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IDF Europe General Assembly Munich, October 14, 2005 Activities in Germany National Action Forum Diabetes (NAFDM), Diabetes Attitudes, Wishes and Needs (DAWN) and many others Rüdiger Landgraf for National Action Forum Diabetes (NAFDM) and DAWN Diabetes Center, University of Munich, Germany Patient has to be the center of all health care activities National disease management programme for type 2 diabetes in Germany 2002 (§ 137f, Abs. 2 SGB V ) Optimization of patient care Patient empowerment by training Prevention of diabetic-specific secondary complications Improvement of quality of life Structured patient care based on evidence-based diagnostic and therapeutic procedures including structured documentation and central data management and evaluation Improvement of integrated care Reduction of costs Continuous evaluation Integrated Patient Care Inclusion in a DMP Basic programme Patient without risks or complications (f.e. DIABCARE Standard) Children+ Adolescents Disease Manager (GP) Risk programme One additional risk More additional risks Complication programme Retino- Nephro- PNP/Foot Macropathy pathy syndrome angiopathy Pregnancy Disease Management Programme © R. Landgraf, S. Eberl, W. Piehlmeier 2005 Health Care Providers Interdisciplinary Cooperation Health Insurances Angiology Ophthalmology Surgery/Orthopedics Gastroenterology Medical Associations Social Services Gynecology/Obstretics Lay organizations Cardiology GP Nephrology Diabetes Team Diabetes Nurse Neurology Orthopedic Shoemaker Patient Psychiatry/Psychology Nutrition Adviser Physiotherapy Radiology Urology Intensive Care Sport Groups Diabetes Specialist Foot Clinic Dialysis Transplantation Medicine Dentistry Laboratory Pharmacy Diabetes qualified GP Diabetes Clinic Rehabilitation Quality Manager Informatician Statistician Disease Management Programme © R. Landgraf, S. Eberl, W. Piehlmeier 2005 Health Care Card implemented in 1993 In the next (15th) edition: inclusion of the WHO–5 well being score More than 3,5 millions cards have been distributed Server-Technology Internet Mobil phones Internet Intranet Telemonitoring Teleinformation Telemonitoring Teleinformation MD/Team Patient Client – Server Architecture Interface to practice software Additive Functions/ Software components: • Recall/Reminder • Watchdog • Check of plausibility Interactive training programmes Algorithms for diagnosis and therapy Electronic patient record and validity of the data • Evaluation • Cost analysis Disease Management Programm Drug interactions Coding and reimburse ment Evidence based guidelines Structure - and Process quality © R. Flexible integration of regional specialities Landgraf, S. Eberl, W. Piehlmeier, 2005 Future plan : Health Care Card (EuroMed-ID Systems 2005) 50 MB DVD 1 GB 128 KB Active involvement of the patient carrying his whole medical record Evidence based and practical guidelines „Psychosocial Aspects and Diabetes“ GLOBAL IDF-DAWN PSYCHOSOCIAL DIABETES GUIDELINE TASK FORCE Well-being Index (WHO-5) (DAWN Study 2005) good (Score18) medium (Score 11-17) bad 0 Type 1 1 Typ 20 Type22mit withInsulin insulin Typ 40 60 Type22 ohne withoutInsulin insulin Typ • In general significant reduced well-being • Signs of depression start at a score <10 80 Evidence-based and practical guidelines (produced and published by the German Diabetes Association) • • • • • • • • • • • • • • • • • • Definition, classification and diagnosis of diabetes mellitus Epidemiology and course of diabetes in Germany Diabetic neuropathy Diabetes and hypertension Diabetes and nephropathy Diabetic retino- and maculopathy Diabetes and the heart Therapy of type 2 diabetes Therapy of type 1 diabetes Diagnosis and therapy of type 1 diabetes in children and adolescents Prevention and therapy of obesity Psychosocial aspects and diabetes Diabetic foot syndrome Diabetes in the elderly Nutrition and diabetes In preparation: Diabetes and migrants National guidelines Diabetes and pregnancy Training programms to become a: • • • • • • Diabetes specialist Psycho-Diabetologist Diabetes nurse Diabetes assistant Podologist Diabetes-spezialized pharmacist Novo Academy Mini Novo Academies 60 academies since 2001 Clinical medicíne+communication Nearly 1700 participants In all regions of Germany GP´s, diabetes specialists, diabetes nurses 15-20/yr Topics: Clinical medicine, psychology, communication Presentation of the DAWN study at annual meetings (DDG) 2004, 2005 Press conference 2004 14 articles about DAWN have been printed Seminars in practical diabeteology: Controversial issues + health politics DAWN Diabetes Attitudes, Wishes and Needs In preparation: CD and live concert with diabetic singers KOL visits Benefit soccer match: German national team Against an international team Youth meeting 2006 N=1300 Introduction of Diabetes Quality Management in hospitals and diabetes centers Diabetes Quality-ModelTM 3 stages of diabetes institutions 1.Specialized institution 2. Specialized institution with QM +external audit 3. Center of excellence DIN ISO 9001 : 2000 KTQ ® proCumCert ® Philosophy of EFQM ® EFQM = European Foundation for Quality Management Diabetes Quality Management Structure quality Process quality Outcome quality Transfer quality Integrated Patient Care Outpatient Care Inpatient Care Outpatient Care Interface Specialist Specialist GP GP Path Interface Path Path Path Interface Interface Path Interface Diabetes Quality Management Category I - Diabetes management Cooperation with all subspecialities and patient questionnaires Category II Category III Team qualification Postgraduate training Knowledge management Infrastructure of the center Category IV Category V Category VI Institutional management Strategy Cooperation Politics Partnership Employee management Financial Plan Supplier Schematic Quality Development by the DQM™ Quality level Report and Evaluation Report and Evaluation Improvement Report and Evaluation Accreditation/ Certificate niveau Improvement Report and Evaluation © DCEM-Group. Improvement 2004 2005 Start internal QM 2006 2007 First assessment by an external audit Year National Action Forum Diabetes mellitus NAFDM (www.nafdm.de) 2005 Intranet Nationales Aktionsforum Diabetes Mellitus 01 Organisation 02 Wissen 03 Projektarchiv Protected area for active members of the NAFDM National Actions Forum Diabetes mellitus (NAFDM) 1. Founded October 7, 2004 2. Aims: Improvement in prevention, early detection, care and research of diabetes by visualization and coordination of all actions and groups 3. This cooperation includes representatives of all key organs and organizations, like ministries, insurance companies, political parties, scientific and other professional associations, lay organizations, schools, kindergarten, media, industries National Action Forum Diabetes mellitus (NAFDM) 4. Development of strategies and programs for the improvement of diabetes care and research 5. Three arears are set up: Prevention - Patient Care – Research (experimental and clinical) 6. Deutsche Diabetes Union is coordinating NAFDM 7. The coordination is supported by the Ministry of Health and Social Security, Aventis Foundation and others 8. Position statements for prevention and patient care have been published in April 2005. A research statement is in preparation. Publications of position statements concerning prevention and patient care Structure of the National Action Forum Diabetes mellitus Professional Steering Committee Political Steering Committee Coordination Unit Project group: Prevention Project group: Patient care „MAP“ of all activities Public affairs Project group: Research Research and development National Diabetes Studies: • Therapy study: Therapy of Type 2 Diabetes focussing on clinical endpoints • Prevention study: Efficacy and efficiency of lifestyle interventions in the prevention of type 2 diabetes National Action Forum Diabetes mellitus NAFDM Coordinated by DEUTSCHEN DIABETES-UNION e.V. Supported by Federal Ministry of Health Optimal therapy of secondary complications of diabetes Optimization of integrated patient care in the different levels of care Early detection of diabetes in high risk populations Diabetes prevention in high risk populations Healthier lifestyle for everyone (f.e. in kindergärten, schools, factories, etc.) Thank you for your interest and your attention