GUIDELINES, AUDIT AND ORGANISATION OF CARE

1. GUIDELINES, AUDIT AND ORGANISATION OF CARE Dr John Morrissey MA MRCP Clinical Lead George Eliot Diabetes Care Team

2. Clinical Practice Guideline “ A systematically developed statement designed to assist clinician and patient decisions about appropriate health care for specific clinical circumstances. ” Sackett DL et al (2000) Evidence Based Medicine

3. Components of a Guideline • Evidence component • Instructional component Sackett DL et al (2000) Evidence Based Medicine

4. Care Pathway “ An integrated care pathway determines locally agreed, multidisciplinary practice, based on guidelines and evidence where available, for a specific patient / user group. It forms all or part of the clinical record, documents the care given and facilitates the evaluation of outcomes for continuous quality improvement . ” De Luk K (1998)

5. Care Pathway “ … the whole structure of care that needs to be put in place by healthcare managers and organising bodies to ensure that the patient’s journey is as effective and person-centred as possible . ” Diabetes UK (2004) Delivering Better Diabetes Care 3 : Structured Care

6. Care Pathway in Diabetes

8. Care Pathway for Cardiovascular Disease

9. PRIMARY CARE DIABETES AUDIT 2004 - 2005 Dr John Morrissey MA MRCP Clinical Lead George Eliot Diabetes Care Team

11. Diabetes in Nuneaton & North Warwickshire • Total population = 180,000. • 6000 with diabetes* : 3.3 % prevalence • 800 with type 1 • 5200 with type 2 • 1400 attend GEH clinic : “2000” in 2004 • 500 with type 1 • 900 with type 2 * 2005 retinopathy screening target

12. GMS2 Diabetes Quality & Outcome Framework • 18 quality indicators • 14 process • 4 outcome • Points per indicator : 3 – 17 • For example : • If > 90% had eye examination in last 15 months = 5 points • If > 50% with HbA1c < 7.4 = 16 points • Total points achievable = 99

20. Diabetes Chronic Disease Management ……………………. Palliative …………………… Renal replacement ………………….. Amputation …………………. Rehabilitation ………………… PCI / CABG Tertiary ……………….. Advanced eye surgery ……………… DKA …………….. Secondary care Infections …………..... …………... CVD CVD Risk …………... Primary Insulin start ………….. Screening eyes Interface …………. Experts Screening feet …………. Secondary Screening renal …….…... Complex cases ………... Diagnosis ………. General treatment Primary ……… Review ….… Screening …… Healthy eating Public Health & Prevention …… Exercise …… Weight care Single Team