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

Authors

  • Mark Dusheiko,

    1. National Primary Care Research and Development Centre, Centre for Health Economics, Alcuin ‘A’ Block, University of York, Heslington, York YO10 5DD, U.K.
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    • Address correspondence to Mark Dusheiko, Ph.D., National Primary Care Research and Development Centre, Centre for Health Economics, Alcuin ‘A’ Block, University of York, Heslington, York YO10 5DD, U.K.; e-mail: mad105@york.ac.uk. Tim Doran, M.D., Harkness Fellow in Health Care Policy and Practice, is with the Harvard School of Public Health, Boston MA. Hugh Gravelle, Ph.D., is with the National Primary Care Research and Development Centre, Centre for Health Economics, University of York, Heslington, York, U.K. Catherine Fullwood, Ph.D., is with the National Primary Care Research and Development Centre, University of Manchester, Manchester, U.K. Martin Roland, D.M., is with the General Practice and Primary Care Research Unit, University of Cambridge, Cambridge, U.K.

  • Tim Doran,

    1. Harvard School of Public Health, Boston MA
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  • Hugh Gravelle,

    1. National Primary Care Research and Development Centre, Centre for Health Economics, University of York, Heslington, York, U.K.
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  • Catherine Fullwood,

    1. National Primary Care Research and Development Centre, University of Manchester, Manchester, U.K.
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  • Martin Roland

    1. General Practice and Primary Care Research Unit, University of Cambridge, Cambridge, U.K.
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Abstract

Objective. To investigate the association between indicators of quality of diabetic management in English family practices and emergency hospital admissions for short-term complications of diabetes.

Study Setting. A total of 8,223 English family practices from 2001/2002 to 2006/2007.

Study Design. Multiple regression analyses of associations between admissions and proportions of practice diabetic patients with good (glycated hemoglobin [HbA1c] ≤7.4 percent) and moderate (7.4 percent <HbA1c ≤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 practice-level 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.

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