012 Audit Ready: Diabetes Audit search folder

012 Audit Ready: Diabetes Audit search folder

3 Treatment Targets

This folder reports on the Practice's performance over the last 12 months of managing diabetes against the nationally specified 3 Treatment Targets
  1. HbA1c ≤58
  2. Blood pressure ≤140/80
  3. Cholesterol ≤4.0
Notes
Some areas of the country may have local schemes which employ slightly different targets, or exclusions of patients with certain characteristics.

Each sub folder is separated into cohorts.
  1. Type 1 Diabetics
  2. Type 2 Diabetics
  3. Early Onset Type 2 Diabetics (those patients aged 18-39)
The Achievement folder displays the number of patients who have met the 3 Treatment Targets, as well as the percentage performance for the cohort.  
The Work To Do folder contains reports detailing the achieved target figures from the last 12 months. Any gaps expose where the patient has not been measured against a target for the year. The data reported may be better manipulated in Excel to sort dates or values to work out which patients may be worth targeting.
A Detailed Work To Do folder highlights patients who have achieved 2 of the 3 targets, and may be useful if the Practice chooses to focus resources on improving one particular measure across their patient cohort.
Idea
One approach to improving the overall achievement is to target efforts on patients with borderline results which may achieve the threshold more easily with a change to management.
Info
Early Onset Type 2 Diabetics are a sub group of the Type 2 Diabetic cohort, so they will appear in both searches or reports.

9 Key Care Processes

This folder reports on the Practice's performance over the last 12 months of managing diabetes against the nationally specified 9 Key Care Processes
  1. BMI
  2. HbA1c
  3. Blood pressure
  4. Cholesterol
  5. Creatinine
  6. eGFR
  7. Foot check
  8. Smoking status
  9. Retinal screening
Notes
Retinal screening is an additional process largely outside of the control of the Practice. Some areas of the country may have deployed local schemes which only look at the 8 other areas which can be managed directly in Primary Care.

Each sub folder is separated into cohorts.
  1. Type 1 Diabetics
  2. Type 2 Diabetics
  3. Early Onset Type 2 Diabetics (those patients aged 18-39)
The Achievement folder displays the number of patients who have met the 9 Key Care Processes, as well as the percentage performance for the cohort.  
The Work To Do folder contains reports detailing the overall work to do lists for all patients with diabetes. Any gaps in the report expose where the patient has not been checked within the last 12 months. The data reported may be better manipulated in Excel to sort dates or values to work out which patients may be worth targeting.
Separate Detailed Work To Do folders give a stratified look at the Key Care Processes to target efforts on patients who may not have a lot of work to do to hit all 9 KCPs.
  1. Reports for 1 and 2 items outstanding could show any of the KCPs which are missing, but typically reveal the same KCPs missing every time. Retinal screening may be an expected item missing, but other items may expose where clinicians are not documenting one particular piece of advice.
  2. Reports for 7/8/All items outstanding may be less useful as they often show patients who may not have been reviewed in the last 12 months, so an appointment is a priority over targeting individual processes.
Idea
Remember that these folders are built to look at a rolling 12 month period. If you wish to see performance for the current contract year, set the relative run date to the next 1st April.

Early Onset Type 2 Diabetes

This folder has been built for v4 of the Audit ready searches to reflect the increased emphasis on Early onset Type 2 Diabetes in the young (T2DAY). A list report shows the earliest ever diabetes mellitus code for patients identified as well as their most recent code term.

Other searches focus on female patients and their fertility, checking which patients have had contraception and conception advice in the last 12 months.

GLP-1 agonist stock shortage

This folder created specifically in response to the July 2023 GLP-1 stock shortage sits within the Diabetes folder of 012 Clinical Searches. It is also available as a standalone folder to support a rapid deployment to sites.
Alert
The top level search has been built to identify patients who are affected by the shortage. This means that the folder should not be used as supplied to identify all patients on GLP-1 agonists as lixisenatide (and albiglutide) is not subject to the alert.



GLP-1 initiated in last 2 years
This search identifies patients who started a GLP-1 in the 2 years prior to the search date to support Practices carrying out a proactive review of patients on GLP-1s. The report can be used as the first part of the review as it extracts relevant information relating to the GLP-1 drug as well as IFCC HbA1c and weight values. Reviewers can use the figures provided to calculate the percentage improvement in HbA1c and weight since each patient started a GLP-1. There are windows around each 'initiation' plus the latest result (which may happen to be a duplicate of an adjacent column).

... before GLP initiation
The most recent result prior to the 1st issue of the 1st GLP-1 in the last 2 years. In most cases it would be expected that this result was within 6 months of initiation. If the interval is longer, or no code seen, consider coding configuration of results.
... 3+ months after initiation
All results with an attached value between 3 and 11 months after the 1st issue of the 1st GLP-1 in the last 2 years. These values can be used to begin to calculate any reduction in HbA1c or weight at around the 6 month point.
... 12+ months after initiation
The 1st result which is at least 12 months after the 1st issue of the 1st GLP-1 in the last 2 years.



The current GLP-1 medication may not be the same as the GLP-1 medication that the patient was first prescribed.
Any empty cells where a value might be expected would indicate that the patient has not been reviewed within the timeframes.

Notes
Patients who were on a GLP-1 between 2 and 3 years ago but changed to a different GLP-1 in the last 2 years are not included.

Review 1 - Children and Young People
Children and young people with T2DM prescribed GLP-1 RAs under the care of specialist paediatric services should be directed back to specialist services.

Review 2 - No diabetes/licensed indication
Identifies any patient who does not have an unresolved diagnosis of diabetes.  Patients on a GLP-1 for weight loss would have prescriptions issued by secondary care, so issues on EMIS Web marked Hospital or Record for notes will not be shown.

Review 3 - Established Rx but last HbA1c >86
Patients who have been on a GLP-1 for at least 90 days and whose HbA1c is elevated should be prioritised for review. It would be necessary to review each patient's record to observe the history and trend of HbA1c results.

Review 4 - HbA1c was >86 before GLP1
Consider prioritising review for people with Type 2 Diabetes whose HbA1c was more than 86 at the point they started their current (active) course of GLP-1.

Review 5 - No HbA1c in the past 6 months
There is no coded IFCC HbA1c result in the last 6 months. Prioritise patients for a blood test (and a review).

Review 6 - Latest urine ACR >30mg/mmol
Consider prioritising patients whose most recent albumin:creatinine ratio is at least 30.

Review 7 - Coded 'Hyperglycaemia'
Patients who have had a hyperglycaemic event at least 30 days after starting their current GLP-1.

CONSIDER A REVIEW
This search pulls together all patients identified in Reviews 1-7. Remember some patients may appear in two or more Review cohorts.

Other

Gestational diabetes evolved to diabetes

This search identifies patients who once had gestational diabetes, but were subsequently diagnosed with diabetes. 
Patients who have a code indicating they were diabetic before the earliest ever Gestational diabetes mellitus code entry are explicitly excluded from the search. 
The report has been designed to pull out some useful information relating to the patient's journey.
  1. Earliest GDM code
  2. Latest GDM code
  3. Earliest diabetes code
  4. Latest HbA1c
It is expected that this data may help to locate more information in the patient's record. The report does not show how many pregnancies the patient had.
Idea
Look at the amount of time elapsed between the earliest GDM code and the earliest diabetes code. 

A small data quality search highlights patients who have a Type 1 Diabetes code added after their Gestational diabetes mellitus diagnosis. 

Support Information

Development Log

VERSION NUMBER

v1.0
Published 27/07/2023
Release notes:

Communications Log

Quote
Supporting Subscribers with NatPSA/2023/008/DHSC

Shortage of GLP-1 Receptor Agonists

To support our subscribers in processing action points from this National Patient Safety Alert  related to GLP1–RA shortages, Primary Care IT is pleased to share a cluster of searches that should help you to identify patients recommended for clinical review by the Primary Care Diabetes Society (PCDS). 

We have built out searches that specifically pick out patients who may need a more detailed review or conversation with a view to stopping their therapy or changing overall strategy, in line with the shared decision-making recommended by the NPSA and PCDS.

Practices or their pharmacy teams can run all searches in the folder at the same time, or just run the audit report RWA-216-AUDIT) On GLP-1 RA - CONSIDER REVIEW to get an interactive overview of the patients suggested for review. 
 

Link to PCDS Guidance

We hope you find these resources useful.

The team at Primary Care IT



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