With one of the highest prevalence rates in the UK at around 8%, diabetes education for Leicester’s doctors and nurses is critical. Failure to meet practices’ training needs means variable levels of care for patients, and can lead to more hospital admissions, complications and specialist care referrals. We use artificial intelligence algorithms to analyse training needs assessments and make individual training recommendations to thousands of HCPs while monitoring uptake saving hours of DSN time analysing records.
Challenges
* Insufficient nurses to manually analyse more than a thousand healthcare professionals’ training records and corresponding strengths and weaknesses - we need a mechanism to automate the process of generating and emailing training recommendations to upskill GPs, nurses and HCAs in diabetes and to monitor uptake
* Low levels of statistic support available so we needed a tool to act as a data warehouse, enabling us to compare knowledge and confidence improvement with diabetes course and mentoring uptake, QOF performance, prevalence levels and practice size growth
* Large amounts of manual data input of survey forms and no means of optic recognition to scan any of the data into our analysis tools
Actions
* Creation of an intelligent database application without any assistance from external organisations, capable of systematically analysing knowledge and confidence survey results, cross referencing recommendations against known attendance and bookings, before deciding who to email
* Purchase of optic recognition scanning tool to minimise manual data input
* Creation of analysis tool that looks for HCPs who have completed a knowledge and confidence survey more than once and then automatically compares them to look for improvements
* Data warehousing tool to produce dashboard reports showing training uptake, QOF performance, knowledge and confidence improvements etc at a glance
* Tools for automating course reminders, generating book confirmations automatically etc.
Results
- 14.8% average improvement in HCPs’ knowledge and confidence levels through EDEN training
- Additional likelihood of MI, stroke, heart failure, or death for people with diabetes lower than in comparable CCGs (2012-13) including Slough, Birmingham Cross City/South, Luton and Bradford District CCGs. Lower likelihood of major amputation (384.2% increased likelihood as compared with 402.2% across the 5 CCGs), better blood sugar control (59mmol HbA1c in 2014-15) when compared against these 5 CCGs (matched only by Bradford CCG)
- Able to systematically analyse 1000s of healthcare professionals’ knowledge and confidence surveys,and identify gaps in training necessitating new courses in a fraction of a section - currently less than 0.3 of a second.
- Other CCGs are now asking us to perform training needs analysis for them including Cambridgeshire, East Leicestershire and West Lincolnshire.
Value
- The administrative costs of the EDEN project remain unchanged - around £41,000 per year and yet we are able to provide training needs and QOF performance analysis to other CCGs for only £1-1.5k.
- Improvement of knowledge and confidence levels of HCPs by 14.3%, reduction in risks of complications for diabetes patients (as described above) and better HbA1c control, plus consistent ratings above 92% (4.6 out of a maximum of 5.0) awarded for our courses by attendees, after 1,803 surveys over four years.
- Accreditation and reaccreditation of our courses by Royal College of General Practitioners and exemplar of best practice in London CCG report on diabetes healthcare professional education
- EDEN intelligent database app produced for only £20k and built in-house
In detail
Ambition
-To analyse the diabetes training needs of tens or even hundreds of thousands of healthcare professionals across the UK, providing CCGs with a blueprint for a programme of tailored EDEN (Effective Diabetes Education Now) training.
-To integrate our intelligent database app with real-time Google Maps of training uptake against diabetes prevalence and confidence levels available over the cloud, with unique logins for CCGs.
-To integrate our new Virtual Learning Environment seamlessly with our training recommendation system to provide links to relevant courses and resources available to any device, whether handheld, laptop or computer.
-To rival the world’s leading diabetes education centre, Joslin, with our unique blend of A.I. and competency-based training.
-To develop our artificial intelligence application further towards Amazon style predictive analysis of prevalence and training recommendation uptake trends to maximise the efficiency of training delivery.
In short, we want to continue to be the standard for healthcare professional diabetes education across the UK, and to expand our training delivery through ‘train the trainer’ to all the CCGs in the UK, so that wherever a patient goes to their GP, the same rigorous education standards are applied so that he or she can always expect the same standard of care.
Outcome
14.8% average improvement in HCPs’ knowledge and confidence levels through EDEN training Additional likelihood of MI, stroke, heart failure, or death for people with diabetes in Leicester lower than in comparable CCGs (2012-13) including Slough, Birmingham Cross City/South, Luton and Bradford District CCGs e.g. 38.9% additional risk of MI compared with 72.3% average across the 5 CCGs.
Leicester has a 14.8% additional risk of stroke for patients with diabetes as compared with 35.9% average across the other comparable CCGs with similar prevalence, ethnicity and indices of deprivation demographics.
There’s also a lower likelihood of major amputation (384.2% increased likelihood as compared with 402.2% across the 5 CCGs), and better blood sugar control (59mmol HbA1c in 2014-15) when compared against these 5 CCGs (matched only by Bradford CCG). Leicester scored 64.2% for the Public Health England treatment targets performance (last HbA1c was 59mmol/mol or less in the previous 12 months) as against the average of 61.5 for these five CCGs or the UK average of 60.4.
Spread
We have delivered EDEN training in no less than 14 CCGs using the infrastructure provided by our in-house developed intelligent database app including CCGs within Staffordshire, Cannock, Lincolnshire, and Essex and organisations from Nottingham Healthcare NHS Foundation Trust to Gibraltar Health Authority.
Our aim is to spread out our diabetes healthcare professional education philosophy through a ‘train the trainer’ approach enabling other CCGs to implement EDEN where they are. At the time of writing, we are carrying out training needs analysis for three different CCGs (Cambridgeshire and Peterborough, West Lincolnshire and East Leicestershire) to help them use gap analysis to decide where to deliver targeting diabetes education for their doctors and nurses.
Value
As a not-for-profit NHS organisation, we provide CCGs with an inexpensive solution to the problems of determining where skills gap lie in an entire workforce of GPs, nurses and HCAs. Our administrative system costs are only £40k per year, plus a further £2k invested in optic recognition software and scanner. For only around £20k, (based on the time spent of one employee) we have built an A.I. powered intelligent database app that can analyse other many other CCGs workforces and produce QOF performance and training needs analysis.
Quite simply, we can do more with the same personnel. The rapid booking system takes seconds rather than minutes as previously to book each HCP, even generating the email that goes out to confirm the booking, we have automated course reminder and recommendation generation systems, tracking tools to measure uptake (17.2% of foundation insulin training recommendations were acted upon – an impressive stat considering how busy local practices are!)
Our small team organises more than 80 training events in a year – next week, our team will fly out to Gibraltar to deliver insulin pump and diabetes training there, plus appearances at PLTs, Diabetes UK and other conferences. The cost of making our intelligent database app was only the time taken to deliver it in-house and less than £2k to pick up some new skills. Our Virtual learning environment, which includes two new e-learning courses was delivered for only £5k yet can be potentially utilised by other CCGs. We are lean and efficient yet offering services to many other CCGs.
Involvement
Our training is not just for doctors and nurses. Recognising the increasingly important role of healthcare assistants, we developed both knowledge and confidence surveys and courses specifically for HCAs, such as our Foundation and Advanced HCA modules. We are using our intelligent database app to chronicle their improvement by taking a pre-course baseline, and then measuring knowledge and confidence levels immediately post-course and then three-six months later. Initial results show a 26% improvement in post-course scores. We regularly seek the views of the HCPs attending our courses and recently had an average score of 4.8 out of a maximum 5.0 for our courses (2015-16 to 2016-17 academic year, as @ 17th November 2016).
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