Integrated Care for

Diabetes: The Derby

ModelParu King

Consultant Physician

Derby Hospitals

.

Diabetes Services in Derby 2008Population 250,000; 17 500 with diabetes

Community

Enhanced Services

Primary Care

Acute TrustTraditional model

Not responsive to user needs

Variation in service provision

Variation in expertise in Primary Care

What were our goals?

User seen in the right place, by the right

person at the right time

Improve outcomes, safety, save money and

reduce variation

Improve User experience

Improve communication

Seamless Pathways Centered

around user

Whole system approach to integration

Organisation

Clinical Finance IT Organisational Governance

INTEGRATION

The 5 pillars of integration• 2 JVOs

• Not for profit

• 50:50 ownership by Primary and Secondary Care

IT

FinanceClinical

Organisation

• Systm1• Responsive• Rapid

communication• Holistic safer care

Single budgetService delivery without competition

• Escalate and de-escalate care

• Education• Single Governance

structure

Evaluation of the InterCare Diabetes Service

1. Process

2. User experience

3. Clinical

4. Financial

Process: Triage Efficiency

Able to see users urgently within 24-48 hours

User views: 2013/14

“I like the services all together” ”its easy to get an appointment”“Better continuity!

Clinical Outcomes NDIS data (DOVE)

Clinical outcomes: Target setting: 2013/14

P<0.01

Clinical Outcomes: Inpatient Activity

A reduction in length of stay by 1.8 days equates to savings of £76,000

Finance: NDIS data expenditure (DOVE)

£800,000 Saved annually

Did we achieve our goals?

User seen in the right place, by the right

person at the right time

Improve outcomes, safety, save money and

reduce variation

Improve User experience

Improve communication

Seamless Pathways Centered

around user

•4T

Prevention, screening, diagnosis

•Structured education

•Self management

•Shared decision makingEmpowerment

•15 care essentials Routine Care

•Eyes, renal, feet, vascular, erectile dysfunction, Feet First

Complication management

•PROCEED

Pregnancy

•Think Glucose

In patient

Children

• Schools

Transition Adult End of Life

•Nursing Homes

Learning disability, ethnic minorities, mental health, Type 1

Serv

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Thank YOU