King's College London, Academic Centre, First Floor, Henriette Raphael House, Guy's Campus, London SE1 1UL, UK.
QJM. 2013 Aug;106(8):737-45. doi: 10.1093/qjmed/hct097. Epub 2013 Apr 25.
To identify commonly captured data in the UK to look at the performance of a district's diabetes care that encompasses both primary and secondary care.
Primary care quality outcomes framework (QOF) measures for diabetes, referral rates for first appointment for specialist secondary care and emergency admission rates for diabetes (Dr Foster/HES) were used to produce a performance index scoring system. Illustrative measures from QOF were total diabetes points, DM23 attainment of HbA1c <7% (53 mmol/mol) and its exemption rate (number of patients excluded from analysis). The performance index was used to study the effectiveness of the Medway district diabetes service and this was compared to another district (Guildford) within the same Strategic Health Authority and nationally.
Medway has the highest prevalence of Diabetes (6.1%) of the 8 Primary Care Trusts examined, the lowest achievement of diabetes QOF points (96.1%) and the lowest achievement of an HbA1c level <7% (53 mmol/mol) (54.3%). Exemption reporting was the 3rd highest. SAR for first diabetes out-patient appointment to the hospital was low at 281 (predicted 576) 48% of expected. The emergency admission rate was high at 225 (predicted 168) 133% of expected. Thus primary care diabetes needs to raise performance and implement a lower threshold for OPD referral to prevent emergency admissions.
It is possible to produce an assessment of diabetes care that transcends primary/secondary care that gives a true reflection of a district's performance which will be useful to plan future health service provision.
确定英国常用的捕获数据，以了解涵盖初级保健和二级保健的地区糖尿病护理的绩效。
使用初级保健质量成果框架（QOF）糖尿病测量指标、专科二级保健首次预约的转诊率和糖尿病急诊入院率（Dr Foster/HES）来制定绩效指数评分系统。从 QOF 中选择的说明性指标包括总糖尿病积分、DM23 实现 HbA1c<7%（53 mmol/mol）及其豁免率（从分析中排除的患者人数）。绩效指数用于研究梅德韦地区糖尿病服务的效果，并与同一战略卫生署内的另一个地区（吉尔福德）和全国范围内进行比较。
在所检查的 8 个初级保健信托中，梅德韦的糖尿病患病率最高（6.1%），糖尿病 QOF 积分的完成率最低（96.1%），HbA1c 水平<7%（53 mmol/mol）的完成率最低（54.3%）。豁免报告率第三高。首次糖尿病门诊预约到医院的 SAR 低至 281（预计为 576），仅为预期的 48%。急诊入院率高，为 225（预计为 168），为预期的 133%。因此，初级保健糖尿病需要提高绩效，并降低 OPD 转诊的门槛，以防止急诊入院。
可以制作一种超越初级/二级保健的糖尿病护理评估，真实反映地区的绩效，这将有助于规划未来的卫生服务提供。
