Interventions using pediatric diabetes registry data for quality improvement: A systematic review

Abstract

Background: Diabetes registries contain vast amounts of data that can be used for quality improvement (QI) and are foundational elements of learning health systems; infrastructure to share data, create knowledge rapidly and inform decisions to improve health outcomes. QI interventions using adult diabetes registries are associated with improved glycemic control, complication screening rates, and reduced hospitalizations; pediatric data are limited.

Objective: To evaluate the effects of QI strategies that use pediatric diabetes registry data on care processes, organization of care, and patient outcomes.

Methods: We searched MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Google, Google Scholar, Directory of Open Access Journals, and diabetes registry websites for studies that evaluated the impact of QI interventions on diabetes care processes, care organization, or patient outcomes, using pediatric diabetes registry data. Two reviewers independently assessed eligibility, extracted data and assessed the risk of bias.

Results: Twelve studies were included. Most interventions targeted health-care providers and evaluated effects on patient outcomes. Five of nine studies that evaluated hemoglobin A1c found improvements of 0.26% to 0.85% (2.8-9.3 mmol/mol) while four found no difference. Many report positive effects on care processes or organization. Study data could not be combined because of variable study design and outcome measures. Included studies represent a minority of existing registries.

Conclusions: Pediatric diabetes registries are underused for QI and may facilitate improved care and outcomes. Existing vast amount of pediatric registry data could be used to foster the development of learning health systems and to improve diabetes care and outcomes.

Keywords: diabetes mellitus; pediatric; quality improvement; registries.