August 13, 2018

According to Dr. Geetha Mukerji, one of the co-primary investigators of the Diabetes balanced scorecard project, one key step to improve the quality of diabetes care is to understand the current gaps. 

Dr. Mukerji is a full-time staff Endocrinologist at Women’s College Hospital, an Assistant Professor at the University of Toronto. 

Dr Mukerji states that, “There are several challenges to improving diabetes care, but one key issue is that, despite having great evidence, there are still large practice gaps. We may know that x, y and z can improve care delivery, but implementation and adherence of x, y and z, in real life clinical practice does not occur with great fidelity, as it doesn’t occur 100 per cent of the time.  So, when we have a large gap between evidence and practice, we are not going to see optimal outcomes.”

Clearly, the most important step is to identify the key gaps and how to improve them, that is at the core of the balanced scorecard project. 

The balanced scorecard project launched in 2014 across University of Toronto with the goal of establishing a set of broad quality indicators to monitor and improve diabetes care though an audit, comprehensive feedback and benchmarking.

The project began with stakeholder engagement of patients, diabetes educators and clinicians to gain a holistic view of what quality in diabetes care meant, and then the team worked to develop a set of key indicators across six identified quality domains. These include safety, effectiveness, patient-centered, timeliness, efficient, and equitable care to reflect quality in diabetes care.

The results of this work was recently featured in both The Canadian Journal of Diabetes, and the International Journal for Quality in Health Care.

From 2016-2017, the balanced scorecard was operationalized, collecting key baseline data to understand diabetes care performance of more than 40 clinicians across five different U of T teaching hospitals, in order to identify priority areas for improvement.

“Another key challenge we face in the diabetes community is that we actually don’t have a universal way of collecting clinical data across different sites and clinicians. Some people are using paper charts, some people are using electronic medical records, but systems are not well integrated.  So, it is a very time-consuming way to collect and analyze the data. Our group is aiming to develop and use an extractable diabetes flowsheet as a first step to standardize and facilitate collecting performance data,” adds Mukerji.

Dr.Mukerji also admits that funding remains an issue, because data collection and implementing new models of care to improve care delivery from their findings are likely to require additional resources — something the entire healthcare system is struggling with.

According to Dr. Mukerji, “Our efforts will help to identify gaps in diabetes care delivery to drive continuous quality improvement efforts and discussions across multiple hospital sites, with the intent to encourage adoption of the scorecard at other hospitals across Ontario. Our aim is to disseminate the scorecard to other hospitals to promote ongoing audit and feedback and benchmarking efforts.”

Generous support for the balanced scorecard project for the participating hospitals has come through an AFP innovation grant, and from the Lawson Foundation, a non-profit agency that is devoted to improving diabetes care delivery.

Other key contributors to the balanced scorecard project include:

Ilana Halperin (Co-Primary Investigator)

Geetha Mukerji (Co-Primary Investigator)

Phillip Segal (Co-Investigator)

Jacqueline James (Co-Investigator)

Julie Gilmour (Co-Investigator)

To learn more about the balanced scorecard research findings and implications please click here:   Canadian Diabetes Journal: Patient Perspectives Manuscript