The Diabetes Register of Belgium · Noëmi Debacker Scientific Institute of Public Health Special...
Transcript of The Diabetes Register of Belgium · Noëmi Debacker Scientific Institute of Public Health Special...
EUropean Best Information through Regional Outcomes in Diabetes
Materials, Methods and Data Analysis of Diabetes Registers
The Diabetes Register of Belgium Noëmi Debacker
Scientific Institute of Public Health
Special BIRO Academy Meeting“Coordinated Information Delivery from Diabetes Registers
to improve quality and outcomes in Europe”Rome 4-5th June 2010
BelgiumReference Population
MAP
Country: BelgiumRegion: Entire countryTotal Population: 10,666,866 (2008)Diabetes Prevalence: 3.5% (2008 HIS)Type of Data Sources: Patient medical record – data obtained for quality assurance purposes
N.Participating Centres: 120 (2007)=> Secondary care diabetes centres (hospital based)
Put your map here
Belgium Local Database Structure
Centre 1: Medical patient
record
IPH:Data
management & analysis
Centre 2: Medical patient
record
Centre n: Medical patient
record
National secondary care dataset: Demographic
and clinical data (similar to DiabCare)
Feedback
Cycle: every 18 months
Belgium Local Database Structure: IT
• Location: server of the IPH• Centres and patients are
anonymous• Declaration towards the commission
for the protection of privacy and ethical committee
• User access management• Security policy of the IPH• Protection of infrastructure• Logical protection• Network protection
2001
Per year of data collection
=> Spreadsheet
20022004
20062007
2009
Belgium Local Database Structure and the BIRO Merge Table
BIROMerge Table
National secondary care dataset: Demographic
and clinical data (similar to DiabCare)
Centre 1: Medical patient
record
IPH:Data
management & analysis
Centre 2: Medical patient
record
Centre n: Medical patient
record
• Demographical data• Type of diabetes and year of diagnosis• Hypoglycaemic and additional treatment• Cardiovascular risk• Process of care (eg. Screening of complications)• Presence of micro- and macrovascular complications
Belgium Using BIRO
Strengths• Very nice and patient people helping you out• In the end the programme is quite logical to use• If it works it can offer a “quick” and “correct”
snapshot of local results Problems/weaknesses• Up to now: mainly technical problems in the
making of the local report => time consuming • Its use and possibilities require an explanation
Belgium Mapping to BIRO European Standard
• The mapping needs a thorough preparation/knowledge of the source database => written and correct document such as the BIRO Common Dataset is necessary
• BIRO field description: difficult to read in the BIRObox
• Time consuming the first time• Data in data source configuration: difficult to obtain
(sometimes rough estimation), originates from different years: to what extent are these taken into account?
Belgium Merge Table Contents
End Stage Renal TherapyRenal Dialysis
Renal TransplantStroke
Active Foot UlcerMyocardial Infarction
LaserHypertension
BlindnessAmputation
Antihypertensive MedicationHypoglycemic Drug Therapy
Oral Drug TherapyPump Therapy
Total CholesterolHDLTriglyceridesEye ExaminationRetinopathy StatusMaculopathy StatusFoot ExaminationFoot PulsesFoot SensationNasal TherapyAverage InjectionsSelf MonitoringDiabetes Specific EducationLipid Lowering TherapyAnti-platelet TherapyPatient Enrolment in DMP
Patient IDData Source IDType Of DiabetesSexMonth & Year of BirthYear of DiagnosisEpisode DateSmoking StatusCigarettes per dayAlcohol IntakeWeightHeightBody Mass IndexSystolic Blood PressureDiastolic Blood PressureHbA1cCreatinineMicroalbumin
Belgium Additional Data
Activity Table:Not available
Population Table: Available: data from 2007
Diabetic Population Table:Available from Health Interview Survey 2008:
Validity? No data by type of diabetes
Belgium Running BIRO: Data Quality Results
• Results of the obtained BIRO report were verified:=> The largest part of the results were correct=> Those not correct were reported to BIRO:– Inverse presentation of complications– Missing values treated as absence of complications– Some slight difference in absolute numbers: reason?– Strange presentation of percentages (foot examination &
age)– Some wrong results (process smoking status)=> For some of the results, the calculation behind was not
understood/calculations were not appropriate for the type of data we have
– Life expectancy– Visit frequency– Prevalence of DM
Belgium Statistical Report
Belgium Statistical Report: General Characteristics
• Type of diabetes & age
• Duration of diabetesType 1 diabetes Type 2 diabetes
Male Female Total Male Female Total
0-9 yrs 614 (32%) 418 (28%) 30% 1243 (37%) 1166 (33%) 35%
10-19 yrs 565 (29%) 444 (29%) 29% 1368 (41%) 1391 (39%) 40%
20+ yrs 737 (38%) 654 (43%) 41% 762 (23%) 965 (27%) 25%
19-34
Belgium Statistical Results: BIRO Indicators (1)
Hypoglycaemic treatment:100% treated with insulin (problem with
results: missing values are counted as « not insulin treated »)
Additional oral treatment: 50% DM2 and 8% DM1 (identical problem)
Selfmonitoring100%
Belgium Statistical Results: BIRO Indicators (2)
Prevalence of diabetes complications• ESRF: 3.7%• Foot ulcer: 8.5%• Amputation: 4.3%• Stroke: 10.4%• MI: 11.6%
Belgium Statistical Results: BIRO Indicators (3)
<7%7-7.9%≥ 8%
Belgium Statistical Results: BIRO Indicators (4)
• BMI<25 kg/m²: 47% (DM1) - 12% (DM2)• BMI increases with age until age 75 in DM1• Obesity prevalence decreases with age in
DM2• BMI by gender
Belgium Statistical Results: BIRO Indicators (5)
Smokers: 21% (DM1) - 12%(DM2); 11% ♀ - 19% ♂
By age
Belgium Statistical Results: BIRO Indicators (6)
BP<140/90 mmHg: 71% (DM1) – 52% (DM2)By age
Belgium Statistical Results: BIRO Indicators (7)
Total cholesterol
Belgium Statistical Results: BIRO Indicators (8)
HDL-cholesterol
Belgium Statistical Results: BIRO Indicators (9)
Microalbuminuria
NormalAbnormal
Belgium Statistical Results: BIRO Indicators (9)
Process of care• Foot examination/12 mo : 90%• Eye examination/12 mo : 76%• ≥ 1 BP measurement/12 mo: 99%• ≥ 1 lipid measurement/12mo: 96%• µalb measurement/12 mo: 79%• ≥ 1 HbA1c measurement/12mo: 99%
Belgium Conclusions (1): Statistical Results
• Intensively treated diabetes population with large diabetes duration and high age
• Prevalence of complications is considerable• Quality of care is good in terms of process
indicators (less good results for the eye and kidney examination)
• Quality of care is good in terms of outcome indicators and comparable to other health care settings
• Room for improvement remains• Data is NOT representative for entire Belgian
diabetes population!
Belgium Conclusions (2):BIRO usage
• I believe that once the system works, the immediate local feedback could be an important tool for the evaluation of quality of diabetes care, however:– Up to now: time consuming– Results in report need to be verified– Need for consequent treatment of missing values– Up to now structure of the report does not seem entirely
logical– Minimal knowledge of data management is required– Some parts of the report do not apply for all kinds of
databases
BelgiumFuture LOCAL Perspectives
• No large changes are foreseen with regard to IQED (actual data used for BIRO) – most fields map well to the BIRO as they actually are
• Additional dataMost data originate from QA projects
We do not have data on all patients of a certain region
– Additional data on paediatric type 1 diabetes can become available
– Maybe additional primary care data will become available
Belgium Future BIRO Perspectives
• Although the result in the end is very nice (but not entirely finished):– Plenty of intermediate steps to reach the result
which seem “source database” specific <--> magic box?
– The structure and methodology of the report might need some reconsideration
Belgium
Thanks for the attention!
Belgium Statistical Results: BIRO Indicators (11)
Antihypertensive treatment:
Belgium Statistical Results: BIRO Indicators (12)
Antiplatelets:
Belgium Statistical Results: BIRO Indicators (13)
Lipid lowering treatment: