Performance management in clinical diabetes: Are the Diabetes UK '15 health care essentials' a good enough measure of the standard of diabetes care?

Abstract

Having the right care is essential for the wellbeing of all people with diabetes. There is a minimum level of health care that every person with diabetes should expect. In 2010, Diabetes UK produced a list of 15 essential checks and services that people with diabetes should expect to receive. We wanted to assess whether we were adequately achieving all of these targets in our own diabetes service and assess whether the targets were themselves adequate and appropriate. We retrospectively reviewed the medical records of 200 randomly selected patients attending the diabetes review clinic in a district general hospital. We recorded whether the parameters outlined in the Diabetes UK '15 health care essentials' had been achieved in the last 12 months and then collated the data. The data showed that we scored well in terms of monitoring HbA1c, blood pressure, body mass index, retinal screening and cholesterol. However, we scored sub-optimally in terms of the following parameters: smoking cessation, pregnancy planning, structured education, measurement of waist circumference and psychological assessment. In conclusion, the Diabetes UK 'essentials' checklist may be viewed as mechanistic, but it provides a useful starting point to assess the effectiveness of a diabetes service in providing the basics of patient care in much the same way as the WHO surgical checklist reduces adverse outcomes. We have been able to see where the deficiencies in our own service lie and have made amends to ensure that these areas are covered in future. One issue that arose is that there are certain other 'essentials' that would be good to include in such a checklist, such as: erectile dysfunction (as suggested by the NICE guidelines), obstructive sleep apnoea, vitamin D deficiency, neuropathy screening and monitoring of liver function to rule out incipient steatohepatitis/fatty liver disease. Copyright © 2012 John Wiley & Sons.