A Service Evaluation – Following the Patient Journey through the Diabetes Integrated Care Service

Background: For too long, patients' voices in healthcare, particularly when considering the complex relationship between physical and psychological health, have not been adequately considered in service design. This rigid, outdated approach is being challenged, as we aim to routinely make adaptations based on the essential feedback from patients. DICE (Diabetes Integrated Care Service, Ealing) has been designed with this in mind; DICE is a specialist service that delivers care for people with complex or difficult-to-control diabetes. Disciplines in our service include, but are not limited to, diabetes specialist nurses, specialist dieticians, consultants, endocrinologists, psychology, podiatrists, peer support link workers, and numerous diabetes education groups. Through both our multidisciplinary approach and capturing patients’ experiences of our service in the form of interviews and pre- and post-outcome measure scores, we aspire to continually improve a dynamic service that best serves the needs of those who receive our care.

 

Approach: We will firstly outline the individual disciplines that form our integrated care service, and demonstrate how collaboration in diabetes services can improve patients’ healthcare journeys. Our data will consist of qualitative and quantitative data to highlight how we evaluate and improve the DICE service as a whole. Qualitative data will be gained by analysing semi-structured interview responses from service user(s). This rich data will be separated by discipline, and a thematic analysis will be completed to identify key themes.

 

Quantitative data will be captured from the X-PERT structured diabetes education group, delivered by DICE’s diabetes psychologist. This program integrates physical and psychological health education. We will capture average scores of both psychometric as well as physical health markers (namely, HbA1c) pre- and post- intervention.

 

Results: Our qualitative data captures what our connected, but distinct, disciplines have done well as well as identifies any areas of improvement. We are using patient stories and pre- and post-outcome measure data from an education group to enrich us with data of how to further develop our service.

Implications: Iteration is most effective when applied dynamically to drive meaningful improvements. Based on our data above, we can continue our collaborative work but also consider adding regular training and development opportunities within wider teams. Furthermore, we will continue collecting and discussing Patient Stories, and create “You Said, We Did” posters to present service improvements based on patient feedback. Similar interviews with healthcare staff are also considered.

 

Implications: From our findings, we can continue to regularly collect feedback, share with the team as a training/development opportunity, and make relevant adaptations. We also consider the difficulties/limitations of not having feedback from patients who did not wish to engage.

Whilst this work makes a positive start in identifying how we can adapt our service in an iterative process, there remains scope for developing a standardised approach to consistently incorporating service user feedback into the betterment of community healthcare services.

This evaluation illustrates the importance of providing patients’ voices a platform as well as the positive implications of considering both physical and psychological health difficulties in healthcare services.