Integrated Care for
Diabetes: The Derby
ModelParu King
Consultant Physician
Derby Hospitals
.
Diabetes Services in Derby 2008Population 250,000; 17 500 with diabetes
Community
Enhanced Services
Primary Care
Acute TrustTraditional model
Not responsive to user needs
Variation in service provision
Variation in expertise in Primary Care
What were our goals?
User seen in the right place, by the right
person at the right time
Improve outcomes, safety, save money and
reduce variation
Improve User experience
Improve communication
Seamless Pathways Centered
around user
Whole system approach to integration
Organisation
Clinical Finance IT Organisational Governance
INTEGRATION
The 5 pillars of integration• 2 JVOs
• Not for profit
• 50:50 ownership by Primary and Secondary Care
IT
FinanceClinical
Organisation
• Systm1• Responsive• Rapid
communication• Holistic safer care
Single budgetService delivery without competition
• Escalate and de-escalate care
• Education• Single Governance
structure
Evaluation of the InterCare Diabetes Service
1. Process
2. User experience
3. Clinical
4. Financial
Process: Triage Efficiency
Able to see users urgently within 24-48 hours
User views: 2013/14
“I like the services all together” ”its easy to get an appointment”“Better continuity!
Clinical Outcomes NDIS data (DOVE)
Clinical outcomes: Target setting: 2013/14
P<0.01
Clinical Outcomes: Inpatient Activity
A reduction in length of stay by 1.8 days equates to savings of £76,000
Finance: NDIS data expenditure (DOVE)
£800,000 Saved annually
Did we achieve our goals?
User seen in the right place, by the right
person at the right time
Improve outcomes, safety, save money and
reduce variation
Improve User experience
Improve communication
Seamless Pathways Centered
around user
•4T
Prevention, screening, diagnosis
•Structured education
•Self management
•Shared decision makingEmpowerment
•15 care essentials Routine Care
•Eyes, renal, feet, vascular, erectile dysfunction, Feet First
Complication management
•PROCEED
Pregnancy
•Think Glucose
In patient
Children
• Schools
Transition Adult End of Life
•Nursing Homes
Learning disability, ethnic minorities, mental health, Type 1
Serv
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acr
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Der
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Thank YOU