Diabetic/Endocrine Patient Management System
This project involves the implementation statewide of the PED information management system. It is a database developed by Dr Don Anderson in MS Access. It was developed privately without the use of Hunter New England Health (HNEH) resources. It has been used in John Hunter Children’s Hospital since June 2000. Recently, it has been upgraded to link to the SQL Server database – the same as the major HNEH computer systems use. This upgrade has been made essential because Microsoft has withdrawn support for version 2000. It is being implemented at the paediatric unit at Royal North Shore and Royal Canberra Hospitals. Sydney Children’s Hospital and Westmead Children’s Hospital are currently using a database and so are not included in this proposal, however we aim to unify the data from all sources for analysis. Royal Canberra Hospital (not NSW Health) is not included in this application. The application is for installation in the following clinics: Armidale, Tamworth, Ballina, Lismore, Coffs Harbour, Grafton, Dubbo, Forster, Taree, Gosford, Orange, Port Macquarie & Wagga Wagga.
The PED database is a patient management system, for use by medical, nursing, allied health and their support secretarial staff in the management and care of children with diabetes (type I and type II) and endocrine conditions.
It is used in daily care to:
- Provide rapid access to patient demographics, details of external consultations, diagnoses and hospitalisations.
- Record diabetes related data and in particular parameters for newer approaches to therapy such as MDI and insulin pump.
- Record current and past medications.
- Minimise time processing letters and reports and have these on line for immediate review.
- Produce reports for specific categories of patient.
- Share information among team members and set alerts for specific patients.
- Collect and analyse numerical pathology data related to diabetes.
- Provide online percentiles for Ht, Wt, BMI, BP and surface area.
- On line calculator for commonly used conversion units/exchange v grams/unit
- Collate information – available at the time of transition to adult care.
- Management of complications screening.
- Monitor individual diabetes patients educational program.
The system provides the capacity for online audit relating to:
- Case numbers, subdivided into many categories.
- Rate of readmission to hospital.
- Clinic Average HbA1c
- Patients with specific diagnoses
- Patient attending specific schools and living in specific suburbs.
The data from all clinics can be combined “warehoused” and then distributed to participating centres and used for the presentation at the paediatric outreach meetings.
It is well established that improved metabolic control reduces the incidence of long term complications of diabetes. In addition early management of complications, including diabetic retinopathy and proteinuria can limit or prevent severe disability. It is also well established that young children with poor diabetes control have lower IQ, school failure and mood disorders.
The functions in the database can improve management and so reduce these complications by:
- Tracking patient attendance, diabetes control and early signs of diabetes complications. This information can then be used to ensure those at risk are reviewed and prioritised for intervention.
- Reducing the incidence of errors in clinical management by improving documentation and easily distributing management plans to all relevant clinicians, clients and parents.
- Selecting population subgroups who will most benefit from new therapies and/or educational programs. Eg Young children with poor control are known to particularly benefit from use of an insulin pump, and adolescents with poor self management skills from camps.
- Using collated information across NSW to improve treatment protocols and identify geographic areas and population subgroups requiring additional support.
Aims and objectives
- Provide the PED system for all units in NSW caring for children with Type I Diabetes Mellitus who do not already have an appropriate system for recording data. Each site has been contacted and only those in need of the system will be included in the project.
- Develop a system of monitoring data quality and provide online phone support to units experiencing difficulties in maintaining data quality.
- Every 6 months combine the data from all participating units and provide an automated report.
- Annually at the Paediatric Diabetes Outreach meeting present the
data and use it to report trends in incidence and develop approaches
to treatment that work and are cost effective.By improving care through
the development of new treatment approaches brought about by the monitoring
of incidence trends through the PED system:
- Reduce the incidence of blindness, renal failure, cardiovascular events and amputation arising from poor diabetes metabolic control.
- By improving diabetes metabolic control reduce the incidence of intellectual impairment, school failure and mood disorders.
Expected outcomes
- Patients HbA1c will improve to <7.5% for Type 1 patients and <6.5% for type 2 patients.
- All patients will have 3 monthly clinical review and HbA1c
- All patients will have annual biochemical and clinical review for diabetes associated complications and risk factors.
- All patients will have 2 yearly ophthalmologist or optometrist review from 5 years after diagnosis.
- Inpatient admissions for ketoacidosis or hypoglycaemia will decrease and reduce health care costs.
- From 10 years following diagnosis, reduced incidence of renal failure, blindness and hypertension.
- Improved self efficacy, educational and employment outcomes.
Key performance indicators
The success of the project will be measured by:
- Database derived evidence of decrease in Network 6 month average HbA1c
- Database derived evidence of increase in percentage of patients having 3 monthly clinical reviews and HbA1c
- Database derived evidence of increase in percentage of patients having annual complications reviews and eye examinations.
- Database derived evidence of decrease in inpatient Bed Days arising from patients having diabetes decompensation.
- Database derived evidence of reduced proportion of patients with microalbuminuria and hypertension.
Progress
The request for funding for this project arose from requests from Diabetes Educators working in smaller centres to have access to a computerised database to record information relating to their contact with paediatric patients with diabetes. The support for the project was confirmed with a distributed document and phone discussions. HNEHS IT staff were then consulted and required a review of the technical aspects of the project. These reviews and some modifications were performed by Dr Don Anderson and others but took longer than anticipated – 6 months. None of the allocated funds were used for this purpose. Once this preliminary work had been completed the community based diabetes educators were consulted again. Over the elapsed time there had been role out or planning to role out CHIME software to these centres. This is substantially different to PED as it has limited ability to record clinical outcomes and mainly records narrative and data required by managers to plan workforce. However, there was a consensus from the Educators that they will not be able to learn and enter data in two new computer systems. I discussed this in detail with the sponsor of the project and it was agreed that given the changed circumstances application of the allocated funds to this project was no longer appropriate. The project has therefore been terminated.
The funds allocated to this project have been approved by NSW Health for diversion to other areas of need within the Northern Child Health Network.