The ADIPS pilot National Diabetes in Pregnancy Audit Project

Background: Limited resources are available to compare outcomes of pregnancies complicated by diabetes across different centres. Aims: To compare the use of paper, stand alone and networked electronic processes for a sustainable, systematic international audit of diabetes in pregnancy care. Methods: Development of diabetes in pregnancy minimum dataset using nominal group technique, email user survey of difficulties with audit tools and collation of audit data from nine pilot sites across Australia and New Zealand. Results: Seventy-nine defined data items were collected: 33 were for all women, nine for those with gestational diabetes (GDM) and 37 for women with pregestational diabetes. After the pilot, four new fields were requested and 18 fields had queries regarding utility or definition. A range of obstacles hampered the implementation of the audit including Medical Records Committee processes, other medical/non-medical staff not initially involved, temporary staff, multiple clinical records used by different parts of the health service, difficulty obtaining the postnatal test results and time constraints. Implementation of electronic audits in both the networked and the stand-alone settings had additional problems relating to the need to nest within pre-existing systems. Among the 496 women (45 type 1; 43 type 2; 399 GDM) across the nine centres, there were substantial differences in key quality and outcome indicators between sites. Conclusions: We conclude that an international, multicentre audit and benchmarking program is feasible and sustainable, but can be hampered by pre-existing processes, particularly in the initial introduction of electronic methods.