McKay Ailsa J, Gunn Laura H, Vamos Eszter P, Valabhji Jonathan, Molina German, Molokhia Mariam, Majeed Azeem
Department of Primary Care and Public Health, Imperial College London, London, UK.
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.
Diabetes Res Clin Pract. 2021 Apr;174:108746. doi: 10.1016/j.diabres.2021.108746. Epub 2021 Mar 10.
To describe associations between incentivised primary care clinical and process indicators and mortality, among patients with type 2 diabetes in England.
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.
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).
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.
描述英国2型糖尿病患者中，激励性初级保健临床指标和过程指标与死亡率之间的关联。
一个历史性队列（2010 - 2017年，n = 84441名成年人）来自英国全科医学研究数据库（CPRD）。暴露因素包括英国质量与结果框架糖化血红蛋白（HbA1c；<7.5%，<59 mmol/mol）、血压（<140/80 mmHg）和胆固醇（<5 mmol/L）指标达标情况；以及2010 - 2011年完成的国家糖尿病审核护理流程数量。主要结局是全因死亡率。
在中位3.9（标准差2.0）年的随访期内，发生了10711例死亡。调整后的风险比（aHR）表明，分别达到HbA1c和胆固醇指标的患者死亡率降低了12%（95%置信区间8 - 16%；p < 0.0001）和16%（11 - 20%；p < 0.0001）。完成7 - 9个护理流程的患者死亡率也低于完成0 - 3个或4 - 6个护理流程的患者（aHR分别为0.76（0.71 - 0.82），p < 0.0001和0.61（0.53 - 0.71），p < 0.0001），但血压指标达标情况对死亡率无明显影响（aHR 1.04, 1.00 - 1.08；p = 0.0811）。
胆固醇、HbA1c和综合过程指标达标与生存率提高相关。审查基于社区的护理服务可有助于缩小指标标准与当前结果之间的差距，进而提高预期寿命。
