NICE Consults On Draft Quality Standards For Diabetes And Glaucoma

NICE has published for public consultation its draft quality standards for the clinical management of type 1 and 2 diabetes in adults and for the care of people with glaucoma.

NICE quality standards are derived from the best available evidence, usually NICE guidance or other sources that have been accredited by NHS Evidence. They are designed to reflect the very best in high quality patient care and they aim to help healthcare practitioners and commissioners of care deliver excellent services. Produced collaboratively with the NHS and social care professionals, along with their partners and service users, they are aimed at patients and the public, clinicians, public health practitioners, commissioners and service providers. They are the only standards in health and social care that apply nationally in England.

The draft quality standard on diabetes consists of 15 statements, each with associated quality measures, including:

– People with diabetes participate in an annual care planning review which leads to agreed and documented goals and an action plan.

– People with diabetes receive personalised nutritional advice from an appropriately trained healthcare professional or as part of a structured education programme and physical activity advice on an ongoing basis.

– People with diabetes discuss and agree with their healthcare professional a personalised documented HbA1c target level (a measure of the level of glucose in the blood), usually between 6.5% and 7.5% (48 and 58 mmol/mol), and receive support to minimise hypoglycaemia including review of glucose levels and strategies while achieving and maintaining this level of HbA1c through structured education and medication.

– People with diabetes receive an assessment for the presence and risk of retinopathy, nephropathy, neuropathy, cardiovascular disease including peripheral arterial disease, and sexual dysfunction, and are managed appropriately.

– People with diabetes at increased or high risk of foot ulceration or who have a foot ulcer are regularly reviewed by a foot protection team in accordance with NICE guidance.

The draft quality standard on glaucoma defines high quality patient care to include the following:

– People referred for definitive diagnosis in the context of possible chronic open angle glaucoma (COAG) or ocular hypertension (OHT) receive all relevant tests in accordance with NICE guidance.

– People with COAG, suspected COAG or with OHT have a diagnosis and management plan formulated by a suitably trained healthcare professional with competencies and experience in accordance with NICE guidance.

– Sufficient service capacity exists for people with COAG, suspected COAG or with OHT to have access to follow-up appointments and specialist investigations at appropriate intervals in accordance with NICE guidance, and systems are developed to identify those needing clinical priority if appointments are cancelled, delayed or missed.

– People with COAG who are at risk of progressive loss of vision despite treatment or who present with advanced visual loss are offered surgery with pharmacological augmentation (mitomycin C [MMC] or 5-fluorouracil [5FU])[1] as indicated and are also offered information on the risks and benefits associated with surgery.

Dr Fergus Macbeth, Centre for Clinical Practice Director at NICE, said: “As these draft quality standards highlight, an integrated approach to provision of services is fundamental to the delivery of high quality care to adults with diabetes and people with glaucoma. These draft quality standards require that services should be commissioned from and coordinated across all relevant agencies encompassing the whole care pathways for both conditions. They will set the benchmark for healthcare quality in these two disease areas, and can be used to assess existing practice and improve future services so that healthcare commissioners and providers can deliver the best care locally.”

The government’s recently published Transparency in outcomes – a framework for the NHS consultation[2] proposes that NICE quality standards are used to produce more detailed commissioning guidance to meet the suggested national outcome goals included in the framework.

The draft quality standards are available on the NICE website until 5.00pm, 16 December and allow stakeholders to comment on the drafts and help prioritise which statements are most important to support quality improvement. These drafts have been issued for consultation; NICE has not yet published the final quality standards to the NHS.

All eligible comments will be reviewed by the independent Topic Expert Group and the standards will be refined in light of this information. The final quality standards for diabetes and glaucoma are expected to be published in June 2011.

Source: NICE