Colleagues from the Oxfordshire Integrated Diabetes Care Programme team, Dr Rustam Rea, consultant in diabetes and acute general medicine and David Waterton, IT manager, share their experiences of developing and using IT solutions to support a population-level approach to healthcare management.

A clinician’s perspective: Dr Rustam Rea on the need for a whole population approach

Our ambition in Oxfordshire is to provide good diabetes care to the whole population independent of where they live and which diabetes service they use. To do that effectively we need real-time high quality data from across the region. The diabetes dashboard, a locally developed solution, will provide us with information on how well the whole diabetes population is supported in general practices across the region (see figure 1 for an illustrative example of the diabetes dashboard).

In my everyday work as a clinician working on integrating diabetes services, the diabetes dashboard will be an invaluable tool. To give one example, as part of our integration project, healthcare professionals from primary, community and secondary care attend virtual clinics where we not only discuss individual patient cases, but also review the delivery of care across services, identifying gaps in the diabetes service provision as a whole.

Having the diabetes dashboard reports available on a monthly will significantly help with those reviews. Up to now, we have been using reports from the National Diabetes Audit (NDA) and the annual Oxfordshire Diabetes Audit, but the time-lag between data collection and report publication, particularly in the case of the NDA, has proved to be a source of frustration for GPs.

The aim of the diabetes dashboard is to support ongoing diabetes care improvement and ensure the effectiveness and efficiency of diabetes service provision as services become more integrated. The diabetes dashboard will provide real-time, reliable and locally relevant information that we as clinicians can use to identify and resolve issues.

It is a dynamic resource and can be modified to suit local priorities. We see the dashboard as a starting point for any discussions on care improvement, enabling learning from the highest achieving practices in order to better support other practices to reach the same standard.

An IT manager’s perspective: David Waterton on the development of the diabetes dashboard

The vision in developing the diabetes dashboard was to have an adaptable tool, relevant for Oxfordshire, which would enable clinical teams to:

· look at the quality and variance of coding

· identify opportunities for learning

· see how targeted support can enable services to work together

· identify opportunities for new ways of working or engaging with patients.

The dashboard provides us with additional opportunities to learn more about diabetes service provision in the local area. For example, if we see low figures for ‘foot checks’ across Oxfordshire, it allows us to ask why. Is this because practices are not confident in capturing this information? Do the tools to support the consultation need improving? Does communicating this information to the practices, federations or CCG help to improve figures? What can we learn from practices achieving high figures?

As the data is submitted each month, if particular items have been identified as areas for improvement, you can monitor trends to see if the intervention, such as targeted support, has made an improvement.

The CCG is also looking at new ways of working to bring diabetes care providers closer together. For example, at present we are able to capture information on outpatient appointments. Using the same example of foot care, we can see if there is a relationship between practices with low foot checks completed and outpatient podiatry services. If we identify that a specific group of practices has low figures, we can explore whether offering specific training and education improves foot check coding within the practice, and ultimately reduces numbers of outpatient appointments.

The dashboard is should also help to identify some options for public health interventions. If, for example, we identify that most patients requiring foot checks are within a certain geographic area, this could indicate a need for targeted advertising of services in that area, or the need to highlight this variation to the practices in the affected area.