The Australasian Diabetes in Pregnancy Society published a successful pilot study of 3 approaches to clinical audit (paper, stand-alone electronic, networked electronic) across 9 different clinical settings (rural, urban, large proportion of indigenous, New Zealand) linked with a Benchmarking Centre in 2007 [Australian and New Zealand Journal of Obstetrics and Gynaecology 2007;47:198–206]. With the Australian National Diabetes Strategy Goal 4 being to “Reduce the impact of pre-existing and gestational diabetes in pregnancy”, the need to re-establish the audit programme to monitor achievement of the goal, became clear, and ADIPS volunteered to undertake this task. In 2018, the ADIPS Board established the Diabetes in Pregnancy Clinical Audit Programme Working Group which has developed a revised dataset, a process for de-identification of patients and sites, a publication protocol and proposed central data analysis and reporting site protocols. The need for the audit was presented to the Federal Minister, the Hon Greg Hunt at the National Diabetes Forum in October 2018. After the Forum, the Australian Institute of Health and Welfare (AIHW) indicated their interest in assisting with the data repository and to align the ADIPS dataset with other Australian Datasets. However, AIHW also advised that funding would be required to undertake the work.
Since this time, ADIPS has led the development of a proposal for a Clinical Quality Register with the Australian Commission on Safety and Quality in Health Care. The AIHW has provided a detailed proposal for undertaking the work with governance provided by ADIPS with the support of other key organisations. The proposal is still being worked up with the Australian Commission on Safety and Quality in Health Care.
As the approach was expected to take time to complete, ADIPS embarked upon a pilot Diabetes in Pregnancy Clinical Audit Programme. Expressions of interest were requested from ADIPS members and 11 volunteer sites had existing data for women with GDM and/or pre-gestational diabetes in pregnancy. All sites were able to provide de-identified data under existing approvals. The audit involved electronic data transfer using a Standard Format Excel Spreadsheet format with Data Field Definitions developed for this purpose. The audit is now complete with Jincy Immanuel a student at Western Sydney University collating the data as the Trusted Third Party (TTP), checking there were no site identifiers and then forwarding to Professor Flack at Bankstown-Lidcombe Hospital who has cleaned the data and through the TTP addressed any questionable data items. Overall, after cleaning data from 10,144 women were received including 435 with type 1 diabetes, 1013 with type 2 diabetes and the remainder gestational diabetes mellitus. A paper describing the benchmarking process and site variation is being drafted.
David Simmons on behalf of the working group.
Thanks to Ms Jincy Immanuel for TTP work, Prof Jeff Flack and Dr Tania Polhill for the Benchmarking work and ADIPS for their support.
Members of the working group:
Professor David Simmons (Chair)
Professor Jeff Flack, Dr Vincent Wong, Professor Robert Moses, Professor N Wah Cheung, Dr Arianne Sweeting, Professor Jeremy Oats, Dr Alexis Shub, Ian Fulcher , Dr Peter Davoren, Dr Dorothy Graham , Dr Julie Chemmanam, Dr Louise Wolmarans , Dr Anne Duffield , Associate Professor Louise Maple-Brown, Professor Christopher Nolan
Many thanks to the site contributors:
Dr Carl Eagleton, Dr Dorothy Graham, Dr Vincent Wong, Dr Lili Yuen, Ms. Janet Lagstrom, Dr Louise Wolmarans, Ms. Michele Martin, Professor N Wah Cheung, A/Professor Glynis Ross, Professor Jeff Flack