Attainment of primary care quality of care indicators and emergency hospital admissions in people with type 2 diabetes

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. In a study published in the Journal of the Royal Society of Medicine, 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.

Diabetes, cardiovascular and all-cause unplanned hospital admission rates were 7%–12% lower among those who met the Quality and Outcomes Framework HbA1c indicator, and 8%–14% lower among those who met the cholesterol indicator. By contrast, univariate analyses demonstrated that blood pressure indicator attainment was associated with higher rates of all types of unplanned admission. However, this association only persisted for diabetes-related admissions in multivariate analyses, and blood pressure attainment was associated with a significantly lower rate of cardiovascular-related unplanned admissions after adjustment for confounders.

Longer latency to diabetes, cardiovascular and all-cause unplanned admissions was also observed among those who met the HbA1c or cholesterol indicators, and again an association was not observed for the blood pressure indicator. Completing 7–9 National Diabetes Audit processes was associated with lower rates of all types of unplanned admissions, and meeting all nine National Diabetes Audit care processes was linked to 22%–26% lower rates for all types of unplanned admissions.


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