Effectiveness: Diabetes Care
Why is this measure so important?
Diabetes is a serious medical condition that, if not controlled properly, can result in hospitalization and premature death. Children with diabetes do not produce enough insulin, a hormone produced by the pancreas that helps glucose (sugar) move from the bloodstream into the cells. If sugar does not get into the cells, the body will not have the fuel to function properly. Eventually, if too much sugar builds up in the blood, it can damage the body’s organs.
Managing childhood diabetes requires keeping sugar levels in the blood within a safe target range. This is done through a hemoglobin A1c test, which measures the amount of sugar in the blood. If the blood sugar level is too high, it can be lowered through medications and/or insulin and through lifestyle changes.
According to the National Committee for Quality Assurance (NCQA) and the American Diabetes Association (ADA), 34% of children, adolescents and young adults with diabetes should have hemoglobin A1c blood sugar levels below 8%.
How do we track this measure?
We looked at the hemoglobin A1c test results for the 1,451 children, adolescents and young adults with diabetes who were cared for by our hospital in the first two quarters of 2010 and compared our performance with the NCQA and ADA guidelines.
In the first two quarters of 2010, our performance on this measure for all age groups was better than the target recommended by the NCQA and ADA.
How do we compare to other hospitals?
Since not all hospitals report this information publicly, it is impossible to compare our performance to that of other children’s hospitals. Instead, we evaluate ourselves based on how well we meet the NCQA and ADA targets.
What are we doing to improve?
We will soon begin a new system of mailing reminders to patients who have not been seen within the past 60 days, asking them to schedule an outpatient appointment with a member of our diabetes team. Currently, families whose children have not been seen in the past 60 days receive a phone call to book follow-up visits. By encouraging follow-up visits on a regular basis, we can better monitor hemoglobin A1c levels and suggest additional treatments and lifestyle changes for children whose blood sugar levels are too high.
We are also offering group diabetes education programs for patients and families at our outpatient facilities in Boston and Waltham.
Finally, given the increasing numbers of children and young adults with diabetes, we are considering adding resources, including more diabetes nurse educators, nutritionists and social workers to provide more intensive care to this growing patient population.