1. No category

Steno Diabetes Center
Atención integral para la diabetes
Ulla Bjerre-Christensen MD,Ph.D
Head of Education,
Steno Diabetes Center
Diabetes Care in Denmark
Secondary care (Steno and
hospital):
All type 1, Complicated type 2
Shared :
Unknown number
Primary care (GP):
85 % Type 2, Few type 1
Steno Diabetes Center- founded 1932
To improve clinical care of patients and to understand
diabetes
Steno Concepts on Integrated Care
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


Based upon organisation of care
Competency sliding
Optimizing care through improvement in clinical quality
Involvement of users – people with diabetes
Interprofessional collaboration with the patient in
the center.
Research
Health Promotion Research
Research in Patient
Education and Prevention
Business Support
IT, Finance, HR,
Communication / PR
Clinic
Complications,
Epidemiology,
Metabolomics,
Clinical Research Unit
Education
Healthcare professionals
in DK and international,
REACH, STAR
In total approximately 5,700 patients
• 3,450 with type 1 diabetes
• 2,200 with type 2 diabetes: more complicated
• 150 with other types of diabetes
Organisation of Diabetes Care
Focus Areas and Documentation
Innovation of Diabetes Care Delivery
Clinical Quality Data
Morbidity and Mortality
Patient Satisfaction
Innovation of Diabetes Care
Steno Clinic
Innovating Diabetes Care Delivery
Steno Clinic
Creating a value adding even flow
Ambulatory
Day Hospital
Specialist
Ambulatory
Eye
screening
Pump
Clinic
Pregnancy
Clinic
Day
Hospital
Telephone
service
Patient Care
Adolescent
Clinic
Foot Clinic
Home visit
service
Type 2
Clinic
Food Lab
Competency Sliding and
Interprofessional learning
Trainee Programme for Nurses at SDC
 Runs for two years
 Structured programme covering different areas of patient
care at Steno
- both theoretical and practical
 Provide the nurse with specialized individual competencies
 Insulin adjustment
 Individual consultations
 Eye screening
 Ends up with a diploma examination
Steno Clinic
Special attention to special needs
Eye Clinic
Steno Clinic
Eye Clinic
Steno Clinic
Special attention to special needs
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
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
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Three podiatrists
Orthopedic consultant weekly
Assessments of risk patients
Orthopedic foot ware
Treatment of ulcers
Observation, examination, and education
Steno Clinic
Special attention to special needs
Steno Clinic
Improvements based on common agreements
NCQA: National Committee for Quality Assurance
Steno Clinic
Improvements based on common agreements
NCQA: National Committee for Quality Assurance
Steno Clinic
Improvements based on common agreements
Type 2
Share of patients with:
HbA1c > 75 mmol/mol
HbA1c < 53 mmol/mol
HbA1c < 64 mmol/mol
BT > 140/90
BT < 130/80
Eyes screened-yearly
Smoking status
LDL chol > 3,3
LDL chol < 2,6
Nephropathy exams
Feet exams
Goals
2014
≤ 15%
> 30%
> 65%
≤ 10%
> 25%
> 60%
> 85%
≤ 35%
> 80%
> 85%
> 80%
Mar
2014
17,1
26,9
58,8
7,9
28,4
70,8
95,7
12,3
70,5
97,5
87,1
June
2014
17,8
27,7
59,4
7,2
29,9
70,6
94,7
12,4
70,5
97
86,7
Sep
2014
16,3
27,5
60,3
6,2
35,4
67,7
94,3
10,8
73,5
96,4
85,0
Dec
2014
15,9
27,6
59,9
6,2
33,3
69,9
96,5
9,9
76,1
97,0
87,5
Mar
2015
15,2
27,2
60,0
6,9
31,5
72,3
96,6
8,2
77,2
96,8
88,6
June
2015
14,4
27,4
61,2
6,6
30,8
73,5
97,4
7,9
77,0
96,4
86,3
Steno Clinic
Improvements based on common agreements
From: MTRD (Martin Ridderstråle)
Sent: 30. august 2015 16:11
Kære alle, ugens tal!
Til læge: 349 patienter (type 1: 207; type 2: 132):





52 type 1 patienter (25% ) og 37 type 2 patienter (28% ) en HbA1c under 53
mmol/mol.
32 type 1 patienter (15% ) og 22 type 2 patienter (17% ) en HbA1c over 75
mmol/mol.
Der er 53 type 1 patienter over 40 år med LDL > 2,6 mmol/l (74% <2.6 eller ikke
aktuelle for behandling ).
Der er 33 type 2 patienter med LDL > 2,6 mmol/l (75% <2.6 ).
Der er 2 type 1 patienter med blodtryk over 140/85
som ikke er i
antihypertensiv behandling og 4 type 2 patienter med blodtryk over 140/85
som
ikke er i antihypertensiv behandling.
ABC kontrol (<53 + <2.6 + <140/<85): Der er vi denne uge på 19% for T1D
og 14%
for T2D . Der er 5 T1D patienter (2% ) og 7 T2D patienter (5% ) som helt mangler
ABC-kontrol.
Torsdag den her uge er der midtvejsbesøg fra IKAS (dvs for vores akkreditering), men jeg tror
næppe I vil møde dem ude i klinikken.
Mvh,
Martin
Steno Clinic
Optimizing care
A for HbA1c <53 mmol/mol (<7%)
B for Blood pressure <140/<85 mm Hg
C for LDL-Cholesterol <2.6 mmol/liter
Goal attainment (%)
Steno Clinic
B
C
A
ABC
Non-ABC
Goal attainment (%)
Steno Clinic
B
C
A
ABC
Non-ABC
Steno Clinic: long-term outcomes
Reduction in Diabetes Morbidities
T1 diabetes
T2
diabetes
Cardiovascular
Disease
- 12 %
- 30 %
Major
amputations
-70 %
- 82 %
Severe
retinopathy
- 18 %
-34 %
Ostri C, la Cour M, Lund-Andersen H. Acta Ophthalmol. 2013 Aug 3
Costs of complications: The Helsinki Study
60000
55057
DKK
50000
42432
40000
30000
Without complications
With Complications
24x
20000
12x
10000
2259
3644
0
Excess cost of Type 2
diabetes
Excess cost of Type 1
diabetes
Steno Clinic
Patient Satisfaction
Steno Clinic
Patient Satisfaction
Steno Clinic
Patient Satisfaction
Education of Health care professionals
• Since 2000 trained > 13.500 in diabetes in more than 40
countries
Practical Diabetology
International
 Teambased interprofessional
patient centered care
 Steno Diabetes Center faculty
(doctors/nurses/pyschologist/
dietitians)
 Organisation of care/clinical
updates
 Diabetes teams
(e.g. doctors/nurses/dietitians)
 Steno Diabetes Center
 3-day course
 Novo Nordisk Fonden
 Lectures/workshops/group
 Logistical support- NN affiliates
work/experiential learning
Practical Diabetology
International
 Teambased interprofessional
patient centered care
 Steno Diabetes Center faculty
(doctors/nurses/pyschologist/
dietitians)
 Organisation of care/clinical
updates
 Diabetes teams
(e.g. doctors/nurses/dietitians)
 Steno Diabetes Center
 3-day course
 Novo Nordisk Fonden
 Lectures/workshops/group
 Logistical support- NN affiliates
work/experiential learning
Practical Diabetology
International
 Teambased interprofessional
patient centered care
 Steno Diabetes Center faculty
(doctors/nurses/pyschologist/
dietitians)
 Organisation of care/clinical
updates
 Diabetes teams
(e.g. doctors/nurses/dietitians)
 Steno Diabetes Center
 3-day course
 Novo Nordisk Fonden
 Lectures/workshops/group
 Logistical support- NN affiliates
work/experiential learning
Practical Diabetology
International
 Teambased interprofessional
patient centered care
 Steno Diabetes Center faculty
(doctors/nurses/pyschologist/
dietitians)
 Organisation of care/clinical
updates
 Diabetes teams
(e.g. doctors/nurses/dietitians)
 Steno Diabetes Center
 3-day course
 Novo Nordisk Fonden
 Lectures/workshops/group
 Logistical support- NN affiliates
work/experiential learning
Steno Concepts on Integrated Care





Based upon organisation of care
Competency sliding
Optimizing care through improvement in clinical quality
Involvement of users – people with diabetes
Close collaboration across all areas of Steno
Thank you for your attention
www.Steno.dk