Integrated diabetes care in Hong Kong: From research to practice to policy

Abstract

Hong Kong is a cosmopolitan city in South China with a population of seven million leading a westernized lifestyle. Since the 1990s, the epidemic of diabetes in Hong Kong coupled with the challenges of heavy service demands and manpower shortage have motivated the Chinese University of Hong Kong-Prince of Wales Hospital (CUHK-PWH) diabetes team to re-engineer workflow, train nurses and allied health providers to perform structured assessments, and establish a registry for quality assurance and research purposes. This protocol-driven, team-based care programme has improved the efficiency of risk stratification and personalized care with reduction in complications, hospitalizations and death. Within this diabetes centre, establishment of cohorts, biobanks, and clinical databases have helped to define the local epidemiology, validate treatment effectiveness, identify treatment gaps, discover genetic markers, develop risk equations, and select patients for clinical trials. In 2007, state of the art information technology was employed to create the first web-based diabetes management (JADE: Joint Asia Diabetes Evaluation programme) portal, incorporating care protocols, risk engine, decision support, and personalized reporting to reduce clinical inertia and treatment non-adherence in order to improve diabetes-related outcomes. Within this integrated care programme, innovations such as peer support have demonstrated reductions in hospitalizations, especially in those with negative emotions. This series of quality improvement programmes contributed to the strategic framework of the Hospital Authority to develop career paths for diabetes nurses and establish diabetes centres to provide team-based holistic care and reduce disease burden. Through the JADE programme, a network of care professionals has established an Asia Diabetes Database to evaluate the feasibility, acceptability and cost-effectiveness of this ‘high tech, soft touch’ approach in pursuit of accessible, affordable, and sustainable diabetes care. Through these two decades of concerted efforts, the CUHK-PWH team has systematically proved that by promoting pragmatic improvement science, it is possible to define problems, formulate solutions, change practice, influence policy, and make innovations to protect health and prevent disease, all within a real-world setting.