Implementing a national quality assurance system for diabetes care: the Scottish Diabetes Survey 2001-2006.
To create a standardized systematic quality assurance system for diabetes care throughout Scotland. Each of 15 National Health Service (NHS) boards have submitted core diabetes data for a nationally agreed data specification on an annual basis since 2001. These data are collated to produce an annual national report. We describe the iterative progress of the work in obtaining and analysing this information. The setting was Scotland, with a population of 5 million. In Scotland in 2006, 196,801 people (3.9% of the population) were reported as having diabetes compared with 105,777 in 2001. In 2006 the prevalence of reported diabetes varied from 3.5 to 4.4% in different NHS board areas, reflecting variation in completeness of local registers as well as different demographic patterns. The completeness of recording of many clinical parameters has also increased. (2002 data n = 103,755: diagnosis date 77%, HbA(1c), blood pressure and cholesterol within 15 months 71, 67 and 60%, respectively, increasing to 98, 87, 89 and 85% by 2006, n = 196,801.) A national information management and technology solution (Scottish Collaborative Information-Diabetes Care), involving automatic daily collection of data from routinely used systems both in primary and secondary care, is now used to co-ordinate the collection of data in all NHS board areas. We have used routine data to estimate the prevalence of reported diabetes in Scotland, UK. This iterative approach to quality improvement has taken 6 years to achieve a baseline measure of care. There is potential to analyse these data further for a better understanding of the epidemiology of diabetes in Scotland. The national diabetes information technology system will contribute to this process.