Implementation of a diabetes in pregnancy clinical register in a complex setting

Findings from a process evaluation

Renae Kirkham, Cherie Whitbread, Christine Connors, Elizabeth Moore, Jacqueline A. Boyle, Richa Richa, Federica Barzi, Shu Li, Michelle Dowden, Jeremy Oats, Chrissie Inglis, Margaret Cotter, Harold D. McIntyre, Marie Kirkwood, Paula Van Dokkum, Stacey Svenson, Paul Zimmet, Jonathan E. Shaw, Kerin O’Dea, Alex Brown & 2 others Louise Maple-Brown, Northern Territory Diabetes in Pregnancy Partnership

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    Abstract

    Background: Rates of diabetes in pregnancy are disproportionately higher among Aboriginal than non-Aboriginal women in Australia. Additional challenges are posed by the context of Aboriginal health including remoteness and disadvantage. A clinical register was established in 2011 to improve care coordination, and as an epidemiological and quality assurance tool. This paper presents results from a process evaluation identifying what worked well, persisting challenges and opportunities for improvement. 

    Methods: Clinical register data were compared to the Northern Territory Midwives Data Collection. A cross-sectional survey of 113 health professionals across the region was also conducted in 2016 to assess use and value of the register; and five focus groups (49 healthcare professionals) documented improvements to models of care. 

    Results: From January 2012 to December 2015, 1,410 women were referred to the register, 48% of whom were Aboriginal. In 2014, women on the register represented 75% of those on the Midwives Data Collection for Aboriginal women with gestational diabetes and 100% for Aboriginal women with pre-existing diabetes. Since commencement of the register, an 80% increase in reported prevalence of gestational diabetes among Aboriginal women in the Midwives Data Collection occurred (2011–2013), prior to adoption of new diagnostic criteria (2014). As most women met both diagnostic criteria (81% in 2012 and 74% in 2015) it is unlikely that the changes in criteria contributed to this increase. Over half (57%) of survey respondents reported improvement in knowledge of the epidemiology of diabetes in pregnancy since establishment of the register. However, only 32% of survey respondents thought that the register improved care-coordination. The need for improved integration and awareness to increase use was also highlighted. 

    Conclusion: Although the register has not been reported to improve care coordination, it has contributed to increased reported prevalence of gestational diabetes among high risk Aboriginal women, in a routinely collected jurisdiction-wide pregnancy dataset. It has therefore contributed to an improved understanding of epidemiology and disease burden and may in future contribute to improved management and outcomes. Regions with similar challenges in context and high risk populations for diabetes in pregnancy may benefit from this experience of implementing a register.

    Original languageEnglish
    Article numbere0179487
    Pages (from-to)1-15
    Number of pages15
    JournalPLoS One
    Volume12
    Issue number8
    DOIs
    Publication statusPublished - 2017

    Fingerprint

    gestational diabetes
    Pregnancy in Diabetics
    Medical problems
    midwives
    Gestational Diabetes
    Midwifery
    Epidemiology
    health care workers
    epidemiology
    Health
    Northern Territory
    burden of disease
    Quality assurance
    focus groups
    Focus Groups
    cross-sectional studies
    quality control
    diabetes
    Cross-Sectional Studies
    pregnancy

    Cite this

    Kirkham, R., Whitbread, C., Connors, C., Moore, E., Boyle, J. A., Richa, R., ... Northern Territory Diabetes in Pregnancy Partnership (2017). Implementation of a diabetes in pregnancy clinical register in a complex setting: Findings from a process evaluation. PLoS One, 12(8), 1-15. [e0179487]. https://doi.org/10.1371/journal.pone.0179487
    Kirkham, Renae ; Whitbread, Cherie ; Connors, Christine ; Moore, Elizabeth ; Boyle, Jacqueline A. ; Richa, Richa ; Barzi, Federica ; Li, Shu ; Dowden, Michelle ; Oats, Jeremy ; Inglis, Chrissie ; Cotter, Margaret ; McIntyre, Harold D. ; Kirkwood, Marie ; Van Dokkum, Paula ; Svenson, Stacey ; Zimmet, Paul ; Shaw, Jonathan E. ; O’Dea, Kerin ; Brown, Alex ; Maple-Brown, Louise ; Northern Territory Diabetes in Pregnancy Partnership. / Implementation of a diabetes in pregnancy clinical register in a complex setting : Findings from a process evaluation. In: PLoS One. 2017 ; Vol. 12, No. 8. pp. 1-15.
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    title = "Implementation of a diabetes in pregnancy clinical register in a complex setting: Findings from a process evaluation",
    abstract = "Background: Rates of diabetes in pregnancy are disproportionately higher among Aboriginal than non-Aboriginal women in Australia. Additional challenges are posed by the context of Aboriginal health including remoteness and disadvantage. A clinical register was established in 2011 to improve care coordination, and as an epidemiological and quality assurance tool. This paper presents results from a process evaluation identifying what worked well, persisting challenges and opportunities for improvement. Methods: Clinical register data were compared to the Northern Territory Midwives Data Collection. A cross-sectional survey of 113 health professionals across the region was also conducted in 2016 to assess use and value of the register; and five focus groups (49 healthcare professionals) documented improvements to models of care. Results: From January 2012 to December 2015, 1,410 women were referred to the register, 48{\%} of whom were Aboriginal. In 2014, women on the register represented 75{\%} of those on the Midwives Data Collection for Aboriginal women with gestational diabetes and 100{\%} for Aboriginal women with pre-existing diabetes. Since commencement of the register, an 80{\%} increase in reported prevalence of gestational diabetes among Aboriginal women in the Midwives Data Collection occurred (2011–2013), prior to adoption of new diagnostic criteria (2014). As most women met both diagnostic criteria (81{\%} in 2012 and 74{\%} in 2015) it is unlikely that the changes in criteria contributed to this increase. Over half (57{\%}) of survey respondents reported improvement in knowledge of the epidemiology of diabetes in pregnancy since establishment of the register. However, only 32{\%} of survey respondents thought that the register improved care-coordination. The need for improved integration and awareness to increase use was also highlighted. Conclusion: Although the register has not been reported to improve care coordination, it has contributed to increased reported prevalence of gestational diabetes among high risk Aboriginal women, in a routinely collected jurisdiction-wide pregnancy dataset. It has therefore contributed to an improved understanding of epidemiology and disease burden and may in future contribute to improved management and outcomes. Regions with similar challenges in context and high risk populations for diabetes in pregnancy may benefit from this experience of implementing a register.",
    author = "Renae Kirkham and Cherie Whitbread and Christine Connors and Elizabeth Moore and Boyle, {Jacqueline A.} and Richa Richa and Federica Barzi and Shu Li and Michelle Dowden and Jeremy Oats and Chrissie Inglis and Margaret Cotter and McIntyre, {Harold D.} and Marie Kirkwood and {Van Dokkum}, Paula and Stacey Svenson and Paul Zimmet and Shaw, {Jonathan E.} and Kerin O’Dea and Alex Brown and Louise Maple-Brown and {Northern Territory Diabetes in Pregnancy Partnership}",
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    Kirkham, R, Whitbread, C, Connors, C, Moore, E, Boyle, JA, Richa, R, Barzi, F, Li, S, Dowden, M, Oats, J, Inglis, C, Cotter, M, McIntyre, HD, Kirkwood, M, Van Dokkum, P, Svenson, S, Zimmet, P, Shaw, JE, O’Dea, K, Brown, A, Maple-Brown, L & Northern Territory Diabetes in Pregnancy Partnership 2017, 'Implementation of a diabetes in pregnancy clinical register in a complex setting: Findings from a process evaluation', PLoS One, vol. 12, no. 8, e0179487, pp. 1-15. https://doi.org/10.1371/journal.pone.0179487

    Implementation of a diabetes in pregnancy clinical register in a complex setting : Findings from a process evaluation. / Kirkham, Renae; Whitbread, Cherie; Connors, Christine; Moore, Elizabeth; Boyle, Jacqueline A.; Richa, Richa; Barzi, Federica; Li, Shu; Dowden, Michelle; Oats, Jeremy; Inglis, Chrissie; Cotter, Margaret; McIntyre, Harold D.; Kirkwood, Marie; Van Dokkum, Paula; Svenson, Stacey; Zimmet, Paul; Shaw, Jonathan E.; O’Dea, Kerin; Brown, Alex; Maple-Brown, Louise; Northern Territory Diabetes in Pregnancy Partnership.

    In: PLoS One, Vol. 12, No. 8, e0179487, 2017, p. 1-15.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Implementation of a diabetes in pregnancy clinical register in a complex setting

    T2 - Findings from a process evaluation

    AU - Kirkham, Renae

    AU - Whitbread, Cherie

    AU - Connors, Christine

    AU - Moore, Elizabeth

    AU - Boyle, Jacqueline A.

    AU - Richa, Richa

    AU - Barzi, Federica

    AU - Li, Shu

    AU - Dowden, Michelle

    AU - Oats, Jeremy

    AU - Inglis, Chrissie

    AU - Cotter, Margaret

    AU - McIntyre, Harold D.

    AU - Kirkwood, Marie

    AU - Van Dokkum, Paula

    AU - Svenson, Stacey

    AU - Zimmet, Paul

    AU - Shaw, Jonathan E.

    AU - O’Dea, Kerin

    AU - Brown, Alex

    AU - Maple-Brown, Louise

    AU - Northern Territory Diabetes in Pregnancy Partnership

    PY - 2017

    Y1 - 2017

    N2 - Background: Rates of diabetes in pregnancy are disproportionately higher among Aboriginal than non-Aboriginal women in Australia. Additional challenges are posed by the context of Aboriginal health including remoteness and disadvantage. A clinical register was established in 2011 to improve care coordination, and as an epidemiological and quality assurance tool. This paper presents results from a process evaluation identifying what worked well, persisting challenges and opportunities for improvement. Methods: Clinical register data were compared to the Northern Territory Midwives Data Collection. A cross-sectional survey of 113 health professionals across the region was also conducted in 2016 to assess use and value of the register; and five focus groups (49 healthcare professionals) documented improvements to models of care. Results: From January 2012 to December 2015, 1,410 women were referred to the register, 48% of whom were Aboriginal. In 2014, women on the register represented 75% of those on the Midwives Data Collection for Aboriginal women with gestational diabetes and 100% for Aboriginal women with pre-existing diabetes. Since commencement of the register, an 80% increase in reported prevalence of gestational diabetes among Aboriginal women in the Midwives Data Collection occurred (2011–2013), prior to adoption of new diagnostic criteria (2014). As most women met both diagnostic criteria (81% in 2012 and 74% in 2015) it is unlikely that the changes in criteria contributed to this increase. Over half (57%) of survey respondents reported improvement in knowledge of the epidemiology of diabetes in pregnancy since establishment of the register. However, only 32% of survey respondents thought that the register improved care-coordination. The need for improved integration and awareness to increase use was also highlighted. Conclusion: Although the register has not been reported to improve care coordination, it has contributed to increased reported prevalence of gestational diabetes among high risk Aboriginal women, in a routinely collected jurisdiction-wide pregnancy dataset. It has therefore contributed to an improved understanding of epidemiology and disease burden and may in future contribute to improved management and outcomes. Regions with similar challenges in context and high risk populations for diabetes in pregnancy may benefit from this experience of implementing a register.

    AB - Background: Rates of diabetes in pregnancy are disproportionately higher among Aboriginal than non-Aboriginal women in Australia. Additional challenges are posed by the context of Aboriginal health including remoteness and disadvantage. A clinical register was established in 2011 to improve care coordination, and as an epidemiological and quality assurance tool. This paper presents results from a process evaluation identifying what worked well, persisting challenges and opportunities for improvement. Methods: Clinical register data were compared to the Northern Territory Midwives Data Collection. A cross-sectional survey of 113 health professionals across the region was also conducted in 2016 to assess use and value of the register; and five focus groups (49 healthcare professionals) documented improvements to models of care. Results: From January 2012 to December 2015, 1,410 women were referred to the register, 48% of whom were Aboriginal. In 2014, women on the register represented 75% of those on the Midwives Data Collection for Aboriginal women with gestational diabetes and 100% for Aboriginal women with pre-existing diabetes. Since commencement of the register, an 80% increase in reported prevalence of gestational diabetes among Aboriginal women in the Midwives Data Collection occurred (2011–2013), prior to adoption of new diagnostic criteria (2014). As most women met both diagnostic criteria (81% in 2012 and 74% in 2015) it is unlikely that the changes in criteria contributed to this increase. Over half (57%) of survey respondents reported improvement in knowledge of the epidemiology of diabetes in pregnancy since establishment of the register. However, only 32% of survey respondents thought that the register improved care-coordination. The need for improved integration and awareness to increase use was also highlighted. Conclusion: Although the register has not been reported to improve care coordination, it has contributed to increased reported prevalence of gestational diabetes among high risk Aboriginal women, in a routinely collected jurisdiction-wide pregnancy dataset. It has therefore contributed to an improved understanding of epidemiology and disease burden and may in future contribute to improved management and outcomes. Regions with similar challenges in context and high risk populations for diabetes in pregnancy may benefit from this experience of implementing a register.

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    DO - 10.1371/journal.pone.0179487

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    JF - PLoS One

    SN - 1932-6203

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