Factors Influencing Variation in Participation in the National Diabetes Audit and the Impact on the Quality and Outcomes Framework Indicators of Diabetes Care Management

Overview

Journal BMJ Open Diabetes Res Care

Specialty Endocrinology

Date 2018 Nov 7

PMID 30397490

Citations 5

Authors

Caroline E Wright

Stephen Yeung

Helen Knowles

Antoinette Woodhouse

Emma Barron

Sian Evans

Affiliations

Soon will be listed here.

Abstract

Objective: Participation in the National Diabetes Audit (NDA) has become a contractual requirement for all general practices in England and is used as part of the assessment framework for sustainability and transformation partnership (STP) footprints. The study aimed to investigate general practice-related factors which may influence participation in the NDA, and the impact that participation in the NDA may have on diabetes management and patient care.

Research Design: A cross-sectional analysis of routine primary care data from 45 725 646 patients aged 17+ years registered across 7779 general practices in England was performed using logistic regression. The main outcome measures included general practice voluntary participation in the NDA, general practice-related factors (practice size, deprivation, diabetes prevalence, geographic area, practice population age) and diabetes management outcomes (cholesterol, blood pressure, hemoglobin A1c (HbA1c)).

Results: Participation in the NDA differed significantly according to practice size (t(7653)=-9.93, p=0.001), level of deprivation (χ(9)=36.17, p<0.0001), diabetes prevalence (p<0.0001), practice population age (p<0.0001), and geographic area (χ(26)=676.9, p<0.0001). In addition, the Quality and Outcomes Framework diabetes indicator HbA1c (OR 1.01, CI 1.0 to 1.01, p=0.0001) but not cholesterol (p=0.055) or blood pressure (p=0.76) was independently associated with NDA participation when controlling for practice-related factors.

Conclusion: Variation in NDA participation exists. It is suggested that some practices may need additional support when submitting data to the NDA and that NDA participation may have an impact on diabetes outcomes. However, the use of NDA outcomes as a measure of progress with diabetes care by STPs is still unclear and further investigation is needed.

Citing Articles

The Development of the Municipal Registry of People with Diabetes in Porto Alegre, Brazil.

Dal Moro R, Helal L, Almeida L, Osorio J, Schmidt M, Mengue S J Clin Med. 2024; 13(10).

PMID: 38792326 PMC: 11121854. DOI: 10.3390/jcm13102783.

Primary care service utilisation and outcomes in type 2 diabetes: a longitudinal cohort analysis.

Hodgson S, Morgan-Harrisskitt J, Hounkpatin H, Stuart B, Dambha-Miller H BMJ Open. 2022; 12(1):e054654.

PMID: 35105641 PMC: 8808402. DOI: 10.1136/bmjopen-2021-054654.

National diabetes registries: do they make a difference?.

Bak J, Serne E, Kramer M, Nieuwdorp M, Verheugt C Acta Diabetol. 2020; 58(3):267-278.

PMID: 32770407 PMC: 7907019. DOI: 10.1007/s00592-020-01576-8.

Data quality predicts care quality: findings from a national clinical audit.

Yates M, Bechman K, Dennison E, MacGregor A, Ledingham J, Norton S Arthritis Res Ther. 2020; 22(1):87.

PMID: 32303251 PMC: 7164190. DOI: 10.1186/s13075-020-02179-y.

Disparities in glycaemic control, monitoring, and treatment of type 2 diabetes in England: A retrospective cohort analysis.

Whyte M, Hinton W, McGovern A, van Vlymen J, Ferreira F, Calderara S PLoS Med. 2019; 16(10):e1002942.

PMID: 31589609 PMC: 6779242. DOI: 10.1371/journal.pmed.1002942.

References

Hex N, Bartlett C, Wright D, Taylor M, Varley D . Estimating the current and future costs of Type 1 and Type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabet Med. 2012; 29(7):855-62. DOI: 10.1111/j.1464-5491.2012.03698.x. View

Ashworth M, Armstrong D . The relationship between general practice characteristics and quality of care: a national survey of quality indicators used in the UK Quality and Outcomes Framework, 2004-5. BMC Fam Pract. 2006; 7:68. PMC: 1647283. DOI: 10.1186/1471-2296-7-68. View

Khunti K, Ganguli S . Who looks after people with diabetes: primary or secondary care?. J R Soc Med. 2000; 93(4):183-6. PMC: 1297974. DOI: 10.1177/014107680009300407. View

Khunti K, Ganguli S, Baker R, Lowy A . Features of primary care associated with variations in process and outcome of care of people with diabetes. Br J Gen Pract. 2001; 51(466):356-60. PMC: 1313998. View

. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998; 352(9131):837-53. View

Snow V, Weiss K, Mottur-Pilson C . The evidence base for tight blood pressure control in the management of type 2 diabetes mellitus. Ann Intern Med. 2003; 138(7):587-92. DOI: 10.7326/0003-4819-138-7-200304010-00017. View

Nathan D, Genuth S, Lachin J, Cleary P, Crofford O, Davis M . The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993; 329(14):977-86. DOI: 10.1056/NEJM199309303291401. View

Nam S, Chesla C, Stotts N, Kroon L, Janson S . Barriers to diabetes management: patient and provider factors. Diabetes Res Clin Pract. 2011; 93(1):1-9. DOI: 10.1016/j.diabres.2011.02.002. View

Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M . Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008; 358(24):2560-72. DOI: 10.1056/NEJMoa0802987. View

10.

Turnbull F, Neal B, Algert C, Chalmers J, Chapman N, Cutler J . Effects of different blood pressure-lowering regimens on major cardiovascular events in individuals with and without diabetes mellitus: results of prospectively designed overviews of randomized trials. Arch Intern Med. 2005; 165(12):1410-9. DOI: 10.1001/archinte.165.12.1410. View

11.

Griffin S . Diabetes care in general practice: meta-analysis of randomised control trials. BMJ. 1998; 317(7155):390-6. PMC: 28634. DOI: 10.1136/bmj.317.7155.390. View

12.

Millett C, Car J, Eldred D, Khunti K, Mainous 3rd A, Majeed A . Diabetes prevalence, process of care and outcomes in relation to practice size, caseload and deprivation: national cross-sectional study in primary care. J R Soc Med. 2007; 100(6):275-83. PMC: 1885380. DOI: 10.1177/014107680710000613. View

13.

Griffiths P, Murrells T, Maben J, Jones S, Ashworth M . Nurse staffing and quality of care in UK general practice: cross-sectional study using routinely collected data. Br J Gen Pract. 2009; 60(570):36-48. PMC: 2801804. DOI: 10.3399/bjgp10X482086. View

14.

Langdown C, Peckham S . The use of financial incentives to help improve health outcomes: is the quality and outcomes framework fit for purpose? A systematic review. J Public Health (Oxf). 2013; 36(2):251-8. DOI: 10.1093/pubmed/fdt077. View

15.

Zoungas S, de Galan B, Ninomiya T, Grobbee D, Hamet P, Heller S . Combined effects of routine blood pressure lowering and intensive glucose control on macrovascular and microvascular outcomes in patients with type 2 diabetes: New results from the ADVANCE trial. Diabetes Care. 2009; 32(11):2068-74. PMC: 2768202. DOI: 10.2337/dc09-0959. View

16.

Khunti K, Ganguli S, Lowy A . Inequalities in provision of systematic care for patients with diabetes. Fam Pract. 2001; 18(1):27-32. DOI: 10.1093/fampra/18.1.27. View

17.

Goyder E, McNally P, Drucquer M, Spiers N, Botha J . Shifting of care for diabetes from secondary to primary care, 1990-5: review of general practices. BMJ. 1998; 316(7143):1505-6. PMC: 28554. DOI: 10.1136/bmj.316.7143.1505. View

18.

McLean G, Guthrie B, Sutton M . Differences in the quality of primary medical care services by remoteness from urban settlements. Qual Saf Health Care. 2007; 16(6):446-9. PMC: 2653180. DOI: 10.1136/qshc.2006.020875. View