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Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
Sunz2013 emmanuel jo
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Sunz2013 emmanuel jo

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  • 1. The development and validation of a “Virtual Diabetes Register” (VDR) for monitoring diabetes prevalence and the quality of diabetes care in New Zealand • Emmanuel Jo1, Paul Drury2, • 1.New Zealand Ministry of Health, 2.Auckland Diabetes Centre and New Zealand Society for the Study of Diabetes
  • 2. What is Diabetes Mellitus (DM)• DM defines a condition of a person having too much glucose (sugar) in the blood.• This is because the pancreas cannot make enough insulin.• Simply, the body can not control glucose level
  • 3. Importance of DM patient care • DM patient care is very important as DM can cause further complications, leading to more health expenditurePicture source: http://scientopia.org, http://diabetes.webmd.com, http://healthlineinfo.com
  • 4. Complications of diabetes• Eyes - blindness• Kidneys - dialysis• Amputation of feet• Mens sexual health• Womens sexual health• Diabetes-specific skin conditions• General skin conditions• Gum, mouth and teeth problems• Nerve damage (neuropathy)• Heart and blood vessel problems• Thyroid
  • 5. What we knew about DM prevalence prior to 2008/09• About 100,000~300,000 DM patients in New Zealand (depends on which survey)• Maori/Pacific are about 10 years earlier to have diabetes than others in New Zealand
  • 6. What MOH does for DM?• Ministry of Health (MOH) set targets for each local *District Health Board (DHB).• The percentage of free annual diabetes checks is defined to be a measure of access to good quality care for Diabetes Mellitus (DM) patients.• It monitors the level of glycosylated hemoglobin (HbA1c; a measure of diabetes management) and fasting lipid test (a measure of Cardiovascular Disease (CVD) risk)
  • 7. How to measure?Number of DM patient checked  100  DM Rate(DHB)% Number of DM patient
  • 8. Health Survey
  • 9. How the result of the survey used National DM Rate (by age and ethnicity) x Local DHB Population (by age and ethnicity) = Estimated Local DM population Maori Pacific Other DHB1 57 32 146 DHB2 64 36 106 DHB3 80 41 126 DHB4 73 42 112 DHB5 50 43 189 DHB6 37 39 126
  • 10. Diabetes Get Checked Rate by DHB 2007/08 Pacific Over 100% ? 140%Get Checked as a % of estimated number 120% with known diabetes 100% 80% 60% 40% 20% 0% DHB
  • 11. What MOH wanted• New Zealand wished to establish a database where individuals can be located so that it can reveal specific data from the pool of data set
  • 12. Searching for data• National Minimum Data Sets (Inpatient)• National Non-Admitted Patient Collection (Outpatient)• Primary Health Organisation Enrolment Collection (PHO Enrolment)• National Health Identifier (NHI)• Pharmaceutical Collection (PHARM)• Laboratory Claims Collection (LAB)• PHARM and LAB data accessed via SAS access to Oracle module
  • 13. VDR methodology• Regards as having diabetes if:  Admission coded as diabetes  Hospital OP visit for diabetes or diabetes education,  Retinal screening performed  On insulin, metformin, sulfonylureas (at least 2 scrips)  Exclude women age 12 and 45 taking metformin but no other medication (PCOS)  At least 4 HbA1c in past 2 years (must have ACR as well if that only evidence)• Cut off is data up to 31 Dec, thus available about mid-March/April for previous year• Criteria on validation appear ca 95% specific but probably ca 90% sensitive
  • 14. The VDR concept diagram National Health Index (Demographic information) NHI Duplication Checks Outpatient Pathology tests Pathology tests Primary Health Hospital Pharmaceutical Outpatient nursing DM Outpatient DM Pharmaceutical claims claims Organisationadmissions with non-metformin medical DM education/mana retinal screening metformin only HbA1c>=4 for ACR test >=1 for (PHO) DM DM medication gement last 2years last 2years enrollment DM patient selection filter Virtual Diabetes Registry (VDR)
  • 15. Result New Zealand Diabetes Prevalence Rates 1 January 2010: PHO enrolled population 18% 16% 14% New Zealand 12%Prevalence rate 10% 8% 6% 4% 2% 0% 00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age
  • 16. Diabetes Prevalence Rates 1 January 2010: PHO enrolled population 50% 45% 40% 35% European/Other MäoriPrevalence rate 30% Pacific people 25% Indian 20% 15% 20+ years 10% 5% 0% 00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age
  • 17. New Zealand Diabetes Prevalence Rate as of 31 Dec 2011 European/Other Mäori Pacific people Indian 50% 45% 40% Unpublished data (Drury & Jo)Rate (Base=Practice enrolled population) 35% 30% 25% 20% 15% 10% 5% 0% 00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age group
  • 18. Direct same-scale comparison of prevalence 2005 & 2011 Unpublished data (Drury & Jo) New Zealand Diabetes New Zealand Diabetes Prevalence Rate as of 31 Dec Prevalence Rate as of 31 Dec 2005 201150% 50% European/Other European/Other45% Mäori 45% Mäori Pacific people Pacific people40% 40% Indian Indian35% 35%30% 30%25% 25%20% 20%15% 15%10% 10%5% 5%0% 0% 00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ 00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age group Age group
  • 19. New Zealand Virtual Diabetes Registerend-2005 to end-2011 Unpublished data (Drury & Jo) Increase is in both genders, also across all ethnicities
  • 20. Southern Unpublished data (Drury & Jo) South Canterbury CanterburyDiabetes prevalence rates by DHB of domicile West Coast VDR Dec 2005 Nelson Marlborough Wairarapa Hutt Capital and Coast VDR Dec 2007 Whanganui MidCentral Taranaki VDR Dec 2009 Hawkes Bay Tairawhiti Bay of Plenty Lakes VDR Dec 2011 Waikato Counties Manukau Auckland Waitemata Northland 8% 7% 6% 5% 4% 3% 2% 1% 0%
  • 21. Diabetes prevalence rates by Deprivation 7.0% 6.0%Diabetes prevalence rate 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% 1 2 3 4 5 6 7 8 9 10 Deprivation
  • 22. • An example of VDR application Mortality Risk Ratio (DM/non DM) Mortality Risk Ratio - Male Mortality 85+ 75-84 65-74 55-64Age group 45-54 35-44 25-34 15-24 00-14 5.0 4.0 3.0 2.0 1.0 0.0 1.0 2.0 3.0 4.0 5.0 Risk ratio
  • 23. An example of VDR application ACS admission rate for people in VDR vs not in VDR in 2008/09 for age 35-84 Conditional Probability: P(ACS patients/non VDR PHO population)1.800% Conditional Probability: P(ACS patients/VDR PHO population)1.600%1.400%1.200%1.000% 4.1x more chance to have one or more ACS admissions than0.800% those who not exist in the VDR0.600%0.400%0.200%0.000%
  • 24. An example of VDR application 30 days mortality rate after the last hospital discharge in 2007/08 20.00% 18.00% 16.00% Patients exist in the VDR 14.00% Patients not exist in the VDR1 year mortality rate 12.00% 10.00% 8.00% 6.00% 4.00% 2.00% 0.00% 00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age
  • 25. How the VDR is used• The VDR is recognised as the official diabetes prevalence for New Zealand by NZSSD and MOH• Use SAS and SAS Add on for Microsoft Office (AMO) to share the data within MOH in a data cube form• The patient level VDR return to their DHB for monitoring patient’s DM care in PHO level• We are thinking about sharing VDR cube with DHB via SAS AMO in the future
  • 26. SAS AMO for VDR
  • 27. Conclusions• Superior method involves the whole diabetes population in comparison to sampling used in other national surveys• The central authority monitors and local primary care organizations can monitor• Very accurate and robust: reveal the true representation• The VDR is the best option to monitor diabetes prevalence unless the national diabetes registry is established.• The VDR is invaluable for monitoring national prevalence and supporting clinical quality improvements.• The VDR is readily applicable to other areas to investigate the correlation between the two or amongst many other factors• SAS has been the key tool to develop and share the VDR in very effective way

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