 4.5 | 9.0 | 23.8 | ||
| BMI/SDS > 1.5 (%) | 22.0 | 26.9 | 21.8 | ||
Conclusions: Data show that process indicators regarding HbA1c and obesity indices are satisfactory, while other process indicators require additional attention in the execution and/or in data recording on EMRs. Outcome indicators show satisfactory mean HbA1c levels and need of reducing BMI, LDL-cholesterol, and, in age 12-18 years, blood pressure. Direct measurement, feedback, and regular reporting and discussion of indicators are expected to further enhance the effectiveness of care in the years to come.
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