title: The novel use of commonly captured data to assess a district's diabetes service that encompasses both primary and secondary care.
abstract: OBJECTIVE
  To identify commonly captured data in the UK to look at the performance of a district's diabetes care that encompasses both primary and secondary care.
  
  
  METHODS
  Primary care quality outcomes framework (QOF) measures for diabetes, referral rates for first appointment for specialist secondary care and emergency admission rates for diabetes (Dr Foster/HES) were used to produce a performance index scoring system. Illustrative measures from QOF were total diabetes points, DM23 attainment of HbA1c <7% (53 mmol/mol) and its exemption rate (number of patients excluded from analysis). The performance index was used to study the effectiveness of the Medway district diabetes service and this was compared to another district (Guildford) within the same Strategic Health Authority and nationally.
  
  
  RESULTS
  Medway has the highest prevalence of Diabetes (6.1%) of the 8 Primary Care Trusts examined, the lowest achievement of diabetes QOF points (96.1%) and the lowest achievement of an HbA1c level <7% (53 mmol/mol) (54.3%). Exemption reporting was the 3rd highest. SAR for first diabetes out-patient appointment to the hospital was low at 281 (predicted 576) 48% of expected. The emergency admission rate was high at 225 (predicted 168) 133% of expected. Thus primary care diabetes needs to raise performance and implement a lower threshold for OPD referral to prevent emergency admissions.
  
  
  CONCLUSIONS
  It is possible to produce an assessment of diabetes care that transcends primary/secondary care that gives a true reflection of a district's performance which will be useful to plan future health service provision.
authors.affiliation: King's College London, Academic Centre, First Floor, Henriette Raphael House, Guy's Campus, London SE1 1UL, UK. emma.russell-jones@kcl.ac.uk
authors.forename: E C
authors.initials: EC
authors.lastname: Russell-Jones
authors.forename: A
authors.initials: A
authors.lastname: Gough
authors.forename: S
authors.initials: S
authors.lastname: Lawrence
authors.forename: I N
authors.initials: IN
authors.lastname: Scobie
mesh_terms: D003627:Data Interpretation, Statistical; D003920:Diabetes Mellitus / Q000191:economics / Q000628:therapy*; D019468:Disease Management; D006301:Health Services Needs and Demand; D006801:Humans; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards; D012017:Referral and Consultation / Q000706:statistics & numerical data; D040841:Resource Allocation; D063127:Secondary Health Care / Q000592:standards*