title: Diabetes prevalence, process of care and outcomes in relation to practice size, caseload and deprivation: national cross-sectional study in primary care.
abstract: OBJECTIVE
  To examine the association between practice list size, deprivation and the quality of care of patients with diabetes.
  
  
  METHODS
  Population-based cross-sectional study using Quality and Outcomes Framework data.
  
  
  METHODS
  England and Scotland.
  
  
  METHODS
  55,522,778 patients and 8970 general practices with 1,852,762 people with diabetes.
  
  
  METHODS
  None.
  
  
  METHODS
  Seventeen process and surrogate outcome measures of diabetes care.
  
  
  RESULTS
  The prevalence of diabetes was 3.3%. Prevalence differed with practice list size and deprivation: smaller and more deprived practices had a higher mean prevalence than larger and more affluent practices (3.8% versus 2.8%). Practices with large patient list sizes had the highest quality of care scores, even after stratifying for deprivation. However, with the exception of retinal screening, peripheral pulses and neuropathy testing, differences in achievement between small and large practices were modest (<5%). Small practices performed nearly as well as the largest practices in achievement of intermediate outcome targets for HbA1c, blood pressure and cholesterol (smallest versus largest practices: 57.4% versus 58.7%; 70.7% versus 70.7%; and 69.5% versus 72.7%, respectively). Deprivation had a negative effect on the achieved scores and this was more pronounced for smaller practices.
  
  
  CONCLUSIONS
  Our study provides some evidence of a volume-outcome association in the management of diabetes in primary care; this appears most pronounced in deprived areas.
authors.affiliation: Department of Primary Care and Social Medicine, Imperial College, Reynolds Building, St Dunstan's Road, London W6 8RP, UK. c.millett@imperial.ac.uk
authors.forename: Christopher
authors.initials: C
authors.lastname: Millett
authors.forename: Josip
authors.initials: J
authors.lastname: Car
authors.forename: Darren
authors.initials: D
authors.lastname: Eldred
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Khunti
authors.forename: Arch G
authors.initials: AG
authors.lastname: Mainous
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
mesh_terms: D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000628:therapy; D004739:England / Q000453:epidemiology; D005194:Family Practice / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D015995:Prevalence; D011610:Psychosocial Deprivation; D011787:Quality of Health Care / Q000592:standards*; D012606:Scotland / Q000453:epidemiology; D012959:Socioeconomic Factors