Does higher quality of diabetes management in family practice reduce unplanned hospital admissions?
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.


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


METHODS
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.


METHODS
Practice quality measures extracted from practice records linked with practice-level hospital admissions data and practice-level covariates data.


RESULTS
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.


CONCLUSIONS
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.
Dusheiko
Mark
M
National Primary Care Research and Development Centre, Centre for Health Economics, Alcuin A Block, University of York, Heslington, York YO10 5DD, UK. mad105@york.ac.uk
Doran
Tim
T
Gravelle
Hugh
H
Fullwood
Catherine
C
Roland
Martin
M
D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D005194:Family Practice / Q000706:statistics & numerical data*; D006442:Glycated Hemoglobin / Q000032:analysis; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015995:Prevalence; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D006113:United Kingdom
D006442:Glycated Hemoglobin