The National DAFNE Audit

Transcription

1 The National DAFNE Audit Data Quality and Centre Performance David Hopkins King s College Hospital, London DAFNE Collaborative 26 th June 2015

2 Why audit matters Audit has been at the centre of DAFNE since the start of the national programme It has enabled DAFNE to demonstrate its benefits outside of the setting of a clinical trial in routine practice Evidence of service quality and effectiveness is vital to maintain support for the programme from commissioners

3 First National Audit patients entered DAFNE in 2005 Complete HbA1c data were available for 523 (47%) HbA1c Mean baseline 8.46 ± 0.06 % Mean follow-up 8.18 ± 0.06 % Mean Change 0.28% p= <0.001 For those with baseline A1c > 8.5% mean change -0.76% A1c of < 7.5 achieved by 35 % (22% baseline) Hopkins D Care 2012

4 First National Audit Improvement in hypoglycaemia Mean SH rate fell from 7.8 to 2.2 episodes/yr (p=<0.001) 91/ 189 (48%) reported restoration of HA at 1 year Improvement in psychological parameters HADS Anxiety HADS Depression 0.00 PAID

5 Since 2009 Simplification of data collection for most centres Core Dataset - Baseline demographics HbA1c, severe hypoglycaemia rate and awareness Data collection at baseline and 1 year only Aim to achieve optimal data quality - target 70% matched baseline and 1 year data

6 From 2012 Key performance indicators introduced on data quality and performance Data Quality: number of patients with matched baseline and follow-up data Target 70% Scoring: > 70% Green 50 to 70% Amber < 50% Red Centres scoring less than 50% not analysed further

7 KPI 1: Mean change in A1c Ideal target: mean A1c reduction of > 0.5% for all patients at centre over 3 year period Excludes patients with A1c < 7.5% at baseline Scoring: > 0.5% Green 0.25 to 0.5% Amber < 0.25% Red

8 KPI 2: % Achieving < 7.5 Ideal target: > 40 % of patients will achieve A1c 7.5% (58 mmol/mol) at 1 year post DAFNE Scoring: 40 % Green % Amber 24% Red For comparison 28% of type 1 DM in England have A1c <7.5% (National Diabetes Audit)

9 KPI 3: % Free of severe hypos Based on patients who have had severe hypos in the year preceding DAFNE only Ideal target: > 50 % of patients who have had severe hypo in year before DAFNE will be free of further severe hypos Scoring: 50 % Green % Amber 30% Red

10 DAFNE Audit Includes all DAFNE courses run between 1 st July 2012 and 31 st December 2013 Utilised all 1 year follow up data entered into the database by May 2015

11 National Dataset Complete data on 2363 patients available (44%) mean (SD) age 41±14 years mean diabetes duration 17 ± 13 years mean HbA1c 8.7 ± 1.5% 32% impaired hypo awareness 17% had severe hypo in previous year

12 Overall results (1) For all patients with matched data (n=2363) Mean HbA1c fell from 8.72 to 8.37 % (p<0.001) - Mean change -0.35%

13 Overall results (1) For all patients with matched data (n=2363) Mean HbA1c fell from 8.72 to 8.38 % (p<0.001) - Mean change -0.35% Excluding patients with baseline A1c <7.5% (n=1288) Mean fall -0.47%

14 Overall results (2) Achievement of Target HbA1c Proportion of patients with A1c < 7.5% increased from 21% to 31% Reduction in Hypoglycaemia Prevalence of Severe hypoglycaemia fell from 17 to 11 % of the cohort

15 Overall results (2) Achievement of Target HbA1c Proportion of patients with A1c < 7.5% increased from 21% to 31% Reduction in Hypoglycaemia Prevalence of Severe hypoglycaemia fell from 17 to 11 % of the cohort Of those who had suffered severe hypoglycaemia in the year before DAFNE, 81% were free of further hypos at follow-up

16 Overall results (3) Hypoglycaemia Unawareness Prevalence of impaired hypoglycaemia awareness fell from 32% to 19% Of those who reported impaired awareness at baseline 65% reported identifying hypoglycaemia at follow up

17 Results by centre 39 centres achieved >50% data completeness (6 more than in last audit) Among these 23 achieved >70%

18 Results by centre KPI heat map Centre Data Quality Change A1c <7.5 % Hypo free Centre Data Quality Change A1c <7.5 % Hypo free A T B U C V D W E X F Y G Z H AA I BB J CC K DD L EE M FF N GG O HH P JJ Q KK R LL S MM NN

19 Results by centre 39 centres achieved >50% data completeness (6 more than in last audit) Among these 23 achieved >70% 15 achieved mean A1c fall > 0.5% 8 achieved A1c < 7.5% in over 40 % of graduates 35 achieved > 50% recurrence of hypoglycaemia

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21 In conclusion DAFNE continues to deliver clinically relevant improvements in glycaemic control with reduction in hypoglycaemia More centres have achieved adequate data entry for analysis More centres have demonstrated clinically relevant improvements in outcomes compared to audit

22 The way forward Maintaining and improving data quality is vital to future of audit Next audit cycle Jan- December 2014 Last 1 year data due December 2015 Audit data extraction end of March 2016 aim to have complete data entry by then

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