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Effect of the quality and outcomes framework on diabetes care in the United Kingdom: retrospective cohort study

BMJ 2009; 338 doi: (Published 27 May 2009) Cite this as: BMJ 2009;338:b1870

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Improvements in glycaemic control and cholesterol concentrations associated with the Quality and Outcomes Framework.

We congratulate Dr Calvert and colleagues for their work describing
diabetes management from repeated cross-sectional primary care data.
Ascertaining whether changes in the quality of diabetes care have occurred
since the implementation of QoF targets is crucial to refine the processes
for delivering future diabetes care in the UK. We are concerned that the
results of Calvert et al suggesting limited beneficial impact of the QoF
in people with type 2 diabetes, and specifically in people with an HbA1c
>10%, might lead readers to conclude that the QoF has not been
associated with improved diabetes care in the UK.

We have just completed an audit to determine whether the proportion
of patients with diabetes meeting glycaemic control and lipid targets
changed over a 2 year period. We retrieved computer held biochemical
measurements of HbA1c and total cholesterol for 9022 adults with diabetes
whose biochemical tests were performed at Southampton General Hospital for
whom data were available for both 2006 and 2008.

In 2006, 39.6% of adults (n=3562) had glycaemic control below the
more stringent QOF DM6 threshold (HbA1c <7.5%); by 2008, this
proportion had risen to 47.7% (n=4290) (p<_0.001. these="these" data="data" are="are" not="not" comparable="comparable" to="to" those="those" presented="presented" by="by" calvert="calvert" et="et" al="al" who="who" used="used" the="the" dm20="dm20" criterion="criterion" of="of" hba1c="hba1c" _7.5.="_7.5." table="table" below="below" summarises="summarises" data.="data." pre="pre"/>
Calvert et al Southampton

2006 2007 2006 2008
HbA1c<_10 _83.4="_83.4" _82.7="_82.7" _88.1="_88.1" _90.6="_90.6" chol="chol" _="_" mmol="mmol" l="l" _66.7="_66.7" _74.2="_74.2" _76.5="_76.5" _84.1="_84.1" pre="pre"/>

In contrast to Calvert and colleagues we have examined HbA1c levels
and cholesterol concentrations in the same individuals over a 2 year time
frame. We conclude there has been marked improvement in the management of
hyperglycaemia and hypercholesterolaemia among people with diabetes over a
2 year period among people for whom repeated measurements were available.
Absolute values and improvements in these intermediate measurements among
individuals over time may differ between populations and may be masked by
making comparisons across whole populations.

Competing interests:
None declared

Competing interests: No competing interests

12 June 2009
Christopher D Byrne
Isaac Oluwatowoju, Emmanuel Abu, Sarah H. Wild
Institute of Developmental Sciences, (University of Southampton), Southampton General Hospital