Diabetes management
AD-0728

Simple interventions for maximum impact in primary care
L. Edwards1
1Diabetes UK, Service Redesign And Improvement Consultancy, London, United Kingdom 

Background
There is significant local variation in diabetes health outcomes across England, and within local CCG (Clinical Commissioning Group) areas. The Diabetes UK Consultancy supports local areas to create local improvement programmes to reduce variation and improve outcomes.
Aim
To demonstrate how using real time local data and modelling local excellence can drive improvements in key diabetes health outcomes.
Method
A Diabetes Primary Care Profiling Tool (DPCPT) has been developed that creates an accurate snapshot of a local diabetes population. Part of the tool’s focus is identifying those patients who met, and those who did not, all 3 key diabetes control targets (HBa1c, Blood Pressure and Cholesterol).The tool also highlights people who miss any of the checks in the past 12 months. It also identifies people at risk of developing diabetes.
Our clients all now have accurate baseline data, with one CCG embarking upon a pragmatic programme of diabetes improvement (Best Practice Modelling). This programme replicates local excellence in diabetes care and achievement of key targets. The best performing practices are identified using the DPCPT followed by a structured interview process that elicits the specific subtle nuances that create better diabetes care. The learning is then disseminated across other practices.
Results
Table 1
Highlights of improvements across a CCG using DPCPT. 
	Year 1 	Year 2 	Improvement 
Receiving at least 1 key check 
Across whole CCG 	95.65% 	15,490 	95.90% 	16,287 	797 more people 
Practice with greatest improvement 	88.97% 	242 	93.45% 	271 	29 more people 
HbA1C Achievement 
Across whole CCG 	39.40% 	6380 	40.71% 	6914 	534 more people 
Practice with greatest improvement 	37.94% 	140 	45.60% 	176 	36 more people 
Good Control (all 3 Targets met) 
Across whole CCG 	21.45% 	3437 	22.18% 	3767 	330 more people 
Practice with greatest improvement 	17.90% 	63 	25.20% 	96 	33 more people 
This highlights that practices who focus on improving the care they provide can produce significantly better results than those who don’t. Improvements include:
1) Receiving at least 1 check increased across the whole CCG by almost 800 people

2) HbA1c achievement increased by 534 more people
3) Good Control (3 NICE targets) increased by 330 people
The CCG has a practice improvement officer who visits each practice annually. The DPCPT was used to inform these discussions and will have influenced these outcomes.
Following these improvements the CCG are keen to share the learning from the best performing practices and have now commissioned a programme of Best Practice Modelling. Six months after this has been completed the DPCPT will be rerun across the CCG to measure further improvement.
Table 2: Highlights of Improvement in one London practice that adopted recommendations from Best Practice Modelling.
	Baseline 	DPCPT results after year 1 	Improvements (number of people) 
Diabetes Population 	5.10% 	788 	5.04% 	796 	8 more 
BP checked in last 12 months 	89% 	698 	97% 	769 	71 more 
Cholesterol Checked in last 12 months 	84% 	664 	94% 	748 	84 more 
HbA1c Checked in last 12 months 	86% 	678 	95% 	756 	78 more 
Missing all checks in last 12 months 	6.34% 	50 	2.51% 	20 	30 less 
BP Target Achievement 	72.59% 	572 	87.94% 	700 	128 more 
Cholesterol Target Achievement 	68.78% 	542 	76.01% 	605 	63 more 
HbA1C Target Achievement 	47.08% 	371 	53.89% 	429 	58 more 
All 3 target Achievement 	32.61% 	257 	39.70% 	316 	59 more 
This shows that the DPCPT and Best Practice Modelling processes has enabled this practice to
1.	Identify more people with Diabetes 
2.	Significantly increase the uptake of key checks 
3.	Significantly increase the numbers of people achieving each of the three key targets 
When working with primary care we recommend that practices make 2 key changes. This enables the tasks to be ‘doable’ and achievable. This practice made the following changes:
•	A new intervention to improve uptake of annual HBA1C screening.
•	New follow up procedures for people who do not attend appointments.
Discussion
Primary care is where most people receive most of their care and the place where simple interventions can have a massive impact on people’s lives. It is also where ‘key diabetes moments’ occur, including point of diagnosis, discussions about achieving treatment targets, and avoiding serious diabetes related complications. 
The results within the first year of these simple improvement programmes indicates that a clear, sustainable approach delivers significant improvements in health outcomes.