Standardized Documentation in Pediatric Diabetology

Abstract

An essential feature of standardization of measurement is that it allows for detection and learning from variation present in a health care system. Standardized documentation has the advantage to improve patient care due to better exchange of information among members of a medical team and, in addition allows both, internal and external quality control. This article addresses the latter aspect, based on 20 years of experience from the Austrian/German quality initiative DPV.The aspect of quality of medical care has somewhat different challenges in chronic diseases, as opposed to acute medical disorders. For acute problems, QC (quality control) will focus on the question whether the problem has been solved to the complete satisfaction of patients, whether side effects did occur, for example infection or postsurgery bleeding following a surgical procedure, and what the costs arise for the patient (length of hospitalization, pain, number of control exams, direct financial burden for the patient) as well as for society (time not at work) or reimbursement companies. These aspects are often quite easy to cover with a limited number of items.1 In contrast, the nature of chronic disorders provides specific challenges that have to be addressed when standardized documentation for chronic disorders like diabetes are implemented. 3 The St. Vincent declaration identified 5 major goals to be achieved during the next 5 years (Table 1). 4 The use of standardized documentation and information technology together with the application of quality control techniques developed previously in automobile manufacturing especially in Japan were listed among other tools to improve diabetes care. A specific data set and a documentation tool were developed in Europe (DiabCare or QUALIDIAB), with modifications for children. The St. Vincent initiative has had long-lasting effects on the public health aspects of diabetology 5 and has been adopted to other regions of the world like the "Declaration of the Americas" 6

Lower HbA1c in patients with type 1 diabetes and celiac disease who reached celiac‐specific antibody‐negativity—A multicenter DPV analysis

“…Inconsistent data are reported back, and centers are asked for corrections. All plausible data are aggregated into a cumulative database, the DPV registry . The DPV initiative has been approved by the ethics committee of the University of Ulm and the local review boards of each participating center approved the anonymized data collection.…”

Adolescent type 2 diabetes: Comparing the Pediatric Diabetes Consortium and Germany/Austria/Luxemburg Pediatric Diabetes Prospective registries

“…Twice yearly, anonymized data are exported and transmitted for central analyses. Missing and inconsistent data are reported back to the centers for correction . Data collection is approved by the ethics committee at Ulm University and by the institutional review boards (IRBs) at the participating centers (see Supporting Information).…”

Type 1 diabetes during adolescence: International comparison between Germany, Austria, and Sweden

“…The registries in Austria, Germany, and Sweden have national quality registry status. In Germany, the ethics committee at Ulm University, Germany has positively voted on joint analysis of anonymized data, and the institutional review board (IRB) at each participating center consented with data collection . Patients in Sweden are informed about the registry before agreeing or denying being included.…”