Quality Standards for Diabetes Care Toolkit

Rationale for the toolkit

Diabetes presents a serious health challenge for New Zealand, with 8% of the adult population known to have type 2 diabetes, rising at a rate of 7–8% per annum, and 25% known to have prediabetes (Coppell et al 2013). According to the Virtual Diabetes Register (VDR) as at 31 December 2013 (summary at New Zealand Society for the Study of Diabetes website), the overall diabetes prevalence rate for New Zealand is 243,125, based on primary health organisation (PHO) registered patients by district health board (DHB) domicile. Thus, expected numbers are likely to be in the vicinity of 260,000–265,000 by the end of 2014, and
275,000–290,000 by the end of 2015.
Type 2 diabetes is increasingly being diagnosed at younger ages, even in childhood, with increased morbidity and mortality in this age group (Constantino et al 2013). In addition, the prevalence of gestational diabetes mellitus (GDM) is also increasing. Type 1 diabetes occurs at any age; however, it is more common in young people and New Zealanders of European descent, but it also occurs among other ethnic groups (Joshy and Simmons 2006). Consistent with worldwide trends, the prevalence of type 1 diabetes is increasing by 4% annually (Willis et al 2006). This is despite there being no clear association with modifiable risk factors (eg, obesity, low physical activity levels and smoking), as is the case for type 2 diabetes.
The Ministry of Health has a number of health targets on which DHBs are required to report. For diabetes, the target is encompassed within a risk assessment for cardiovascular disease that is inclusive of having an HbA1c test. The current target for ‘More Health and Diabetes Checks’ states that 90% of the eligible population should have had their cardiovascular risk assessed in the last five years, to be achieved by July 2014.
The Ministry of Health has now developed this set of Quality Standards for Diabetes Care (the Standards) encompassing wide ranging aspects of diabetes care. The objective of the Standards is to guide DHB planning and funding departments, managers, clinicians and consumers who are involved in the design and delivery of health services, on what and how services could be provided across the continuum of care (prevention, primary health and secondary care specialist services) and the full spectrum of diabetes (lifespan, pregnancy, complications and other vulnerable groups). These standards should be considered when planning your local service delivery. They provide guidance for clinical quality service planning and implementation of equitable and comprehensive patient-centred care – scaled to local diabetes prevalence. They should be read alongside the NZGG and other guidelines that highlight specific clinical expectations. The Standards will also guide the measurement of meaningful outcomes.
The Ministry of Health is supporting the implementation of these standards through the provision of a toolkit that will include the rationale for each Standard, as well as implementation and evaluation advice. There is considerable potential for improving the consistency of services across DHBs and providing a mechanism for measuring and benchmarking through the implementation of the Standards. The process included:

1. the establishment of an advisory group to guide project planning, toolkit development and content

2. a limited literature review to identify key guidelines, academic rationale and evidence for each of the Standards

3. identifying relevant toolkits locally and from other countries and disciplines

4. contacting planning and funding departments and clinical leaders to identify examples of implementation and innovative practice relevant to each Standard

5. reviewing and analysing identified innovations or models of care (national or international) for their quality, effectiveness, accessibility and generalisability across New Zealand

6. reporting to, and gaining feedback from, the Ministry of Health National Diabetes Service

7. Improvement Group members and the Ministry of Health Long Term Conditions Team

8. consultation with a range of stakeholders and experts.