How data for the National Diabetes Footcare Audit is collected

Information about the structures of care is collected annually from CCG and LHB commissioning leads via an electronic form or online survey. This element of the NDFA collects data on if

• there is a programme to ensure that all health care professionals who undertake routine screening to define foot risk in people with diabetes have the necessary training
• there is an established pathway showing that people with increased foot risk are referred to a designated Foot Protection Service for further assessment and for long-term surveillance and risk management, as appropriate
• there is a pathway showing that a person with new, deteriorating or recurrent diabetic foot disease can be assessed by a member of an expert Multidisciplinary Foot Care Team (MDFT) within 24 hours when appropriate

Participating services record the characteristics of the worst ulcer (index ulcer) on all new episodes of diabetic foot ulceration (this means the point at which a patient first presents to a foot treatment service with or without a referral from another service for example GP, community team, A&E, another specialist service). A foot ulcer is defined as a break in the skin surface exposing subcutaneous tissue.

From the standpoint of any foot treatment service a new episode is

• the first encounter with a patient irrespective of any previous treatment history
• a repeat encounter with a patient if, after a course of treatment, there has been an interval in which they were completely free of foot ulcers

During analysis measurements will be case-mix adjusted for type of diabetes, age, deprivation, and ethnicity; weight, smoking and diabetic complications status using data linked from other sources (mainly the core NDA).

For every new diabetic foot ulcer episode:

• the clinic will record six items at the first expert assessment of a person with a newly presenting lesion:
• NHS Number and date of birth
• consent obtained (tick yes/no) *mandatory for Welsh healthcare services only
• date
• interval between first presentation to a health professional and first assessment by your team (tick one of 5 options)
• presenting features (tick one or more of 9 options)
• SINBAD score (tick yes/no to 6 choices; SINBAD is a simple validated ulcer severity scoring system; the yes and no definitions are listed on the Data Collection Form)
• lost to follow-up at either 12 weeks or 24 weeks. For patients no longer under your care at week 12 or week 24

At 12 and 24 weeks following the initial expert assessment, the clinic record whether the patient is alive and whether they are free from active foot disease (= no current ulcers i.e. all ulcers present at the start of this episode have fully healed and no other ulcers remain unhealed).

These locally collected items are recorded on the NDFA Data Collection Form. If the patient has consented the data will need to be copied onto a web form for secure submission to NHS England. NHS England  link the locally recorded data with data items from the NDA and with HES (Hospital Episode Statistics) for England and PEDW (Patient Episode Database for Wales) for Wales and Office for National Statistics (ONS) mortality data.

The total dataset is analysed to create reports of structures, processes and outcomes of diabetic foot disease treatment for the service, the comparative local reports show data at provider (Trust), commissioner (Clinical Commissioning Group) and network (Clinical Network) level. A full list of data items used in the analysis is included in the appendices.

The NDFA offers the following benefits

• an easy to use, validated approach to the collection and analysis of quality monitoring information covering all the key interventions and preventable adverse outcomes of diabetic foot disease.
• reliable annual benchmarked (against all participating services in England and Wales) reports that can be used for service assurance, prioritisation of areas for improvement and measurement of the effectiveness of improvement initiatives.
• every participating service will get a report but for a report to include statistically significant comparisons a minimum of 100 patients will need to have been treated during the audit year. Participating centres should attempt to record data on ALL new referrals to their service.
• annual national diabetes footcare audit reports

Compliance with the expectations of Professional Bodies, Care Quality Commission, Monitor and National Health Service Litigation Authority

The audit was launched on 14 July 2014, the audit is a continuous data collection with an annual data submission deadline. Once you have familiarised yourself with the audit, you should start collecting data on all new foot ulcer episodes from this point onwards.