Implementing guidelines is at the forefront of healthcare quality improvement in India. In an effort to improve quality of diabetes care we are supporting implementation of quality standards (QS) and measurable indicators at a primary health centre attached to the Bhabha Atomic Research Centre (BARC) in Mumbai. The quality standards aim to improve identification and timely referral of patients with diabetic foot. The quality standards were derived from recommendations in the standard treatment guideline (STG) on diabetic foot, developed by the STG task force constituted by the Ministry of Health and Family Welfare and facilitated by the National Health Systems Resource Centre (NHSRC). It is part of a group of 14 STGs of key importance for India http://www.idsihealth.org/blog/idsi-in-action/india-2/. The STGs were contextualized for the Indian healthcare system by adaptation of existing evidence-based guidelines, by multidisciplinary guideline development groups.
The implementation of the diabetic foot quality standards is critical as India is estimated to have 65 million people with diabetes, projected to reach over 100 million by 2035. Patients with diabetes are at risk of developing serious complications such as lower limb amputation, cardiovascular disease, kidney failure and blindness, all preventable through better detection and appropriate management. The implementation of the diabetic foot quality standards in primary care practice aims to identify diabetics at risk of foot complications to help in the timely provision of interventions like corrective footwear for prevention of foot ulcers and gangrene. Complications of the foot are responsible for more hospital admissions than any other complication of diabetes. The implementation of the quality standards can potentially decrease the huge risk to individual patients and economic burden.
The team at the BARC primary healthcare center spent six months preparing for the implementation of the QS, including re-designing the care pathway, creating new new data input processes and referral to diabetic foot services provided by the surgery department, and developing a standardized and reliable data recording system . Core training on diabetes and diabetic foot management was provided by Dr Amanda Adler and Dr Prashant Vaz, both UK diabetic experts . In the implementation phase, continuous quality improvement is being facilitated. This includes local data capture and analysis to monitor compliance with the QS and address issues as their arise. Explicit reporting & transparent sharing of data with all concerned staff is being encouraged.