Peer review of rural and tertiary Queensland paediatric diabetes services: A pilot project from the National Health Service.

Aim: Peer review is one component of the improvement of diabetes care delivered by the National Health Service (NHS) in England and Wales. Queensland has a decentralised model of service provision with an established state diabetes network.

Methods: The NHS scheme was adapted for use in Australia, and seven trained reviewers were recruited to visit 14 'hub' centres, which in turn covered 29 'spoke' units delivering care to over 95% of all public patients <16 years old in the state. Details of control as measured by glycosylated haemoglobin (HbA1c), the rate of presentation of diabetic ketoacidosis (DKA), the use of state guidance and staffing levels were recorded. Thirteen minimum standards of care were used as a basis for assessment. A report for the use of each inspected unit was produced at the end of the process.

Results: Most units had not previously collected outcome data; 45% of new cases presented with DKA. The centre mean HbA1c was 9.1%, and only 21% of patients achieved the Australian recommended level of <7.5%. Only three centres met some of the internationally recommended staffing levels. Only two centres provided transitional care to adult services. Of 13 NHS minimum standards of care, a mean of 5 were achieved (range 1-8), a mean of 4.6 partially achieved (range 3-6) and a mean of 3.9 not achieved (range 0-9). The care for 68 patients with type 2 diabetes was particularly poor.

Conclusions: Paediatric diabetes care in Queensland is suboptimal. Recommended remedial actions are suggested that may be applicable to other states.