Super Six reduces diabetes-related hospital admissions
A review of the Super Six model of care has shown a significant decrease in diabetes-related hospital admissions.
Figures show that since the new way of working was introduced five years ago there has been a 29.5 per cent decrease in the rate of admissions from diabetic ketoacidosis (DKA).
There has also been a 42 per cent drop in the rate of admissions relating to hypoglycaemic events and 30 per cent less hyperosmolar hyperglycaemic state (HHS) admissions.
The Super Six model, which was established in Portsmouth Hospitals NHS Trust five years ago, was developed to streamline care across the Clinical Commissioning Groups in its catchment area with the aim to improve health outcomes of people with diabetes.
The six services were:
- Inpatient diabetes
- Foot diabetes (with predefined criteria)
- Poorly controlled type 1 diabetes, including adolescents
- Insulin Pump services
- Low eGFR or patients on renal dialysis
- Antenatal diabetes
To determine how effective the model has been in improving clinical outcomes for people with diabetes five years after implementation outcome measures were set which included patient and primary care practitioner satisfaction and diabetes-related hospital admissions.
Approximately 150 patients completed the survey and the average satisfaction rating was 9.5.
Each participating practice completed the survey, which represented their collective opinion of the service and in total, 96.6 per cent scored between 8–10 on satisfaction in regards to the services available.
A total of 100 per cent of practices reported they would continue to use the services provided.
The model was created after it had been identified there was a lack of co-ordinated and communicated plans across healthcare providers.
Dr Partha Kar of Portsmouth Hospitals NHS Trust, who helped pioneer the Super Six model, said: “This model of care looks at how differently we can approach diabetes care and the initial idea was really very simple.
“It was based on specialists using the hospitals for high-end care, with the rest of the services being managed in primary care.
Dr Kar, who is based at the Queen Alexandra Hospital and is also associate national clinical director for diabetes for NHS England, added: “We, as a community, are working to get this right. We don’t believe it’s the perfect model of care, but it’s held its own and is bound by a core strategy – which uses the same group of specialists working in both community and acute settings.
“The term ‘community diabetologist’ is archaic and irrelevant in an era where patients are seen across the system. A hospital is only part of the community- and this is what our model of care has tried to reflect.”
It was also discovered, that despite caring for people who had been discharged from the same hospital, there were variations in the quality of the service provided in primary care and in the community, and in systems for the two primary care trusts.
So, by using existing policy and best practice guidance, it was agreed that clinicians would work together to discharge 90 per cent of people with diabetes who were currently receiving follow-up secondary care in “general/complex diabetes clinics” back into primary care.
Key to the new, proposed model of care was an understanding that offering the best care did not necessarily mean all patients were to be seen in a specialist service based within a hospital.
However, it was agreed that there were areas of diabetes care that needed to be under the auspices of the specialist setting.
Following the definition of the services that the specialist care team would manage, consultants and GPs undertook a joint review of all patients known to the specialist service and identified those who could be discharged to primary care and those who were more appropriately retained by the specialist care team within the Super Six clinics.
Subsequently, both a diabetologist and a specialist nurse attended practice meetings over a 12-month period to review individuals and identified them for potential discharge to primary care and to facilitate their transition.
Practice teams did not ignore the fact that those being discharged might still have complex needs. Despite the variable expertise and resources available in primary care, it was felt that these needs could still be supported, drawing on the expertise of the specialists in their capacity as educators.
This underlined the basic principle that the consultant team in the specialist unit had two main roles – that of medical “specialist” and “educator”.
The specialist role involved leading the Super Six pathways within the acute trust, while the educator role was developed to support primary care managing those in the community.
Support offered by the educator was guided by the needs of primary care and conducted in a combination of virtual and face-to-face communications.
It was intentionally exible and led by the requests of the practice (e.g. discussion around specific complex cases and insulin initiation).
Practice visits were held at least every six months, which complemented the existing contacts by the community nurse specialists.
In addition, with local Clinical Commissioning Group (CCG) approval, a free educational portfolio including the following topics was established, which has since been run on an annual basis.
A Local Enhanced Service agreement is in place that recommends that the lead GP and nurse for each practice attend a minimum of 10 hours of education a year.