Associations between attainment of incentivised primary care diabetes indicators and mortality in an English cohort
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
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.
Date Issued
2021-04-01
Date Acceptance
2021-03-02
Citation
Diabetes Research and Clinical Practice, 2021, 174 (1), pp.1-9
ISSN
0168-8227
Publisher
Elsevier
Start Page
1
End Page
9
Journal / Book Title
Diabetes Research and Clinical Practice
Volume
174
Issue
1
Copyright Statement
© 2021 Elsevier B.V. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/33713716
PII: S0168-8227(21)00099-1
Subjects
General practice
National Diabetes Audit
Quality and Outcomes Framework
Type 2 diabetes
Publication Status
Published
Coverage Spatial
Ireland
Article Number
108746
Date Publish Online
2021-03-10