Trends in the prevalence and management of diagnosed type 2 diabetes 1994–2001 in England and Wales

Lusignan, Simon de; Sismanidis, Charalambos; Carey, Iain M.; DeWilde, Stephen; Richards, Nicky; Cook, Derek G

doi:10.1186/1471-2296-6-13

Cited by 66 publications

(52 citation statements)

References 16 publications

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“…We have outlined earlier methods for identifying good-quality data in DIN-LINK 8 and this approach was repeated with further updates of the database. Validations of the DIN-LINK database have shown that its age-gender population structure is highly comparable with another large primary care database (the General Practice Research Database), 8 and we have shown that prevalence rates for a wide range of conditions including ischaemic heart disease (IHD), 8 diabetes, 9 atrial fibrillation 10 and common childhood diagnoses 11 are similar to other published data. This report is based on 152 practices that contributed continuous high-quality data 8 between 2000 and 2005 (pre-and post-dating the introduction of QOF).…”

Section: Methodssupporting

confidence: 81%

Blood pressure recording bias during a period when the Quality and Outcomes Framework was introduced

et al. 2009

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Section: Methodssupporting

confidence: 81%

Blood pressure recording bias during a period when the Quality and Outcomes Framework was introduced

et al. 2009

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“…21 Further, our predicted values for HbA1c may be less robust than those for cholesterol and blood pressure as these were based on achievement during 2000-2003, when a linear trend was valid, rather than 1997-2003. The decline in HbA1c control evident in 1999 is consistent with previous studies 22 and may relate to changes to the diagnostic criteria for diabetes or changes in laboratory referencing introduced at this time. 23,24 Strengths and weaknesses of the study Our study has a number of strengths and limitations.…”

Section: Previous Researchsupporting

confidence: 84%

Pay for perfomance and the quality of diabetes management in individuals with and without co-morbid medical conditions

Millett

Bottle

et al. 2009

J R Soc Med

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SummaryObjective To examine the impact of the Quality and Outcomes Framework, a major pay-for-performance incentive introduced in the UK during 2004, on diabetes management in patients with and without co-morbidity.Design Cohort study comparing actual achievement of treatment targets in 2004 and 2005 with that predicted by the underlying (pre-intervention) trend in diabetes patients with and without co-morbid conditions. Setting A total of 422 general practices participating in the General Practice Research Database.Main outcomes measures Achievement of diabetes treatment targets for blood pressure (< 140/80 mm Hg), HbA1c (# 7.0%) and cholesterol (# 5 mmol/L). ResultsThe percentage of diabetes patients with co-morbidity reaching blood pressure and cholesterol targets exceeded that predicted by the underlying trend during the first two years of pay for perfomance (by 3.1% [95% CI 1.1-5.1] for BP and 4.1% [95% CI 2.2-6.0] for cholesterol among patients with $ 5 co-morbidities in 2005). Similar improvements were evident in patients without co-morbidity, except for cholesterol control in 2004 (−0.2% [95% CI −1.7-1.4]).The percentage of patients meeting the HbA1c target in the first two years of this program was significantly lower than predicted by the underlying trend in all patients, with the greatest shortfall in patients without co-morbidity (3.8% [95% CI 2.6-5.0] lower in 2005). Patients with co-morbidity remained significantly more likely to meet treatment targets for cholesterol and HbA1c than those without after the introduction of pay for perfomance.Conclusions Diabetes patients with co-morbid conditions appear to have benefited more from this pay-for-performance program than those without co-morbidity.

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“…As in previous research on the quality of care delivered to diabetes patients in the United Kingdom before the introduction of QOF, 17 our analysis indicates an underlying trend of general improvements in HbA 1c , cholesterol, and blood pressure control predating QOF. The introduction of this pay-for-performance scheme appeared to have only a modest impact on some intermediate outcomes; it was associated with initial accelerated improvements in systolic blood pressure in white and black patients, but these improvements were sustained only in black patients.…”

Section: Discussionsupporting

confidence: 81%

Effect of a UK Pay-for-Performance Program on Ethnic Disparities in Diabetes Outcomes: Interrupted Time Series Analysis

Alshamsan¹,

Lee²,

Majeed³

et al. 2012

The Annals of Family Medicine

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PURPOSE We wanted to examine the long-term effects of the Quality and Outcomes Framework (QOF), a major pay-for-performance program in the United Kingdom, on ethnic disparities in diabetes outcomes. METHODSWe undertook an interrupted time series analysis of electronic medical record data of diabetes patients registered with 29 family practices in South West London, United Kingdom. Main outcome measures were mean hemoglobin A 1c (HbA 1c ), total cholesterol, and blood pressure. RESULTSThe introduction of QOF was associated with initial accelerated improvements in systolic blood pressure in white and black patients, but these improvements were sustained only in black patients (annual decrease: -1.68 mm Hg; 95% CI, -2.41 to -0.95 mm Hg). Initial improvements in diastolic blood pressure in white patients (-1.01 mm Hg; 95% CI, -1.79 to -0.24 mm Hg) and in cholesterol in white (-0.13 mmol/L; 95% CI, -0.21 to -0.05 mmol/L) and black (-0.10 mmol/L; 95% CI, -0.20 to -0.01 mmol/L) patients were not sustained in the post-QOF period. There was no benefi cial impact of QOF on HbA 1c in any ethnic group. Existing disparities in risk factor control remained largely intact (for example; mean HbA 1c : white 7.5%, black 7.8%, south Asian 7.8%; P <.05) at the end of the study period.CONCLUSION A universal pay-for-performance scheme did not appear to address important disparities in chronic disease management over time. Targeted quality improvement strategies may be required to improve health care in vulnerable populations.

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Trends in the prevalence and management of diagnosed type 2 diabetes 1994–2001 in England and Wales

Cited by 66 publications

References 16 publications

Blood pressure recording bias during a period when the Quality and Outcomes Framework was introduced

Blood pressure recording bias during a period when the Quality and Outcomes Framework was introduced

Pay for perfomance and the quality of diabetes management in individuals with and without co-morbid medical conditions

Effect of a UK Pay-for-Performance Program on Ethnic Disparities in Diabetes Outcomes: Interrupted Time Series Analysis

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