Department of Public Health Sciences, 14727University of North Carolina at Charlotte, Charlotte, NC 28223, USA.
School of Data Science, 14727University of North Carolina at Charlotte, Charlotte, NC 28223, USA.
J R Soc Med. 2021 Jun;114(6):299-312. doi: 10.1177/01410768211005109. Epub 2021 Apr 6.
England has invested considerably in diabetes care over recent years through programmes such as the Quality and Outcomes Framework and National Diabetes Audit. However, associations between specific programme indicators and key clinical endpoints, such as emergency hospital admissions, remain unclear. We aimed to examine whether attainment of Quality and Outcomes Framework and National Diabetes Audit primary care diabetes indicators is associated with diabetes-related, cardiovascular, and all-cause emergency hospital admissions.
Historical cohort study.
A total of 330 English primary care practices, 2010-2017, using UK Clinical Practice Research Datalink.
A total of 84,441 adults with type 2 diabetes.
The primary outcome was emergency hospital admission for any cause. Secondary outcomes were (1) diabetes-related and (2) cardiovascular-related emergency admission.
There were 130,709 all-cause emergency admissions, 115,425 diabetes-related admissions and 105,191 cardiovascular admissions, corresponding to unplanned admission rates of 402, 355 and 323 per 1000 patient-years, respectively. All-cause hospital admission rates were lower among those who met HbA1c and cholesterol indicators (incidence rate ratio = 0.91; 95% CI 0.89-0.92; < 0.001 and 0.87; 95% CI 0.86-0.89; < 0.001), respectively), with similar findings for diabetes and cardiovascular admissions. Patients who achieved the Quality and Outcomes Framework blood pressure target had lower cardiovascular admission rates (incidence rate ratio = 0.98; 95% CI 0.96-0.99; = 0.001). Strong associations were found between completing 7-9 (vs. either 4-6 or 0-3) National Diabetes Audit processes and lower rates of all admission outcomes (-values < 0.001), and meeting all nine National Diabetes Audit processes had significant associations with reductions in all types of emergency admissions by 22% to 26%. Meeting the HbA1c or cholesterol Quality and Outcomes Framework indicators, or completing 7-9 National Diabetes Audit processes, was also associated with longer time-to-unplanned all-cause, diabetes and cardiovascular admissions.
Attaining Quality and Outcomes Framework-defined diabetes intermediate outcome thresholds, and comprehensive completion of care processes, may translate into considerable reductions in emergency hospital admissions. Out-of-hospital diabetes care optimisation is needed to improve implementation of core interventions and reduce unplanned admissions.
近年来，英国通过质量和结果框架（Quality and Outcomes Framework）和国家糖尿病审计（National Diabetes Audit）等计划，在糖尿病护理方面投入了大量资金。然而，特定计划指标与关键临床终点（如急诊住院）之间的关联尚不清楚。我们旨在研究达到质量和结果框架和国家糖尿病审计初级保健糖尿病指标是否与糖尿病相关、心血管和全因急诊住院有关。
历史队列研究。
总共 330 个英国初级保健实践，2010-2017 年，使用英国临床实践研究数据链接（UK Clinical Practice Research Datalink）。
总共 84441 名 2 型糖尿病成人。
主要结局是任何原因的急诊住院。次要结局为（1）糖尿病相关和（2）心血管相关急诊入院。
共有 130709 例全因急诊入院，115425 例糖尿病相关入院和 105191 例心血管入院，相应的无计划入院率分别为 402、355 和 323/1000 患者年。糖化血红蛋白和胆固醇指标达标者的全因住院率较低（发病率比=0.91；95%CI 0.89-0.92；<0.001 和 0.87；95%CI 0.86-0.89；<0.001），糖尿病和心血管入院也有类似发现。达到质量和结果框架血压目标的患者心血管入院率较低（发病率比=0.98；95%CI 0.96-0.99；=0.001）。完成 7-9 项（与 4-6 项或 0-3 项相比）国家糖尿病审计流程与较低的所有入院结局发生率之间存在很强的关联（-值<0.001），完成所有 9 项国家糖尿病审计流程与所有类型的急诊入院率降低 22%-26%显著相关。达到糖化血红蛋白或胆固醇质量和结果框架指标，或完成 7-9 项国家糖尿病审计流程，也与无计划的全因、糖尿病和心血管入院时间延长相关。
达到质量和结果框架定义的糖尿病中间结局阈值和全面完成护理流程，可能会显著降低急诊住院率。需要优化院外糖尿病护理，以改进核心干预措施的实施并减少非计划性入院。
