Ailsa J McKay1, Laura H Gunn2, Eszter P Vamos3, Jonathan Valabhji4, German Molina5, Mariam Molokhia6, Azeem Majeed7. 1. Department of Primary Care and Public Health, Imperial College London, London, UK. Electronic address: ailsa.mckay08@imperial.ac.uk. 2. 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: laura.gunn@uncc.edu. 3. Department of Primary Care and Public Health, Imperial College London, London, UK. Electronic address: e.vamos@imperial.ac.uk. 4. 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: jonathan.valabhji@nhs.net. 5. Independent researcher, Charlotte, NC, USA. Electronic address: german@alumni.duke.edu. 6. Department of Population Health Sciences, King's College London, London, UK. Electronic address: mariam.molokhia@kcl.ac.uk. 7. Department of Primary Care and Public Health, Imperial College London, London, UK. Electronic address: a.majeed@imperial.ac.uk.
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.
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.
Authors: Shivani Misra; David Gable; Kamlesh Khunti; Emma Barron; Bob Young; Partha Kar; Jonathan Valabhji Journal: Diabet Med Date: 2022-08-23 Impact factor: 4.213