Improvements in glycaemic control and cholesterol concentrations associated with the Quality and Outcomes Framework: a regional 2-year audit of diabetes care in the UK.

AIMS: To determine whether there have been changes in glycaemic control and lipids in a cohort of people with repeated glycated haemoglobin (HbA(1c)) measurements since the implementation of the Quality and Outcomes Framework (QOF) for diabetes care.
METHODS: Retrospective retrieval of computer-held biochemical measurements of glycaemic control (HbA(1c)) and lipid profiles in adults in Hampshire, UK between 2006 and 2008. Routine data on age, sex, HbA(1c) and plasma lipids were available on an NHS database on 8997 adults with data available for HbA(1c) in both 2006 and 2008.
RESULTS: In 2006, 39.7% of adults had glycaemic control within the QOF threshold (HbA(1c) < 7.5%); by 2008, this proportion had risen to 52.1% (P < 0.001). In 2006, 11.8% of subjects had poor glycaemic control (HbA(1c) > 10.0%); by 2008, this proportion had decreased to 10.1% (P < 0.001). The proportion of subjects achieving HbA(1c) and cholesterol targets (both HbA(1c) < 7.5% and total cholesterol < or = 5.0 mmol/l) was 30.2% in 2006; in 2008, this proportion had increased to 43.7% (P < 0.001). Individuals with poorer glycaemic control (HbA(1c) > 10.0%) were younger and had higher cholesterol concentrations than people with good (HbA(1c) < 7.5%) or moderate (HbA(1c) 7.5-10.0%) glycaemic control (P value for trend, both P < 0.001).
CONCLUSION: Since the introduction of performance indicators for primary care and the incorporation of pay for performance in 2004, there has been marked improvement in the management of hyperglycaemia and hypercholesterolaemia among people with diabetes with data available in 2006 and 2008. It remains to be seen whether the new HbA(1c) audit target (HbA(1c) < 7.0%) introduced in 2009 will result in a further improvement in glycaemic control.