Variation in practice: should we be standardising diabetes care to improve quality?

Abstract

It is recognised that there are highly variable outcome and complication rates for patients with diabetes across the UK. The practice of healthcare professionals has been transformed by a growing evidence base quantifying the benefits and risks of interventions in diabetes and the development of clinical practice guidelines summarising this evidence base. Interventions which target the system of chronic disease management, along with patient mediated quality improvement strategies, are important factors significantly contributing to improvements in diabetes care and outcomes. This article explores this phenomenon and demonstrates some of the key quality improvement work that has been done in this area.

Evaluating diabetes integrated care pathways

“…Their nature means that they should be adapted over time following a review of usability for both patients and health care professionals. To understand whether integrated care has been successful, it is first necessary to define the goals of integrated care and to ensure that in‐built and ongoing evaluation provides a clear clinical dashboard which allows for the better development of diabetes services . Ultimately, it may not matter which method is being used just so long as there is some form of deeper analysis designed to deliver better diabetes care.…”

“…The central tenet of ICPs is to ensure that the most appropriate care is being provided based on the latest evidence and a consensus of best practice. The theory is that patients will automatically have the best care delivered to them by the right practitioner, in a timely manner, in order to reduce unnecessary variation …”

“…In many areas there has been a move to greater collaboration among health care professionals in order to streamline patient management and avoid duplication within the system. Several locations in the UK have developed ‘integrated care pathways’ (ICPs) in order to help standardise treatment and reduce variation in care – often a major failing when it comes to diabetes outcomes and complication rates . Differences in practice between clinicians and different organisations can lead to variation.…”

The art of diabetes

“…A previous BJDVD article from 2014 described how variation in practice leads to differing outcomes and it is important that clinical diabetes is an art strongly informed by specialist experience and science. 1,2 To keep you up to date and informed we cover pharmaceutical issues (a further look at the latest evidence surrounding pioglitazone, the experience of use of GLP-1 as a weight loss agent in obese people without diabetes -recently licensed for use in the US) and the recurring problem of sub-optimal medication compliance and optimisation due to the important phenomenon of 'clinical inertia', well recognised but under-addressed in clinical practice, by Kamlesh Khunti and colleagues.Secondly, we have three articles looking at the 'how' of care provision, from the shift of diabetes care activity in parts of South London following greater integration, to an analysis of transitional diabetes clinics in Scotland and a look at how to consider performance evaluation in the delivery of diabetes care in Kent and Surrey.Finally, we are also proud to be co-publishing two of the latest JBDS in-patient guidelines (in parallel with Diabetic Medicine) which provide a common sense, evidence-based approach to the management of HHS and the best way to approach the utilisation of intravenous insulin via a variable rate infusion, essential reading for the practicing diabetologist. …”

“…A previous BJDVD article from 2014 described how variation in practice leads to differing outcomes and it is important that clinical diabetes is an art strongly informed by specialist experience and science. 1,2 To keep you up to date and informed we cover pharmaceutical issues (a further look at the latest evidence surrounding pioglitazone, the experience of use of GLP-1 as a weight loss agent in obese people without diabetes -recently licensed for use in the US) and the recurring problem of sub-optimal medication compliance and optimisation due to the important phenomenon of 'clinical inertia', well recognised but under-addressed in clinical practice, by Kamlesh Khunti and colleagues.…”