A system of quality promotion and epidemiology in diabetes care IKED/IPQED/IQED

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A system of quality promotion and epidemiology in
diabetes careIKED/IPQED/IQED

• Noëmi 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
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History 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

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Diabetes centre 1
Diabetes centre 2
Diabetes centre n
Scientific Institute of Public Health
Report Pooled results - Public
Feedback Personal
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Specific 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

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Data 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)

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Data collection (2)
New sampling procedure
DC 1
DC 2
DC 3
DC 4
DC 5
DiabCare
ACCESS registration tool
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Data collection (3)

• Demographic data
• Metabolic control
• Cardiovascular risk
• Microvascular complication
• Macrovascular complications
• Screening for complications
• Hypoglycaemic treatment
• Additional treatment

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Data collection (4)

• Form2007_NL.pdf

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Population
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Feedback 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

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Feedback
Per centre (not public)
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Feedback Percentile tables
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Feedback

• Addition of radar graphs (Excel)

• Advantage
• Global evaluation of care

Centre result
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Quality 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

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Yearly eye examination (Process)
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Yearly foot examination (Process)
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HbA1c (outcome)

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Blood pressure (outcome)






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Blood lipids LDL-cholesterol (outcome)




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BMI (outcome)



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Results (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

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PROCESS

• Better organised medical record?
• Better registration?
• More examinations?
• Probably a combination

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OUTCOME

• Improvement of
• Blood lipids
• Blood pressure
• HbA1c (last 2 years)
• Deterioration BMI

IQED?
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Utility 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

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IQED-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)