Does Higher Quality of Diabetes Management in Family Practice Reduce Unplanned Hospital Admissions?

Abstract

Objective. To investigate the association between indicators of quality of diabetic management in English family practices and emergency hospital admissions for shortterm complications of diabetes. Study Setting. 7.4 percent) and moderate (7.4 percent oHbA1c 10 percent) glycemic control. Covariates included diabetes prevalence, baseline admission rates, socioeconomic, demographic, and geographic characteristics. Data. Practice quality measures extracted from practice records linked with practicelevel hospital admissions data and practice-level covariates data. Principal Findings. Practices with 1 percent more patients with moderate rather than poor glycemic control on average had 1.9 percent (95 percent CI: 1.1-2.6 percent) lower rates of emergency admissions for acute hyperglycemic complications. Having more patients with good rather than moderate control was not associated with lower admissions. There was no association of moderate or good control with hypoglycemic admissions. Conclusion. Cross-sectionally, family practices with better quality of diabetes care had fewer emergency admissions for short-term complications of diabetes. Over time, after controlling for national trends in admissions, improvements in quality in a family practice were associated with a reduction in its admissions.

A population-based analysis of incentive payments to primary care physicians for the care of patients with complex disease

“…In studies of the UK Quality and Outcomes Framework, in which incentives were directly tied to measured quality of care, any observed decreases in hospital admissions accompanying observed changes in quality were small, [25][26][27] and some studies found no association between measured quality and hospital admissions. 28,29 Research to date, largely from the United Kingdom and United States, has provided mixed evidence of the effectiveness of these programs.…”

“…39 Most research in this area focuses on care for individual diseases, using the delivery of specific services as indicators of quality. 24,[30][31][32][33][34] Evidence of the effect of incentive-based programs on broader outcomes such as access to primary care, continuity of care, 40 hospital admissions [25][26][27][28][29]41,42 and overall resource use 30,34,43 has been inconclusive.…”

“…8,[10][11][12][13] We may not observe some follow-up contacts under a block payment option discontinued Jan. 1, 2008, but as there was no increase in contacts in 2008, any effect must be small. We assessed relational continuity of care with a single provider, because the incentives target care provided within a doctor-patient dyad, 27 but were unable to measure informational or management continuity. 23 Rates of hospital admission are at best an incomplete proxy for the impact of care on disease progression, but if inaccessible, disorganized or noncontinuous primary care leads to acute admissions, improving primary care would affect hospital admissions soon after policy changes.…”

Does Quality Affect Patients’ Choice of Doctor? Evidence from England

“…The quality indicators in the QOF were chosen on the basis of evidence about the effects of the activities they measure on patient health. Higher achievement of the quality indicators has been shown to be associated with fewer emergency hospitalisations for conditions which should be managed in primary care (Dusheiko et al ., 2011). 13 From 2006/7 practices could receive up to 1,000 points for achieving quality indicators grouped into four domains (clinical, organisation, patient experience and additional services) and for a holistic care indicator.…”

“…Although the QOF was intended to improve care for long‐term conditions and to reduce hospital admissions, there is only a weak negative correlation between ACSCs and QOF points. This may be because there are both negative and positive correlations between admissions for particular ACSCs and the QOF clinical indicators for management of those conditions (Downing et al ., 2007; Bottle et al ., 2008; Dusheiko et al ., 2011; Purdy et al ., 2011). The three patient‐reported measures are reasonably highly correlated with each other but much less well correlated with the QOF measures.…”