National Diabetes Audit Quality Improvement Programme ReportPublished: 16th September 2016
This report summarises the results and conclusions of a primary care diabetes quality improvement programme commissioned by NHS Digital (formerly the Health and Social Care Information Centre) and conducted by the Clinical Innovation and Research Centre (CIRC) of the Royal College of General Practitioners (RCGP) between June 2015 and September 2016.
A model of disseminated quality improvement using a train the trainer approach with mentoring and practice-based support was used. Diabetes clinical leads in three Clinical Commissioning Groups (CCGs) in England and one Local Health Board (LHB) in Wales were selected and attended a training day in quality improvement methodology led by the RCGP leads. Each CCG/LHB clinical lead then recruited practices in their region. The quality improvement training was disseminated to the practices, who then devised and implemented a practice-level diabetes quality improvement project. The evaluation used a variety of data sources to gather information on the context, processes and impact of the programme. It was anticipated that confidence with diabetes quality improvement could increase, but that clinical outcomes may take longer to demonstrate.
From a planned total of 24 practices, 18 remained active during the programme. 16 practices reported an increase in confidence with quality improvement and 7 practices demonstrated quantitative improvement in NDA care processes and/or treatment targets. Several contextual and process factors were identified as common drivers for quality improvement activity (e.g. good teamwork, clear leadership, a simple well-defined intervention) or constraints hindering such activity (e.g. high workload, staffing changes, lack of data gathering and poorly-defined interventions). A majority of practices reported that their interventions were relevant and sustainable, but that additional external support would be helpful.
The results of the evaluation support a model of disseminated quality improvement in diabetes care using a train the trainer approach with mentoring and practice-based support. However, there are several significant contextual and process factors that can reduce the impact. Future programmes should consider ways to ameliorate these factors and maximise the improvements.
One of the outputs from the programme is an online diabetes quality improvement toolkit. It is anticipated that this will help to share the learning from the programme and facilitate CCG/LHB clinical leads and individual practices in quality improvement activity.