This category was open to any improvement programme targeting unacceptable variation in delivery or quality of care.
Raising Awareness, in an Area Experiencing a High Level of Diabetes
NHS Airedale Bradford and Leeds
It is estimated that more than 32,000 people in the Bradford district have diabetes and 7,400 of these are unaware they have the disease. In response to these statistics Airedale and Bradford NHS long-term conditions service funded a project to work in the community to raise awareness of risk factors and symptoms of type 2 diabetes. Efforts to improve patient self-management and reduce 'did not attend' (DNA) levels were also implemented in a number of selected GP practices. These awareness and education drives became embedded in the diabetes pathway as part of an early intervention strategy, with face-to-face, tailored interventions created in an accessible way that was understandable to the general population. A community development worker was also provided to work intensively with the practices on their premises with patients who were at serious risk of developing complications because of poor self-management of their condition. Notable improvements include an average reduction in HbA1c levels of 0.53 across the four practices where figures are available.
Outreach and Admission Avoidance
Anglian Community Enterprise
An outreach service was established to reach patients who had a poor attendance record at clinic appointments and frequent hospital admissions, while an admission avoidance helpline was set up to provide out of hours support to HCPs. The outreach service concentrated on patients who lived within areas of deprivation across North East Essex and Tendring, offering structured education close to home, access to local health trainers, foot checks and other services. About 200 patients were seen during the first year and the results showed a reduction in cardiovascular risk and an average drop of 1.5 per cent in their HbA1c. The admission avoidance helpline managed to save 41 admissions and £47,667 over the 6 month pilot period.
Leicester Foundation Group: Structured education for people with new onset type 1 diabetes
Leicester General Hospital
The Leicester Foundation Group programme was set up to provide structured group education for adults with onset type 1 diabetes, of which there are between 70 to 80 diagnosed each year in Leicestershire. It offers education and peer support to people regardless of the insulin regimen they are currently using, and aims to improve self-efficacy as a precursor to self-care and reduce inequalities compared to individual/traditional care. All eligible people are encouraged to attend as part of their routine care. Education on self-management and dose adjustment skills focuses on problem-solving techniques and applying an understanding of how individual insulin regimens work. Observations suggest that people who have attended the foundation group are more likely to go on to attend further group education sessions such as DAFNE and that participants are more likely to suggest changes to their insulin type or regimen during clinic appointments.
Addressing unacceptable variation in the management of diabetic foot disease
West Middlesex University Hospital
Up to 100 people per week in the UK have a limb amputated as a result of diabetes, and diabetic foot ulcers precede more than 80 per cent of such amputations.This hospital was the first in North West London to develop and implement an evidence-based diabetic foot care bundle on all acute diabetic admissions. It was also the first trust in the region to screen inpatients with diabetes on admission for acute foot problems. Main developments include separating the initial assessment to become entirely nurse-led, with a clear and simple check-list that identifies any active foot disease in diabetic patients. Once identified, the nurse escalates the assessment to a junior doctor on the ward, who completes a doctor’s assessment and is led step-by-step through the recommended management. The project has been rolled out to two other medical wards in the trust, and upon completion of the current project, it will rolled out to neighbouring PCTs and acute trusts.
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