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Selected Outputs

CPRU and SCIE have joined together to produce a range of materials to support partnership working in child protection. Cross-cutting lead for social care, Amanda Edwards, coordinated the project that focused specifically on liaison between acute paediatric and child protection services.

Further information

Long Term Conditions Projects

Type 1 Diabetes - Psycho-educational interventions

Effectiveness of UK-based psycho-educational interventions in children and young people with type 1 diabetes: a systematic review

Description: Structural educational programs, with or without psychological elements, constitute an integral part of diabetes management in children. However, evidence for the effectiveness of psycho-educational interventions in children with diabetes is predominantly available from the USA and may not be directly applicable to the NHS context. This systematic review aims to synthesise evidence provided by UK-based randomised trials for the effectiveness of psycho-educational interventions in improving glycaemic control and other psycho-educational outcomes in children with type 1 diabetes.

For further information contact Dimitrios Charalampopoulos

Variation in Glycaemic Control and DKA Admissions

Exploring Variation in Glycaemic Control and Diabetic Ketoacidosis (DKA) admissions among Paediatric Diabetes Units (PDUs) in England & Wales over an 8-year period (2005-2013)

Long term prognosis for Type 1 Diabetes (T1D) in children remains poor. Metabolic control in T1D is the most important modifiable risk factor for the development of diabetes complications, but for reasons that are unclear the glycosylated haemoglobin (HbA1c) level, a quality of care outcome measure, differs considerably between clinics across England and Wales. In addition, results from the NHS Diabetes Atlas of Variation provided evidence for alarming variation in DKA admissions.

Variation in diabetes outcomes, together with the observed differences in care processes across units, indicate that clinic-level factors might have an impact on poor metabolic outcomes in children and young people with T1D.

This project is conducted in collaboration with the Royal College of Paediatrics and Child Health and the National Paediatric Diabetes Audit (NPDA) and aims to:

  1. explore variation in glycaemic control and DKA admissions across PDUs over an 8-year period
  2. undertake a detailed assessment examining any changes in the patterns of care over time and how these relate to metabolic control and recurrent DKA admissions
  3. examine whether differences in glycaemic control and DKA admissions among centers remain after adjustment for patient-level characteristics

For further information contact Dimitrios Charalampopoulos

Patient Experience and Glycaemic Control

Association between patient experiences and glycaemic control in CYP with T1D in England & Wales

Patient Reported Experience Measure (PREM) is increasingly recognized as an important indicator of quality of healthcare since it provides a key means of incorporating patients views into healthcare decision making.

PREM was first introduced in diabetes units in England and Wales during 2012-13 with 13,118 children and their families providing their feedback. Published results from the first year of implementation revealed considerable differences in patient satisfaction across diabetes units. Although about 73% of patients reported a good overall satisfaction, there was a 2.9-fold variation (from 35% to 100%) across centres.

The observed variation in patients experience highlights the problem of inequality in health care provision for diabetic children in England and Wales and stresses the need to explore potential links between patients experience and diabetes outcomes.

For further information contact Dimitrios Charalampopoulos

Quality Standards and Diabetes Outcomes

Association between compliance to quality standards and diabetes outcomes in CYP in England

This is a collaborative project between CPRU, National Paediatric Diabetes Audit (NPDA) and The National Diabetes Peer Review (NDPR) Team. The objectives of the project are:

1. To explore whether compliance with measures collected as part of the peer review process is in any way linked to or has influence on glycaemic control

2. To investigate whether better compliance to standards of care is associated with improved patient experience

3. To examine whether differences in compliance with standards of care between clinics are linked to hospital admissions due to Diabetic Ketoacidosis (DKA) and Hypoglycaemia

For further information contact Dimitrios Charalampopoulos

Social and ethnic determinants of type 1 diabetes, and those related to its healthcare processes and outcomes

The main aim of this project is to investigate social and ethnic determinants of Type 1 Diabetes (T1D), and those related to its healthcare processes and outcomes using robust markers of socioeconomic status (SES) and reliable measures of ethnicity.

There are strong differences in incidence of T1D by both ethnicity and SES. Non-Hispanic White children have the highest rates of T1D and generally lower rates are seen ethnic minority groups. T1D is also thought to be higher in children of high income or socioeconomic status.

However, ethnic minority children and adolescents are less likely to receive all or many of the prescribed healthcare processes, have lower attendance rates in clinics and worse outcomes (hypoglycaemia and diabetic ketoacidosis). Measures of glycaemic control (such as mean HbA1c levels) are also worse in ethnic minority and lower socioeconomic groups. Many of these health inequalities track into adulthood.

Studies on health inequalities related to T1D in England and Wales have so far been conducted on smaller study samples and restricted to particular clinics or regions. Some studies have also shown contradictory results.

Using the National Paediatric Diabetes Audit (NPDA) this project will:

  1. Provide ‘population-specific’ prevalence and incidence rates of T1D in England & Wales.
  2. Investigate inequalities in T1D treatment, healthcare processes, and outcomes.
  3. Undertake International comparisons of recurrent diabetic ketoacidosis admissions.

For further information contact Amal Khanolkar

'Did not attends' and safeguarding responsibilities

The local management of 'did not attends' for long term condition appointments in relation to safeguarding responsibilities

NHS organisations are required to have DNA (‘Did Not Attend’) or ‘Family Disengagement’ guidelines in place as part of broader child safeguarding policies. These aim to help healthcare practitioners deal with the ‘unseen child’ and manage families that have poor attendance at child health services.  

Our earlier scoping review of guidelines demonstrated that, while many guidelines are similar in key respects (structure, purpose, background), there is variation in safeguarding response. For some, one missed appointment may trigger a safeguarding response, while for in others it may take two or three defaulted appointments. 

The guidelines usually offer only the briefest advice to practitioners about how to deal with DNAs, and there is little research on the practitioner experience of implementing DNA guidelines, and the results of such implementation. For this reason, we intend to interview a number of people who create guidelines, people who implement them at trust level and people who implement them on the front line.

  1. The aim of this work is to add to our understanding of good safeguarding  by:
  2. mapping DNA policies in paediatric services; 
  3. examining differences in safeguarding response to child/young person/family non-attendance;
  4. describing the advice to practitioners contained in the policies; 
  5. exploring the experience of creating and implementing the guidelines and using them on the frontline.        

For more information contact Helen Roberts

2014 Workforce Survey of Paediatric Diabetes Services in the UK

The UCL Children’s Policy Research Unit in collaboration with the British Society for Paediatric Endocrinology and Diabetes (BSPED), the Association of Children's Diabetes Clinicians (ACDC), the National Children and Young People's Diabetes Networks, and Diabetes UK is carrying out a Workforce Survey of Paediatric Diabetes Services in the UK.

This is the latest in a series of surveys which have been carried out every 4-6 years since 1984 and aims to find out how many healthcare professionals are currently involved in the care of children and young people with diabetes in the UK. We plan to use this information in order to increase our understanding of how staffing levels in diabetes services might contribute to the variability in glycaemic control and other important diabetes outcomes seen between Paediatric Diabetes Units.

For further information contact Dimitrios Charalampopoulos

Page last modified on 27 mar 14 15:16