Diabetes Care Services have been moving steadily over the past decade towards measuring their effectiveness both quantitatively and qualitatively.  This was driven initially by the treatment goals and continuous quality improvement aspirations of the St Vincent Declaration. More recently Clinical Governance and the impending Diabetes NSF have accelerated the trend.

It is very easy, however, for so called 'measurements' of health care to be fundamentally flawed.  Developments in population based diabetes information systems have shown that much of the basic 'counting' is practicable.  Indeed, at the level of individual diabetes services, it is highly beneficial for service planning and development.  But it is a much more difficult task to turn such numbers into valid indicators of service performance, robust enough for reliable service comparisons such as the CHI assessments that will pursue implementation of the Diabetes NSF.

For example, high volume measures (e.g. the frequency of carrying out routine clinic measures) or the achievements of first level treatment goals (e.g. glycaemic control and blood pressure) can be confounded by year on year population changes due to patient movements and variations in attendance rates.  Similarly, relatively low volume measures such as rates of disease end-points (e.g. sight threatening retinopathy, amputation, coronary heart disease) are very sensitive to differences in data collection and validation.

The prime purpose of using such data for inter service comparison is to facilitate improvement through collective learning.  But they will also have to support accountability through Clinical Governance. This can occur only if the measures are perceived to be 'just' by the clinic teams who deliver diabetes care.  They must, therefore, not only be statistically robust but have a high degree of 'face validity' (i.e. they must 'look right' when health care professionals see them). QUIDS is intended to be 'user driven'. Anonymised raw data will be processed and modeled in order to produce draft measures that are then iterated under the guidance of health care professionals throughout the NW Region until they are not only mathematically but also 'culturally' secure.

The North West has been chosen as a Region in which to develop such service indicators for diabetes care.  It has been chosen because of its established programme of diabetes service appraisal, the associated wide deployment of population based diabetes information systems, and because of local expertise in the development of appropriate ways to analyse the data accruing from such systems. However, from 2001 onwards piloting will extend to other regions of England in collaboration with the Diabetes UK Diabetes Services Benchmarking Project (UKDIABS).

QUIDS is also linked to the North West Diabetes Services Appraisal Programme and the generic diabetes services assessment instrument being developed by a Joint Royal Colleges (RCP, RCGP, RCN) & Diabetes UK Group.   

This project will be managed by a small group comprising: Dr Bob Young, Consultant Diabetologist, Salford;  Dr Peter Elton, Director of Public Health, Wigan & Bolton; Ms Sally Hollis, Senior Lecturer in Statistics, University of Lancaster; Dr Charles Khong, GP Warrington;  Dr James Bennett, Research Associate, Department of Epidemiology and Public Health , Imperial College School of Medicine at St Mary's;  Dr John New, Consultant Diabetologist; Mr Malcolm Roxburgh, Statistical Research Officer , Diabetes UK / RCP; and Dr Paul Whitfield, Project Director - Diabetes North West, Centre for Health Care Development.  The project analyst Mr John Burns, based at Hope Hospital will keep everybody in regular touch with the Project.  There will be regular meetings at which participants can debate the issues that emerge.

The project has been funded jointly by the Department of Health (NICE), Diabetes UK and the NHS Executive North West. It is scheduled for completion by June 2002.


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