title: The impact of a diabetes local enhanced service on quality outcome framework diabetes outcomes.
abstract: BACKGROUND
  The rising challenge of diabetes requires novel service delivery approaches. In the UK, Local Enhanced Services (LES) have been commissioned for diabetes. Health professionals from general practices (GPs) who signed up to LES were given additional training (and a monetary incentive) to improve management of patients with diabetes. All practices in the PCT were invited to the LES initiative, which ensured avoiding selection bias. The aim of the study was to examine the impact of LES in terms of diabetes Quality Outcome Framework (QOF) indicators: DM23(glycaemia), DM17(lipid) and DM12(blood pressure; BP).
  
  
  METHODS
  QOF diabetes indicators were examined using data from 76 general practices for 2009-2010 in a large primary care trust area in Birmingham, UK. Data were extracted from Quality Management Analysis System. The primary outcome was a difference in achievement of QOF indicators between LES and NLES practices. A secondary outcome was the difference between LES and non-LES practices for hospital first and follow-up appointments.
  
  
  RESULTS
  We did not find any difference for DM12(BP) and DM17(lipid) outcomes between LES and NLES practices. However, LES practices were more likely to achieve the DM23(glycaemia) outcome (estimated odds 1.459;95% CI:1.378-1.544; P=0.0001). The probability of achieving satisfactory level of DM23(glycaemia) increased by almost 10% when GPs belonged to LES groups compared with GPs in NLES group. LES practices were less likely to refer patients to secondary care.
  
  
  CONCLUSIONS
  Overall, LES practices performed better in the achievement of DM23(glycaemia) and also referred fewer patients to hospital, thereby meeting their objectives. This suggests that the LES approach is beneficial and needs to be further explored in order to ascertain whether the impact exerted was due to LES.
authors.affiliation: National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) Birmingham and Black Country Theme 8, University of Birmingham, Birmingham, United Kingdom ; School of Health and Population Sciences, University of Birmingham, Birmingham, United Kingdom.
authors.forename: Sopna
authors.initials: S
authors.lastname: Choudhury
authors.affiliation: National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) Birmingham and Black Country Theme 8, University of Birmingham, Birmingham, United Kingdom ; School of Health and Population Sciences, University of Birmingham, Birmingham, United Kingdom.
authors.forename: Shakir
authors.initials: S
authors.lastname: Hussain
authors.affiliation: National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) Birmingham and Black Country Theme 8, University of Birmingham, Birmingham, United Kingdom ; Primary Care and population Sciences, University of Southampton, Southampton, United Kingdom.
authors.forename: Guiqing
authors.initials: G
authors.lastname: Yao
authors.affiliation: Birmingham Community Healthcare NHS Trust, Birmingham, United Kingdom.
authors.forename: Jill
authors.initials: J
authors.lastname: Hill
authors.affiliation: Birmingham Community Healthcare NHS Trust, Birmingham, United Kingdom ; Diabetes Centre, Heart of England NHS Foundation Trust, Birmingham, United Kingdom.
authors.forename: Waqar
authors.initials: W
authors.lastname: Malik
authors.affiliation: National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) Birmingham and Black Country Theme 8, University of Birmingham, Birmingham, United Kingdom ; Department of Medicine, Weill Cornell Medical College in New York USA and Doha, Qatar ; Department of Medicine, King's College London, London, United Kingdom.
authors.forename: Shahrad
authors.initials: S
authors.lastname: Taheri
mesh_terms: D000553:Ambulatory Care; D001786:Blood Glucose; D001794:Blood Pressure; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000628:therapy; D019468:Disease Management; D058006:General Practice / Q000592:standards; D006801:Humans; D008055:Lipids / Q000097:blood; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000592:standards; D019984:Quality Indicators, Health Care; D006113:United Kingdom
chemical_list: D001786:Blood Glucose; D008055:Lipids