Diabetes Management

Diabetes is a chronic disease that is a serious and growing health problem. It is the sixth leading cause of death in Ontario and Canada. Diabetes is a leading cause of cardiovascular disease, amputation, blindness and end-stage renal failure leading to dialysis.

In Ontario, more than 900,000 people are living with diabetes. Over the past 10 years, the number of Ontarians with diabetes increased 69 per cent and is expected to grow to 1.2 million by 2010. Each year:

• 350 of these people will go blind;
• 1,100 people will have a limb amputated;
• 2,300 people will have a heart attack; and
• 3,200 people will die.

The Ontario government has explicitly placed the prevention and management of chronic diseases such as diabetes as a major health care priority and aims to prevent $300 million in hospital costs annually. eHealth Ontario’s Strategy 2009-2012 identifies diabetes management as one of its three clinical priorities.

Identifying the diabetes care gap

For the first time in Ontario, eHealth Ontario has identified the diabetes care gap. Through the process of mining existing provincial databases, eHealth Ontario has identified:

• 906,577 patients with diabetes and matched them to the nearly 9,000 primary care providers in the province;
• 53 per cent of Ontarians with diabetes received a blood sugar test in the last six months;
• 64 per cent of Ontarians with diabetes received a cholesterol test (LDL) in last year;
• 64 per cent of Ontarians with diabetes received a retinal exam in the last two years; and
• 34 per cent of Ontarians with diabetes received all three tests/exams within the accepted guidelines.

In addition, for the first time in Ontario, eHealth Ontario has provided Local Health Integration Networks (LHINs) with information about the diabetes care gap in their geographic area and across Ontario.

Diabetes Registry

The Diabetes Registry will be an interactive, real-time information system designed to track how well patients in Ontario with diabetes are cared for according to evidencebased guidelines. It will track the test dates and provide results for lab tests. This information will help improve clinical management and patient self-management of care.

The Diabetes Registry will give care providers and patients reminders, alerts and reports on these indicators. Through integration with other systems such as the Ontario Laboratories Information System, the Diabetes Registry will continually identify new patients with diabetes and will consolidate and update information on critical diabetes indicators.

Patient benefits:

• Patients will be able to view their health information and track how well they are doing against clinically acceptable targets.
• Patient visits to family physicians will be reduced, if best care guidelines are followed.
• Patient morbidity and mortality rates will be reduced.

Health service provider benefits:

• Providers will be able to monitor patient compliance with evidence-based interventions.
• They will be able to set patient care plan goals and view progress against targets as well as receive alerts when best practices are not being followed.

Health system benefits:

• Emergency room wait times and use will be reduced.
• Lessons learned will be used for addressing other chronic disease management areas in a more systematic way.
• New patients with diabetes will continue to be identified and information on critical diabetes indicators will be consolidated and updated.
• Provider and patient reminders, alerts and reports on critical diabetes indicators will reduce the gap between evidence-based guidelines and the care Ontarians receive.

Progress to date

• A test phase of the Diabetes Patient Lists and the Diabetes Care Reports was completed in summer 2009. Provider awareness and public notification campaigns are currently in development.
• A Request for Qualifications (RFQ) to identify qualified vendors for the Diabetes Registry was
  released and three vendors have been short-listed.
• The three short-listed vendors will receive the Request for Proposals (RFP).

Next steps

Diabetes Patient Lists and Diabetes Care Reports will be delivered in stages beginning this winter to approximately 9,000 primary care providers across Ontario. The Diabetes Registry begins limited production rollout in fall 2010.