New IT platform prioritises “hidden risk” diabetes patients

An innovative IT platform developed at Guy’s and St Thomas’ and funded by Guy’s & St Thomas’ Charity can identify high risk diabetes patients who are on a waiting list, enabling them to be prioritised for urgent care and contributing to a reduction in health inequalities.

Details of the pilot project, published in a new paper in Diabetes Research and Clinical Practice, show how the pioneering platform can flag “hidden risk” patients, whose condition is deteriorating but clinicians may be unaware. It prioritises them to get the treatment they need to stabilise their condition.

This innovative approach using data to ensure better care and optimise clinical resources won the Driving Change Through Data and Analytics Award in the Health Service Journal earlier this year.

Results from the project showed that of more than 4,000 people on a waiting list for diabetes appointments at Guy’s and St Thomas’, 549 (13.6%) of them were at risk of their health worsening. Of the 101 highest risk patients the tool prioritised to be seen earlier than scheduled, 40 received treatments that reduced their risk and prevented their condition getting worse.

The proof-of-concept study, funded by Guy’s & St Thomas’ Charity, also found that a disproportionate number of patients highlighted as high-risk were from minoritised backgrounds and lived in areas of social deprivation.

George Brown, 71, has had diabetes for 48 years and used to check his blood sugar levels by doing regular finger-prick tests. Under the pilot project, he was flagged as of higher risk and given a digital sensor to use. It connects to a phone app which regularly monitors his levels and flags any potential issues in real-time to him and also to his clinicians.

The retired electrician, from Ladywell in south east London, said:

The sensor is much easier to use than having to prick my finger. It has an alarm which tells me if my sugar levels are too low or high, and I can better manage my diabetes at the time. The sensor and the app are very easy to use, too.

Plans are now underway for the data prioritisation tool to be used more widely in south east London and beyond, as one way of tackling health inequalities while also helping hospital teams plan appointments more efficiently.

The partnership between Guy’s & St Thomas’ Charity and the Trust’s Centre for Innovation, Transformation and Improvement (CITI) is central to the charity’s long-term focus on innovation and improvement, driving positive change for patients. The charity has committed to further funding that will support the next phase of the programme.

The teams are now working on adapting the tool to benefit patients with other chronic conditions such as kidney disease, heart failure and inherited cardiac conditions, as well as being used in rheumatology and ophthalmology.

The disruption of healthcare caused by the COVID pandemic led to a backlog of outpatient appointments and increased waiting lists for many departments. People with diabetes are at risk of complications which often result in hospitalisation and even premature death. Many of these complications can be delayed or prevented with prompt, effective intervention and enhanced care but clinicians are not always alerted to changes in a patient’s condition while they are on a waiting list.

In a bid to tackle this issue, CITI worked with the diabetes team and analytics partner Factor 50 to develop a data informatics tool.

Using data from electronic health records for 4,022 diabetes patients at Guy’s and St Thomas’, the team worked closely with clinicians to develop a set of risk factors. Patients’ information was then run through the tool to identify those most at risk while waiting for an appointment. This was compared to a sample where clinicians went through the data manually. The tool was proven to accurately identify the patients most urgently needing treatment.

Clinicians and hospital administrators have a dashboard which flags any risks to patients since their last clinic appointment. It enables them to urgently prioritise high risk patients for clinics. It also highlights the patients of lowest risk who could be seen less frequently in clinic, saving them needless journeys to hospital and freeing up appointment slots.

Janaka Karalliedde, a consultant in diabetes and endocrinology at Guy’s and St Thomas’ and who was lead author on the new paper, said:

This IT tool has been invaluable in helping us look after our most vulnerable and poorly patients. By working out patients’ risks, we can make sure those who need urgent care are seen quickly while also helping us use our resources in the most strategic and efficient way.

Chris Spellman, Directory of Delivery at CITI, said: “This is an excellent example of finding innovative solutions to everyday problems in modern healthcare, which directly benefits patients and clinicians. We’re grateful to our partners Factor 50 and to Guy’s & St Thomas’ Charity for making this pilot possible, and we’re excited to see how it can be further developed across other specialties.”

Colin Kinloch, Director of Funding at Guy’s & St Thomas’ charity said: “We are proud to support the incredible staff and exceptional healthcare of Guy’s and St Thomas’. We help Guy’s and St Thomas’ develop world-leading innovations in healthcare and medical breakthroughs that transform patients’ lives.

“This pilot study is a brilliant example of how funding innovative technologies can lead to significant improvements in health outcomes and a reduction in health inequalities. We are very much looking forward to building on this award-winning pilot through the next phase of our partnership with the fantastic CITI team.”

The work of Guy’s & St Thomas’ Charity is supported by generous donors who wish to do something exceptional and help Guy’s and St Thomas’ to provide the very best in healthcare for patients and families. To support their work, visit the Guy’s & St Thomas’ Charity website.