Hypertension dashboard Diabetes dashboard Overdue patients list

River District

Data last updated: 5-Aug-2024

DM treatment outcomes

Outcomes for 3,500 patients under care (registered before 1-May-2024) between 1-May-2024 to 31-Jul-2024

Blood sugar controlled at latest visit in past 3 months

20%

700 patients with FBS <126 mg/dl or HbA1c <7%

Blood sugar not controlled at latest visit in past 3 months

41%   1,435 patients with FBS 126-199 mg/dL or HbA1c 7-8.9%

17%   595 patients with FBS ≥200 mg/dL or HbA1c ≥9%

No visit in past 3 months

22%

770 patients with no visit

Patients under care

Patients under care: Registered patients with diabetes with at least 1 visit in the past 12 months. Dead patients (60) and 12 month lost to follow-up patients (600) are excluded.

Cumulative registered patients: All patients with diabetes registered. Dead patients (60) are excluded.

Monthly registered patients: Patients with diabetes registered each month.

Patients with diabetes with at least 1 visit in the past 12 months

3,500

50 patients registered in Jul-2024

of 4,100 cumulative registered patients

12 month lost to follow-up

Numerator: Patients with no visit in the past 12 months

Denominator: Registered patients with diabetes. Dead patients (60) are excluded.

Patients with diabetes with no visit in the past 12 months

15%

600 patients with no visit from Aug-2023 to Jul-2024

of 4,100 cumulative registered patients

Diabetes treatment cascade

Estimated adults (>30) in River District with diabetes who are registered, under care, and controlled.

Estimated adult (>30) population with diabetes is derived from a STEPS Community Survey conducted in 2022.

100%

60,800

Estimated people with diabetes

7%

4,100

Cumulative registered patients

6%

3,500

Patients under care

1%

700

Patients with blood sugar controlled

Opportunistic screening

% of estimated adult OPD patients screened for diabetes

16%

4,800 individuals screened for diabetes in Jul-2024

of ~30,000 estimated OPD patients >18 years

Patients prescribed statins

Numerator: Patients from the denominator who were prescribed statins at their most recent visit

Denominator: Registered patients ≥40 years old with diabetes with at least 1 visit in the past 12 months. Dead patients (60) and 12 month lost to follow-up patients (600) are excluded.

Patients under care for diabetes ≥40 years old who were prescribed statins at latest visit in the past 12 months

66%

2,300 patients prescribed statins at latest visit in past 12 months

of 3,500 patients under care

Compare sub-regions

Treatment outcomes for patients with diabetes at their latest visit from 1-May-2024 to 31-Jul-2024

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Patients under care Monthly new
patients registered		 Patients
prescribed statins 		FBS <126 mg/dl or
HbA1c <7% 		FBS 126-199 mg/dL or
HbA1c 7-8.9% 		FBS ≥200 mg/dL or
HbA1c ≥9% 		No visit in past 3 months
Sub-regions
Total
Jul-2024
Total
Percent
Total
Percent
Total
Percent
Total
Percent
Total
Percent
River District 3,500 50 2,300 66% 700 20% 1,425 41% 595 17% 770 22%
Cherry Blossom County 300 3 186 62% 93 31% 84 28% 66 22% 57 19%
Fern Grove County 1,100 10 572 52% 286 26% 440 40% 176 60% 198 18%
Grasslands County 80 2 41 50% 20 25% 27 34% 14 18% 18 23%
Hillside County 90 2 45 48% 22 24% 32 35% 15 17% 22 24%
Ice Caps County 50 0 22 44% 11 22% 20 40% 9 18% 10 20%
Mangrove County 1,200 6 430 36% 216 18% 540 45% 216 18% 228 19%
Mountain County 30 1 10 33% 6 17% 14 46% 5 15% 6 22%
Oceanside County 15 12 4 32% 2 16% 7 45% 2 14% 4 25%
Peaks County 46 2 14 30% 7 15% 22 47% 6 12% 12 26%
Rain Forest County 47 0 12 24% 6 12% 20 42% 6 12% 16 34%
Rivers Edge County 90 0 18 20% 9 10% 41 46% 11 12% 29 32%
Sunshine Coast County 18 0 4 18% 2 9% 8 44% 2 10% 7 37%
Tree Top County 300 6 36 12% 18 6% 114 38% 54 18% 114 38%
Vineland County 140 6 14 10% 7 5% 59 42% 17 12% 57 41%
Wind Canyon County 21 0 2 8% 1 4% 11 50% 1 4% 9 42%

Quarterly cohort reports

The treatment outcomes for newly registered patients at the end of the following quarter

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23%
46%
18%
13%
Q4-2022 cohort 300 patients

Result from past visit in Q1-2023

25%
48%
18%
9%
Q1-2023 cohort 350 patients

Result from latest visit in Q2-2023

28%
49%
16%
7%
Q2-2023 cohort 300 patients

Result from latest visit in Q3-2023

29%
48%
18%
5%
Q3-2023 cohort 800 patients

Result from latest visit in Q4-2023

30%
47%
18%
5%
Q4-2023 cohort 1,000 patients

Result from latest visit in Q1-2024

33%
47%
20%
8%
Q1-2024 cohort 750 patients

Result from latest visit in Q2-2024

Q2-2024 cohort 300 patients

Coming Oct-2024

FBS<126 mg/dl or HbA1c <7%
FBS 126-199 mg/dL or HbA1c 7-8.9%
FBS ≥200 mg/dL or HbA1c ≥9%
No visit in quarter

Diabetes drug stock

Numerator: Facilities with ≥30 patient days protocol drugs in stock.

Denominator: All facilities in the diabetes program.

Facilities with ≥30 patient days of diabetes protocol drugs in stock

Metformin — 94% in Jul-2024
Glimeperide — 64% in Jul-2024
 

Availability of blood glucose testing

Numerator: Facilities with point-of-care glucometers or lab testing available.

Denominator: All facilities in the diabetes program.

Facilities with glucometers or lab testing available.

99%

159 facilities with blood glucose testing

of 160 facilities reporting in Jul-2024

1 facility without a blood glucose testing:
CHC Weather Top

Availability of HbA1c testing

Numerator: Facilities with HbA1c lab test available

Denominator: All facilities in the diabetes program.

Facilities with HbA1c lab test available

4%

7 facilities with HbA1c testing

of 160 facilities reporting in Jul-2024

153 facility without a blood glucose testing:
CHC Apple Orchard, CHC Carrot Peak, CHC Cumin Creek, CHC Dandelion Wine, CHC Elderflower Ridge, and 148 others (see table)

Stock reporting by facility

Jul-2024 reports

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Facility
Sub-region
Metformin
in patient days
Glimeperide
in patient days
Availability of
blood glucose testing
Availability of
HbA1c testing
River District 54 60
CHC Apple Orchard Wind Canyon County 54 68 Yes No
CHC Bramble River Tree Top County 34 6 Yes Yes
CHC Bumpy Hill Fern Grove County 33 120 Yes Yes
CHC Carrot Peak Cherry Blossom County 134 180 Yes No
CHC Cumin Creek Oceanside County 46 48 Yes No
CHC Dandelion Wine Vineland County 44 103 Yes No
CHC Elderflower Ridge Riverside County 90 21 Yes No
CHC Riverside Grasslands County 40 14 Yes No
CHC Rhubarb Hills Mangrove County 65 50 Yes No
CHC Turnip Rain Forest County 45 109 Yes No
CHC Ugly Fruit Bay Wind Canyon County 54 68 Yes No
CHC Vine Bay Tree Top County 34 6 Yes No
CHC Watermelon Cove Fern Grove County 33 92 Yes No
CHC Weather Top Cherry Blossom County 134 0 No No
CHC Yellow Melon Oceanside County 102 90 Yes No
CHC Young Potato Vineland County

365

 12 Yes No
CHC Zucchiniville Riverside County 21 45 Yes No
District Hospital Strawberry Oceanside County 102 90 Yes No
PHC Apricot Island Grasslands County 14 40 Yes No
PHC Azalea Hills Mangrove County 65 50 Yes No
PHC Bumblebee Rain Forest County 45 109 Yes No
PHC Capital Town Wind Canyon County 54 68 Yes No
PHC Copperville Tree Top County 34 6 Yes No
PHC Cupola Fern Grove County 33 92 Yes No
PHC Dartboard Hill Cherry Blossom County 134 0 Yes No
PHC Deck Town Oceanside County 46 48 Yes No
PHC Dune Hill Vineland County 44 12 Yes No
PHC Eagle Hill Riverside County 90 21 Yes No
PHC Eggplant Mountain Grasslands County 12 40 Yes No
PHC El Toro Mangrove County 65 50 Yes No
PHC Fang Cove Rain Forest County 45 109 Yes No
PHC Grapefruit Hill Wind Canyon County 54 68 Yes No
PHC Gumdrop Cove Tree Top County 34 6 Yes No
PHC Happy Street Fern Grove County 33 92 Yes No
PHC Hilltop Station Cherry Blossom County 134 0 Yes No
PHC Iceberg Oceanside County 102 90 Yes No
PHC Idaho Hills Vineland County

365

 12 Yes No
PHC Jackfruit Riverside County 21 45 Yes No
PHC Juniperberry Grasslands County 14 44 Yes No
PHC Lard Lane Mangrove County 65 50 Yes No
PHC Lobby Mountain Rain Forest County 45 109 Yes No
Subdistrict Hospital Grape Mangrove County 32 40 Yes No
Subdistrict Hospital Juniper Oceanside County 202 290 Yes No
Subdistrict Hospital Grasslands Grasslands County 100 106 Yes No
UPHC Cinnamon Hill Mangrove County 19 66 Yes No
UPHC Dandelion Mountain Oceanside County 52 12 Yes Yes
UPHC Dill Weed Grasslands County 80 90 Yes Yes
UPHC Dry Marjoram Mangrove County 100 12 Yes Yes
UPHC Dry Mustard Oceanside County 90 0 Yes Yes
UPHC Dry Nutmeg Grasslands County 90 90 Yes Yes
>180 days drug supply
<30 days drug supply or no blood glucose testing or no ofHbA1c testing

Hypertension and diabetes comorbidity

All patients registered in the hypertension and/or diabetes programs

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Patients under care Cumulative registered patients Died*
Hypertension-only 8,632 10,000 105
Both hypertension and diabetes 2,000 2,213 100
Diabetes-only 1,500 2,100 50
TOTAL 12,132 14,313 255
*Deaths may be undercounted.

Comorbid patients with BP controlled

Patients with both hypertension and diabetes with BP controlled at latest visit in past 3 months

50%

1,000 patients with BP <140/90

Age and sex of patients under care for diabetes

3,500 patients under care

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Age Female (64%) Male (36%) Female and male
18-29
6%
4%
10%
30-49
28%
17%
45%
50-69
19%
6%
25%
70+
12%
8%
20%

Definitions

Clear definitions for all indicators will be included here