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Tytuł:
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Associations between attainment of incentivised primary care diabetes indicators and mortality in an English cohort.
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Autorzy:
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McKay AJ; Department of Primary Care and Public Health, Imperial College London, London, UK. Electronic address: .
Gunn LH; Department of Public Health Sciences and School of Data Science, University of North Carolina (UNC) at Charlotte, Charlotte, NC, USA; Department of Primary Care and Public Health, Imperial College London, London, UK. Electronic address: .
Vamos EP; Department of Primary Care and Public Health, Imperial College London, London, UK. Electronic address: .
Valabhji J; NHS England and NHS Improvement, London, UK; Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Metabolism, Digestion and Reproduction, Imperial College London, London, UK. Electronic address: .
Molina G; Independent researcher, Charlotte, NC, USA. Electronic address: .
Molokhia M; Department of Population Health Sciences, King's College London, London, UK. Electronic address: .
Majeed A; Department of Primary Care and Public Health, Imperial College London, London, UK. Electronic address: .
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Źródło:
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Diabetes research and clinical practice [Diabetes Res Clin Pract] 2021 Apr; Vol. 174, pp. 108746. Date of Electronic Publication: 2021 Mar 10.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: 1993- : Limerick : Elsevier Scientific Publishers
Original Publication: Amsterdam : Elsevier Science Publishers B.V., c1985-
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MeSH Terms:
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Motivation*
Diabetes Mellitus, Type 2/*diagnosis
Diabetes Mellitus, Type 2/*mortality
Primary Health Care/*statistics & numerical data
Aged ; Blood Pressure ; Cholesterol/blood ; Diabetes Mellitus, Type 2/epidemiology ; Diabetes Mellitus, Type 2/therapy ; England/epidemiology ; Female ; Glycated Hemoglobin/analysis ; Humans ; Male ; Prognosis ; Reimbursement, Incentive ; Retrospective Studies ; Survival Rate
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Contributed Indexing:
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Keywords: General practice; National Diabetes Audit; Quality and Outcomes Framework; Type 2 diabetes
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Substance Nomenclature:
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0 (Glycated Hemoglobin A)
97C5T2UQ7J (Cholesterol)
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Entry Date(s):
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Date Created: 20210313 Date Completed: 20210517 Latest Revision: 20221207
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Update Code:
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20240104
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DOI:
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10.1016/j.diabres.2021.108746
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PMID:
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33713716
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Aims: To describe associations between incentivised primary care clinical and process indicators and mortality, among patients with type 2 diabetes in England.
Methods: A historical 2010-2017 cohort (n = 84,441 adults) was derived from the UK CPRD. Exposures included English Quality and Outcomes Framework glycated haemoglobin (HbA1c; 7.5%, 59 mmol/mol), blood pressure (140/80 mmHg), and cholesterol (5 mmol/L) indicator attainment; and number of National Diabetes Audit care processes completed, in 2010-11. The primary outcome was all-cause mortality.
Results: Over median 3.9 (SD 2.0) years follow-up, 10,711 deaths occurred. Adjusted hazard ratios (aHR) indicated 12% (95% CI 8-16%; p < 0.0001) and 16% (11-20%; p < 0.0001) lower mortality rates among those who attained the HbA1c and cholesterol indicators, respectively. Rates were also lower among those who completed 7-9 vs. 0-3 or 4-6 care processes (aHRs 0.76 (0.71-0.82), p < 0.0001 and 0.61 (0.53-0.71), p < 0.0001, respectively), but did not obviously vary by blood pressure indicator attainment (aHR 1.04, 1.00-1.08; p = 0.0811).
Conclusions: Cholesterol, HbA1c and comprehensive process indicator attainment, was associated with enhanced survival. Review of community-based care provision could help reduce the gap between indicator standards and current outcomes, and in turn enhance life expectancy.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2021 Elsevier B.V. All rights reserved.)
