TY - JOUR
T1 - Associations between attainment of incentivised primary care diabetes indicators and mortality in an English cohort
AU - McKay, Ailsa J.
AU - Gunn, Laura H.
AU - Vamos, Eszter P.
AU - Valabhji, Jonathan
AU - Molina, German
AU - Molokhia, Mariam
AU - Majeed, Azeem
N1 - Funding Information:
This report is independent research supported by the National Institute for Health Research Applied Research Collaboration Northwest London, and in part by funds provided by the University of North Carolina at Charlotte. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care.
Publisher Copyright:
© 2021 Elsevier B.V.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/4
Y1 - 2021/4
N2 - 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.
AB - 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.
KW - General practice
KW - National Diabetes Audit
KW - Quality and Outcomes Framework
KW - Type 2 diabetes
UR - http://www.scopus.com/inward/record.url?scp=85102875610&partnerID=8YFLogxK
U2 - 10.1016/j.diabres.2021.108746
DO - 10.1016/j.diabres.2021.108746
M3 - Article
C2 - 33713716
AN - SCOPUS:85102875610
SN - 0168-8227
VL - 174
JO - Diabetes Research and Clinical Practice
JF - Diabetes Research and Clinical Practice
M1 - 108746
ER -
