The Western Diabetes Institute (WDI) at Western University of Health Sciences (WesternU) is collaborating with the National Health Service Scotland (NHS Scotland) to enhance the visualization, personalization and communication of diabetes patients’ health conditions, promote self-management, and ultimately to improve health care outcomes.

WDI is working with NHS Scotland to implement a modified version of the Diabetes Cross-Disciplinary Index (DXDI) health scorecard into the award-winning Scottish Care Information-Diabetes Collaboration (SCI-DC) platform.

SCI-DC is Scotland’s national suite of information technology products, and is designed to provide a single, efficient, cost-effective, and up-to-date system that underpins the care delivered throughout NHS Scotland’s Managed Clinical Networks to the country’s more than 275,000 residents diagnosed with diabetes.

Diabetes patients in Scotland can find educational information on the MyDiabetesMyWay website, but research has shown that uniquely personalized and tailored information is much more likely to be effective, said Dr. Debbie Wake, senior clinical lecturer and consultant endocrinologist at University of Dundee School of Medicine/NHS Tayside, and clinical lead on the award-winning interactive diabetes website project MyDiabetesMyWay,

“Allowing them access to information that is specifically linked to their level of care and their medication and the type of diabetes they have is really important. With information and knowledge, they can transform their own self-care,” Wake said. “I think often when we’re looking through patients’ records, the information we need is often spread across different pages or different bits of the site. Whereas this (DXDI) gives you a single snapshot of their care and can easily scan across different important areas and provide a really quick impression.”

Dr. Andrew Pumerantz, WDI’s founder and executive director, agreed. “We need to bring individualized health information, knowledge, and wisdom closer together,” he said. “Diabetes extends beyond just chronic elevations in blood sugar to involve heterogeneous patterns of co-morbidities and complications, sometimes referred to as ‘multimorbidity,’ that differ among individual patients. Maintaining a ‘whole-patient’ view’ requires a contextual reframing of diabetes that incorporates these unique profiles of multimorbidity.”

In contrast to Scotland, a U.S. patient’s health-related information sits on “islands” of data scattered across a sea of providers’ health records, Pumerantz said. WDI developed the DXDI scorecard to capture and convey disparate information to not only display the status of a patient’s blood glucose control, but also the complexity and severity of the multimorbidity that more precisely reflects their unique health status.

“DXDI could provide this ‘at-a-glance’ view from the beginning of the care cycle and afford the patient and their provider team with a better and more granular visualization to improve communication, engagement, self-management, and shared decision-making,” Pumerantz said. “DXDI has been an integral part of WDI’s model for delivering team-based, cross-disciplinary diabetes care since January 2013.”

The patient-provider team can track health outcome trends across multiple domains throughout the care cycle, thus building on incentivizing and positive reinforcement. WDI’s predominantly middle-aged, Hispanic, and female cohort has demonstrated meaningful and sustained improvements in blood glucose control and patient engagement. Pumerantz and his team believe this change is linked to the patients’ acquiring a deeper knowledge and appreciation of their composite health condition.

“We’re recognizing the extent and heterogeneity of multimorbidity that exists across this population, and we’re discovering epidemic prevalence rates of silent severe periodontal and structural heart diseases,” said Pumerantz, an Associate Professor of Internal Medicine and Infectious Disease at WesternU’s College of Osteopathic Medicine of the Pacific. “To collaborate with the group in Scotland offers a wonderful opportunity to test the DXDI scorecard on a large-scale population managed with the aid of a nationwide disease registry.

“Since all health care is local, we needed to adapt the DXDI, which was originally designed for the U.S. health care system, to fit Scotland’s, and we worked collaboratively to develop a modified version that we’re calling ‘Diabetes Cross-Disciplinary Index Scotland,’ or ‘DXDIS,’” Pumerantz said.

Since 2002, nationwide data from sources across 14 Scottish health boards has been captured in a central repository, said Dr. Scott Cunningham, technical consultant at University of Dundee/NHS Tayside, and technical lead for SCI-DC and MyDiabetesMyWay. The goal is to generate DXDIS scores for all diabetes patients in Scotland and provide the health care team access to those numbers.

“We’re also planning to have the visual representation, the charts that have been customized for the Scottish environment, available to all patients within the national system by the middle of February,” he said.

“We’re lucky in Scotland that we have all these data sources and we can use DXDIS as one of the front-facing ways that we display that data, be that for health care professionals or potentially patients, and it would give us a nice summary of care,” Wake said.

Through this international collaboration, DXDI may soon expand beyond the U.S. and Scotland. Dr. Tong Wei Yew, an endocrinologist at the National University Hospital, Singapore, is spending a year working as a visiting researcher with Drs. Wake and Cunningham at Dundee/NHS Tayside. The growing burden of diabetes and multimorbidity in Asia has fueled his commitment to explore innovative methods of health care delivery that might be used in his country.

“Diabetes is a huge public health burden. The prevalence of diabetes in Singapore is 11.3 percent, more than twice the prevalence in Scotland,” Yew said. “One of the emphases in delivering diabetes care is patient-centered, integrated care. All these priorities would be very similar to the idea of DXDI, and I think we are moving in a similar direction. I can’t speak for the whole health care system of Singapore, but the potential of using DXDI is something that we can explore in the future.”

“I look forward to that,” Pumerantz said. “Adapting DXDI to multiple global regions brings all of us closer to developing international standardization for diabetes care outcomes, and moves knowledge closer to wisdom.”