Quality of Pediatric Diabetes Care: Connecting health system, human, and policy perspectives to inform effective health system change

Project number: 
16-173
Approval date: 
Friday, September 30, 2016
Principal Investigator: 
Amed,Shazhan
Institution: 
University of British Columbia (UBC)
Funding Agency: 
Canadian Diabetes Association
Datasets requested: 
consolidation - census geocodes
PharmaNet
Medical Services Plan (BC Ministry of Health)
Consolidation - demographic (Ministry of Health)
Hospital Separations (BC Ministry of Health)
Consolidation registry (Ministry of Health)
Research objective: 

OBJECTIVES UTILIZING DATA FROM POPDATA BC AND EXTERNAL SOURCES:

Question 1: What proportion of children and youth with T1D receive optimal or good care as defined by an adherence definition developed by Amed et al based on clinical practice guidelines (CPGs) that subdivides adherence into 4 categories: optimal, good, minimal and poor. (Journal of Pediatrics, 2013; 163[2])
Hypothesis: CPG adherence is suboptimal or poor for the majority of children and adolescents with T1D in BC.

Question 2: How does the proportion of children and youth receiving optimal or good care change when components of the adherence definition are assigned varying weights? (i.e. for optimal adherence, annual glucagon prescription has less weight than annual physician visit)
Hypothesis: The proportion of children receiving optimal or good care changes when alternate definitions of adherence are used.

Question 3: Does adherence to CPGs differ for diabetes related recommendations (i.e. screening for T1D associated complications) vs. non-diabetes related recommendations (i.e. annual flu shot)?
Hypothesis: Adherence for diabetes related recommendations is the same as adherence for non-diabetes related recommendations.

Question 4: Does adherence to CPGs vary across different regions of the province?
Hypothesis: Adherence to CPGs will vary across different regions of the province.

Question 5: Is the proportion of children and youth receiving optimal or good care higher in those patients receiving a shared-care model (i.e care by specialist and family physician)?
Hypothesis: The proportion of children receiving optimal or good care is higher among those receiving a shared care model.

Question 6: Is adherence to CPGs for the treatment of childhood T1D linked to diabetes-related hospitalizations (i.e. for diabetic ketoacidosis; DKA)?
Hypothesis: Good or optimal adherence to CPGs is linked to fewer diabetes-related hospitalizations.

Question 7: Is adherence to CPGs linked to glycemic control, as measured by A1C?
Hypothesis: Good or optimal adherence to CPGs is linked to better glycemic control.
N.B. This will either be achieved through LifeLabs data or PLIS data, depending on data access at the time of data access.

Question 8: Is adherence to CPGs linked to rates of diabetes related complications in young adulthood? (i.e. nephropathy, retinopathy)
Hypothesis: Minimal or poor adherence is linked to higher rates of diabetes related complications.
N.B. This will not be reported if cell size is less than 5 to protect patient confidentiality

Question 9: Of the patients who have developed diabetes related complications, what proportion have been prescribed treatment in accordance with current guidelines? (i.e. ACE inhibitor for nephropathy)
Hypothesis: Adherence to treatment of diabetes related complications in young people with T1D is sub-optimal.

Question 10: Is better adherence to CPGs during pediatric care linked to better adherence to CPGs (indicating appropriate health care utilization) during the 5 years after transition from pediatric to adult health care services?
Hypothesis: Good or optimal adherence to CPGs during adolescence is linked to good or optimal adherence to CPGs in the 5 years after transition.

Question 11: Does adherence to CPGs differ in children with co-morbidities associated with diabetes (i.e. hypothyroidism, celiac disease) in comparison to those without co-morbidities?
Hypothesis: Adherence to CPGs is higher in children without diabetes related co-morbidities.

OBJECTIVES UTILIZING LINKED DATA SET/RESEARCHER COLLECTED DATA:

Question 12: Is adherence to CPGs linked to glycemic control, as measured by A1C?
Hypothesis: Good or optimal adherence to CPGs is linked to better glycemic control.

Question 13: Is adherence to CPGs linked to patient-reported diabetes related hospitalizations?
Hypothesis: Good or optimal adherence to CPGs is linked to fewer diabetes-related hospitalizations.

Question 14: How is adherence to CPGs related to patient level factors? (i.e. insulin regimen, time since diagnosis of T1D, socioeconomic status, patient reported quality of life, patient reported satisfaction with care)
Hypothesis: Patient level factors are related to CPG adherence.

In the future, we would consider linking in Education Data to answer the following question:
Is there a relationship between scores on the Foundational Skills Assessment and CPG adherence and/or glycemic control (i.e. A1C)?
Hypothesis: Good or optimal adherence and better glycemic control are linked to higher scores on the FSA.


Page last revised: December 5, 2017