| Interventions/Initiatives | Progress Update |
10.1 Establishing a leadership hub for in-hospital service integration and reducing harm from diabetes complications
A forum is required to provide guidance on in-hospital and integration issues relating to diabetes complications from involved specialties.
Note: this may be a new forum or grafting this responsibility on an existing clinical leadership group. The integration leadership group would have a complimentary role with the DCAG role. | Work in progress. |
10.2 Developing Whitiora Diabetes Service’s role as clinical centre of excellence and supporter of system-wide capacity development
The 5 year strategic review (2005-2010) for Whitiora development suggested the following key points for the service: - increased audit cycles
- increased roll-out of primary care support/community clinics
- more active peer review
- encourage internships (Doctors/Nurses/others) between primary care and Whitiora
- greater funded training role
- more group education, and
- enhanced practice flexibility
Develop effective clinical leadership for the delivery of integrated diabetes management. This includes increased non-clinical time to develop resource and QA/research activities.
Increased resource to upskill and support primary care, secondary care services
Support research in service delivery design as it relates to the prevalence and progression of complications. | Work in Progress |
10.3 Ensuring diabetes management activities across primary and secondary care are implemented in a consistent manner
Aligning to 8.2 to ensure the management activities and framework developed in primary care is consistent with that developed for secondary; and that there is consistency in their approach and implementation. | Supporting activity:
CM Sport - Could Green Prescription be an outcome of this? Green Prescription Area Manager already has close links with Cardiac and Pulmonary Rehab Units at Middlemore.
|
10.4 Improving the integration of primary and secondary care diabetes IT systems
This area includes improved functionality for access to patient information, care co-ordination and clinical decision support. It will, to some extent, be dependent on broader issues such as development of the diabetes secondary care database at WDHB and Enigma services. | Work in Progress. |
10.5 Improving clinical data and ethnicity data collection and analysis in order to provide regular performance reports relating to indicator outcomes by ethnicity
Clinical reports will provide key feedback to LBD whether strategies are having an impact – especially in relation to reducing inequalities. Areas of data collection include (by ethnicity where possible): - glycaemic control
- management guidelines met
- % given lifestyle management advice/self management education
- rates of hospitalisation due to diabetes or complications
- rates of renal dialysis, and
- rates of premature mortality
(using Get Checked, CCM, Census and NMDS data) | Work in Progress. |
10.6 Supporting Diabetes in Pregnancy
Develop service integration for comprehensive care in diabetes in pregnancy, including; lead maternity provider, women’s health, secondary care diabetes service, cultural support, community support and primary care.
Specific components of the service review and development to include: - external review
- database development along CCM framework, and
- review of cultural support quality and availability
Data capture and audit processes developed to cover the following: - proportion of mothers with diabetes (gestational or chronic) during pregnancy
- 100% post-pregnancy GTT-performed in women with diabetes diagnosed in pregnancy
- 100% diabetic (gestational or chronic) woman referred to and followed by primary care post pregnancy
- 80% + post-pregnancy contraceptive/preconceptive counselling
- rates of neonatal hypoglycaemia (analysed by DM and GDM)
- rates of Macrosomia (BW > 4500g, or 90%) (analysed by DM and GDM)
- rates of perinatal death (analysed by DM and GDM)
- operative delivery rates (analysed by DM and GDM)
- rates of Birth Trauma (baby and mother) (analysed by DM and GDM)
- rates of congenital defect/anomaly (analysed by DM and GDM)
- rates of developing (permanent) T2DM (for GDM mothers)
Note: LBD is supporting the external review and service process and some data capture issues. However, it is seen that the actual service improvements will be supported by mainstream funding sources. | Supporting activity:
CM Sport - Could Green Prescription Community Programmes be an outcome of this?
|
10.7 Supporting Diabetic Eye Disease
Support diabetic eye disease identification and treatment into a more integrated service design by redesigning the service of retinal screening for example DNA management and follow-up.
LBD will also support improved service capacity planning, modelling disease progression to develop a retinal screening algorithm and integrating screening information back into chronic care support intelligence.
Note: retinal screening advisory groups already exist. | Work in progress. |
10.8 Supporting Diabetic Renal Disease
Supporting diabetic renal disease through: - implementation of National Guidelines (T2DM)
- predictive modelling of for service capacity planning (within LBD modelling) and dialysis review (Regional Review), and
- research in service delivery, prevalence and progression of complications.
| Work in progress. |
10.9 Diabetes and Mental Health
Supporting the links between diabetes and mental health by:
- developing a management resource for prevention, det
- ection and management of
- diabetes in people with mental health problems
- supporting the implementation of the depression module in CCM in 3 pilot PHOs
- providing psychological/mental health support for patients with diabetes, and
- developing a screening/assessment tool for depression.
| Supporting activity:
CM Sport - Green Prescription Area Manager met with Jo Chiplin to establish formal processes to better link these two services.
|
10.10 Supporting Therapeutics Supporting best practice utilisation of medication by:
- Community Pharmacy
- Advice
- Adherence
- Advocacy for best treatment
- Representation to Pharmac
- Encouraging clinical research in CMDHB population. | Work in progress. |
10.11 Texting Trial
Trial a text-based reminder system at one clinic, evaluate impact on DNAs and client perceptions of the service. | Supporting activity:
CM Sport - ARPASS has similar motivational text service planned for Green Prescription clients.
|
