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A pilot quality assurance scheme for diabetic retinopathy risk reduction programmes
Author(s) -
Garvican L.,
Scanlon P. H.
Publication year - 2004
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2004.01300.x
Subject(s) - medicine , quality assurance , diabetic retinopathy , optometry , quality management , quality (philosophy) , national service framework , service (business) , diabetes mellitus , gerontology , external quality assessment , marketing , business , older people , philosophy , pathology , epistemology , endocrinology
Aims We describe a pilot study of measurement of quality assurance targets for diabetic retinopathy screening and performance comparison between 10 existing services, in preparation for the roll‐out of the national programme. Background In 1999 the UK National Screening Committee approved proposals for a national diabetic retinopathy risk reduction programme, including recommendations for quality assurance, but implementation was held pending publication of the National Service Framework for Diabetes. Existing services requested the authors to perform a pilot study of a QA scheme, indicating willingness to contribute data for comparison. Methods Objectives and quality standards were developed, following consultation with diabetologists, ophthalmologists and retinal screeners. Services submitted 2001/2 performance data, in response to a questionnaire, for anonymization, central analysis and comparison. Results The 17 quality standards encompass all aspects of the programme from identification of patients to timeliness of treatment. Ten programmes took part, submitting all the data available. All returns were incomplete, but especially so from the optometry‐based schemes. Eight or more services demonstrated they could reach the minimum level in only five of the 17 standards. Thirty per cent could not provide coverage data. All were running behind. Reasons for difficulties in obtaining data and/or failing to achieve standards included severe under‐funding and little previous experience of QA. Information systems were limited and incompatible between diabetes and eye units, and there was a lack of co‐ordinated management of the whole programme. Conclusion Quality assurance is time‐consuming, expensive and inadequately resourced. The pilot study identified priorities for local action. National programme implementation must involve integral quality assurance mechanisms from the outset.