Defining quality of care for children and adolescents with type 1 diabetes

Abstract

Daneman D, Frank M. Defining quality of care for children and adolescents with type 1 diabetes. Acta Paediatr 1998; Suppl 425: 11-9. Stockholm. ISSN 0803-5326 Recent years have seen an increase in awareness of the need to improve the quality of diabetes care for children and adolescents, as detailed in the Declaration of Kos, for example. This paper addresses some quality-of-care principles and evaluates specific examples of current management. The meaning of the terms quality of care, evidence-based medicine and cost-containment are examined, and the features central to the development and evaluation of quality health care (structure, process and outcome) are explored. The practical aspects of diabetes care are reviewed in terms of the causes and prevention of early mortality, ambulatory vs inpatient care, the value of measuring HbA 1c , other metabolic control criteria (including the effect of patient selection, cultural, socioeconomic and biological differences) and clinical practice guidelines. It is concluded that a multidisciplinary team provides the optimum context for diabetes management and that care must be family centred and multidimensional (i.e. not focusing on HbA 1c levels alone). The task of improving diabetes care is massive and operates at all levels (individual, family, healthcare providers, national and international bodies), but offers significant improvements in quality and cost-effectiveness. ٖ Declaration of Kos, evidence-based medicine, HbA 1c , quality of care D Daneman, Room 5110, ''As they grow and develop, children and adolescents with diabetes have special and changing needs'' (ISPAD/IDF's philosophy on childhood and adolescent diabetes).

Factors associated with glycaemic outcome of childhood diabetes care in Denmark

“…A multidisciplinary diabetes team is recommended in the International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines, in national guidelines, and has been widely recommended as the structure facilitating the best childhood diabetes management [6,7,28–31]. Our results did not show any association between the presence of a diabetes team and glycaemic control, which shows that a diabetes team with all the recommended members per se is not a guarantee of optimal treatment.…”

Health disparities among youth with type 1 diabetes: A systematic review of the current literature.

“…Adolescents with low-SES backgrounds and minority adolescents have been identified as having consistently higher HbA1c levels than average- or high-SES, Caucasian adolescents (Daneman & Frank, 1998; Guo et al, 2011; Naar-King et al, 2006). As such, efforts should be made to include larger numbers of minority participants in research.…”

Diabetic ketoacidosis and cerebral oedema in Sweden—a 2‐year paediatric population study

“…In Australia, an increase in DKA of 0.9% per year in new cases of childhood diabetes was found between 1985 and 1999 [30]. In a report from the Hospital of Sick Children in Toronto, the number of children with newly diagnosed diabetes presenting in DKA declined from 28% from 1983/1984 to 10% in 1995/1996 [31]. The Children's Hospital in Los Angeles reported a decrease from 86% in 1994 to 26% in 1998 [32] after introducing a prevention programme, and, in Italy, an awareness programme at school for 6‐ to 14‐year‐old children, and in physicians’ offices, reduced the rate of DKA at onset of diabetes in their region from 78% to almost 0% over a 6‐year period [33].…”