Establishment of an ADIPS Diabetes in Pregnancy Audit Program
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1 Establishment of an ADIPS Diabetes in Pregnancy Audit Program David Simmons FRACP FRCP MD on behalf of the ADIPS Australasian Diabetes in Pregnancy Clinical Audit Working Group
2 Diabetes in Pregnancy Clinical Audit Programme: Goal To facilitate normal pregnancy outcomes among women with diabetes in pregnancy
3 Diabetes in Pregnancy Clinical Audit Programme: Objectives To provide feedback to clinicians describing clinical care in their centre To provide anonymous benchmarking of clinical care between centres To identify local service needs To justify application for funding to address local need identified by the audit programme To help validate and provide evidence for the existing ADIPS guidelines To assist with providing answers to patients queries
4 Australasian Diabetes in Pregnancy Society (ADIPS) National Audit Pilot sites Sydney (2) inc Benchmarking Centre Melbourne Darwin =Urban Indigenous site Brisbane Perth Shepparton Torres St =Rural site =Rural Indigenous site Hamilton =NZ site ANZJOG 2007: 47:
5 Is it do-able? National Pregnancy in Diabetes Audit Report, 2016 England, Wales and the Isle of Man 12th October 2017
6 Introduction NPID addresses three high level audit questions: Were women with diabetes adequately prepared for pregnancy? Were appropriate steps taken during pregnancy to minimise adverse outcomes to the mother? Were adverse neonatal outcomes minimised? The 2016 audit report: Measures against updated NICE guideline NG3 1 Publishes service level data Compares NPID data over time 1 See References section. 6
7 Local variation in first trimester HbA 1c The percentage of women achieving first trimester HbA 1c <48 mmol/mol varied greatly between services. For women with Type 1 diabetes the range was 0 to 44 per cent and for women with Type 2 diabetes 0 to 73 per cent. Figure 3: percentage of pregnancies where mother had first trimester HbA 1c <48 mmol/mol, by service a, , with interquartile ranges b Direction of better performance a Includes services with at least 10 valid first trimester HbA 1c records: Type 1 diabetes 107 services, Type 2 diabetes 108 services b see slide Use of statistics in analysing NPID data 2016 for more explanation of median and interquartile range 7
8 Diabetes in Pregnancy Clinical Audit Programme: Tasks Governance: Board->W/G + TOR
9 Diabetes in Pregnancy Clinical Audit Programme: Working Group-call for volunteers (WA,SA,Tas,NZ?) Professor David Simmons (Chair)-Campbelltown Hospital, NSW Dr Vincent Wong-Liverpool and Fairfield Hospitals, NSW Professor Christopher Nolan- The Canberra Hospital, ACT Dr Alexis Shub-Mercy Hospital for Women, VIC Professor Robert Moses-Shoalhaven Local Health District, NSW Professor N Wah Cheung-Westmead Hospital, NSW Ms Suzanne Hill-Albury Wodonga Health, Vic/NSW Dr Peter Davoren-Gold Coast Hospital-QLD Professor Jeremy Oats-Melbourne School Population & Global Health, Vic Dr Arianne Sweeting-Royal Prince Alfred Hospital, NSW Associate Professor Louise Maple-Brown-Royal Darwin Hospital, NT Professor Jeff Flack-Bankstown-Lidcombe Hospital-NSW
10 Diabetes in Pregnancy Clinical Audit Programme: Tasks Governance: Board->W/G + TOR Registry of interested clinics created ->Suzie Neylon A minimum dataset (?+ extended dataset) Former ADIPS minimum dataset ANZJOG 2007; 47: Adapt according to recent experience eg NT+ others Other datasets eg NPID (UK), IADPSG Identify other synergistic datasets eg AIHW, NDSS assess if joint work is possible
11 Diabetes in Pregnancy Clinical Audit Programme: Tasks Develop the policy specifying how data are to be collected, stored, maintained and administered Develop the policy specifying the process defining security of collected and stored diabetes data Develop the reporting framework/content Develop approval framework eg ethics/safety
12 Diabetes in Pregnancy Clinical Audit Programme: Tasks Develop Implementation plan Anything missing from the above? Develop maintenance plan Eg $!
13 Diabetes in Pregnancy Clinical Audit Programme: Working Group-Proposed Benchmarking process Sites are anonymous to all except themselves Only electronic de-identified data sent Proposal: Benchmarking Centre=Bankstown-Lidcombe-Jeff Flack Recognised as leader-eg Jeff Flack Award, ANDIAB Benchmarking Centre Benchmarking Centre in the ADIPS pilot Receives de-identified data, cleans data, sends out queries, sends out reports Sites send encrypted de-identified data to Trusted Third Party site TTP-Site strips off site identifiers-sends to benchmarking centre Volunteer? TTP-Coding site (never receives data)-campbelltown Receives dataset password-sends onto benchmarking centre with central site code-passes through site specific data queries
14 Questions?
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