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National Diabetes Audit programme NCVIN

An overview of the National Diabetes Audit
by

Cher Cartwright

on 7 April 2016

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Transcript of National Diabetes Audit programme NCVIN

The National Clinical
Audit Programme

Our practice participates in the National Diabetes Audit please ask a member of staff at reception for more information
What does the Audit Measure?
The National Pregnancy in Diabetes (NPID) Audit measures the quality of pre-gestational diabetes care against NICE guideline based criteria and the outcomes of pre-gestational diabetic pregnancy.

The audit looks at three key questions
:
Were women adequately prepared for pregnancy?
Were adverse maternal outcomes minimised?
Were adverse fetal/infant outcomes minimised?
The NDFA looks at:


Structures:
are the nationally recommended care structures in place for the management of diabetic foot disease?

Processes:
does the treatment of active diabetic foot disease comply with nationally recommended guidance?

Outcomes:
are the outcomes of diabetic foot disease optimised?


Over 5000 records submitted.
The first NDFA Annual Report is
published on
31st March 2016

The National Clinical Audit Programme is managed by the Healthcare Quality Improvement Partnership and funded by NHS England.

The individual audits measure healthcare practice on specific conditions against accepted standards, providing patients, the public and clinicians with a clear picture of the standards of healthcare being achieved. They also give healthcare providers benchmarked reports on their performance, with the aim of improving the care provided.
The National Diabetes Audit Programme is managed by the Health and Social Care Information Centre, in collaboration with Diabetes UK and supported by Public Health England.

The Programme is comprised of a number of audits; Core, Inpatient (NaDIA), Pregnancy (NPID) and Footcare (NDFA). Data is collected from England, Wales and Isle of Man (NPID only).

The National Diabetes Audit - Core
The National Diabetes Audit measures the effectiveness of diabetes healthcare against NICE Clinical Guidelines and Quality Standards, in England and Wales. It brings together data from both primary care and specialist services to help drive changes and improvements in the quality of services and health outcomes for people with diabetes.

Audit Questions
• Is everyone with diabetes diagnosed and recorded on a register?
• What percentage of people received the NICE key processes of diabetes care?
• What percentage of people achieved NICE defined treatment targets for glucose control, blood pressure and blood cholesterol?
• What are the rates of acute and long term complications (disease outcomes)?


How do I take part in the NDA - Core?
Check out the NDA website
http://www.hscic.gov.uk/nda
Materials to support patient involvement
Encouraging trends of improvement in blood pressure control for people with Type 1 and Type 2 diabetes and glucose control for Type 1 diabetes.
People under 65 are less likely to achieve their treatment targets.
Diabetes data collected for 1,894,887 people
Key Findings
Data available at CCG/LHB level, for the first time data available at GP practice level.
Report 2: Complications and Mortality -
Results for 2013-2014 available Autumn 2016
Recommendations for Care Providers (General Practices and Specialist Services)
•Sustain focus on improving glucose and blood pressure control.
•Investigate reasons for underachievement in people of working age and younger. Consider new systems that could increase engagement.

Recommendations for Clinical Commissioning Groups (CCGs) and Local Health Boards (LHBs)
•Support all diabetes care providers to participate in the audit.
•Investigate reasons for underachievement. Provide forums for shared learning from better performers.

National Pregnancy in Diabetes Audit
How do I take part?

Check out the website at www.hscic.gov.uk/npid
Information for people with diabetes
leaflets
consent
forms
easy read reports
NPID audit Annual Reports
Why should you take part in National Clinical Audits?
Key facts from the 2014 Annual Report
Less than half of women in the audit were taking folic acid in any dose prior to pregnancy (41.9 per cent)
6.2 per cent of women were taking potentially harmful medications (statins, ACE inhibitors and ARBs) at the time of conception
Only 15.4 per cent of women with Type 1 diabetes and 35.8 per cent of women with Type 2 diabetes had a first trimester HbA1c measurement below 48 mmol/mol
6.3 per cent of women had one or more hospital stays involving hypoglycaemia during pregnancy
There was a high rate of adverse outcomes, Anomaly (44.2/1000), stillbirth (12.8/1000) and neonatal death (7.6/1000)
Adverse outcomes were related to 1st trimester HbA1c
How do we compare to others?
Data collected in a similar way
Measure against national standards (NICE)
National and local level reports allow for benchmarking
Data used for local quality improvement
Learn from good and poor performers
Secondary uses of data, data used in other sources
Serum Cholesterol
(blood test for cardiovascular risk)

Foot Risk Surveillance
(foot examination for foot ulcer risk)

Body Mass Index
(measurement for cardiovascular risk)

HbA1c
(blood test for glucose control)

Blood Pressure
(measurement for cardiovascular risk)

Serum Creatinine
(blood test for kidney function)

Smoking History
(question for cardiovascular risk)

Urine Albumin/Creatinine Ratio
(urine test for kidney function)

Treatment Targets

Target blood pressure reduces the risk of vascular complications and reduces the progression of eye disease and kidney failure.

Target HbA1c reduces the risk of all diabetic complications
Target cholesterol reduces the risk of vascular complications
Identify where you are performing well and areas for improvement
NaDIA is a snapshot audit of the inpatient care in England and Wales
care processes
What can we learn from others?
Benchmark yourself against others
Secondary use of the data
Atlas of Variation
The NaDIA looks at the following areas:

whether diabetes management minimises the risk of avoidable complications

harm resulting from the inpatient stay

patient experience of the inpatient stay

Audit took place 21-25th September 2015.
211 organisations in England and Wales took part, which resulted in bedside data from 15,190 inpatients with diabetes.

The NaDIA hospital level reports were published on 8 March 2016 and the national report will be available on 23 June 2016.
How can your hospital participate?
Visit our website at www.hscic.gov.uk/nadia
Sample documents of the previous audit can be used locally
Information for people with diabetes
Annual Reports
Diabetes Outcomes
versus Expenditure Tool
Contacts for the the Audits
National Diabetes Audit:
diabetes@hscic.gov.uk
National Pregnancy in Diabetes Audit
npid@hscic.gov.uk
National Diabetes Inpatient Audit:
nadia@hscic.gov.uk
National Diabetes Foot Care Audit:
ndfa@hscic.gov.uk
Audit Manager:
Cher Cartwright
Audit Manager:
Tom Latham
Telephone:
0300 303 5678

Telephone:
0300 303 5678

http://www.hscic.gov.uk/pubs/ndauditcorerep1415
57% of GP practices participated in the Audit
Links NDA Core data with Hospital Episode Statistics and ONS Mortality data

Myocardial infarction, heart failure, stroke, angina, amputation rates, renal replacement therapy, chronic kidney disease, diabetic ketoacidosis, mortality rate, cause of death
If avoid complications survival is good, greatly reduced in those that do
People with diabetes greater risk (126%) of being admitted to hospital for heart failure than those without diabetes (higher risk in Type 1 people)
People with diabetes more likely to die (34%) than their peers in the general population
14,240 people from the 2009-2010 audit between 2010 and 2013 were admitted to hospital for DKA (should be preventable)

Recommendations
Healthcare cost of diabetes is driven by cost of complications. Review how CCG compares with others. Look at where improvements can be made to reduce complication risk, particular heart failure.
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