ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 66 OC3.1 | DOI: 10.1530/endoabs.66.OC3.1

Using quality improvement methods to enhance HbA1c outcomes for newly diagnosed children and young people with diabetes

Frances Hanson, Tracey Stephenson, Jane Exall, Carol Bacon, Carole Gelder, Sarah Buggins & Callum Rodgers

Leeds Children’s Hospital, Leeds, UK

Introduction: There is increasing emphasis on stringent glycaemic control (HbA1c <48 mmol/mol) within the first year of diagnosis for all types of diabetes, to preserve metabolic memory and reduce future risk of sub-optimal diabetes outcomes. Retrospective data collected on two previous annual cohorts of children and young people (CYP) with diabetes revealed only 9% achieved the HbA1c < 48 mmol/mol target at 12 months post diagnosis despite initial HbA1c improvement until 6 months.

Aim: To achieve HbA1c<48 mmol/mol in 25% of patients and HbA1c <58 mmol/mol in 75% of patients at 12 months post diagnosis.

Method: A small staff representation from the wider multi-disciplinary team employed Quality Improvement processes focusing on improving HbA1c and self-management skills during the first year of diabetes care. Consensus from this group enabled intervention adoption by the wider CYP Diabetes Team. Interventions included a focused timeline from diagnosis, more frequent team contacts and clinic appointments, psychology led age specific new patient groups, earlier home downloading and data interpretation support and use of a digital education resource (DigiBete). Real time data collection highlighted those patients not achieving HbA1c targets and facilitated more intensive team support.

Results: HbA1c data from 34 new patients, aged 1–18 years, was compared with two previous patient cohorts (2015/2016 and 2016/2017). Significant improvement was demonstrated across all data collection points. At 12 months post diagnosis, the percentage of patients achieving HbA1c < 48 mmol/mol increased from 9% to 31% whereas those achieving HbA1c < 58 mmol/mol increased from 46% to 69%.

Conclusion: Project success has resulted from a dedicated multi-disciplinary team with frequent and focused time-limited QI meetings, adoption of a ‘fail fast’ approach and regular review of real time data. The appointment of a QI champion was essential. More intensive early family support and increasing consistency using the timeline have contributed to improved outcomes in the new patient cohort. This is now being embedded as ‘routine practice’ within the wider team. Resources to support and empower families to interpret their own data and confidently make insulin adjustments between clinic visits will continue to be developed.

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