Evidence map›Paper›PMID 19474024›Full record

ArticleBMJ (Clinical research ed.)2009

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

Melanie Calvert, Aparna Shankar, Richard J McManus, Helen Lester, Nick Freemantle

Erratum issuedOpen access · hybridAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ (Clinical research ed.), 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 67 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
67citing papers in PubMed, 7 pooled it
33.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

67 citing papers in PubMed, 7 syntheses or guidelines pooled it, 157 citations in OpenAlex.

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  3. Effectiveness of UK provider financial incentives on quality of care: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2017
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  4. The role of the Quality and Outcomes Framework in the care of long-term conditions: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2017
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7 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

  • Erratum issued
5 · Who and what money

Authors and funding

5 authors at 3 institutions in 1 country.

Melanie CalvertDepartment of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham B15 2TT. m.calvert@bham.ac.uk
Aparna Shankar
Richard J McManus
Helen Lester
Nick Freemantle
University of Birmingham · GBUniversity College London · GBUniversity of Manchester · GB

Funding

Department of Health CDF/01/017
6 · The paper itself

Abstract

objectivesTo examine the management of diabetes between 2001 and 2007 in the United Kingdom and to assess whether changes in the quality of care reflect existing temporal trends or are a direct result of the implementation of the quality and outcomes framework.

designRetrospective cohort study.

setting147 general practices (annual list size over 1 million) across the UK. Patients People with type 1 or type 2 diabetes.

main outcome measuresAnnual prevalence of diabetes and attainment of process and clinical outcomes over the three years before and the three years after the introduction of the quality and outcomes framework.

resultsSignificant improvements in process and intermediate outcome measures were observed during the six year period, with consecutive annual improvements observed before the introduction of incentives. However, the current diagnostic case definition for the quality and outcomes framework does not capture up to two thirds of people with type 1 diabetes and a third of people with type 2 diabetes. After the introduction of the quality and outcomes framework, existing trends of improvement in glycaemic control, cholesterol levels, and blood pressure were attenuated, particularly in people with diabetes who did not meet the case definition of the quality and outcomes framework. The introduction of the quality and outcomes framework did not lead to improvement in the management of patients with type 1 diabetes, nor to a reduction in the number of patients with type 2 diabetes who had HbA(1c) levels greater than 10%. Introduction of the quality and outcomes framework may have increased the number of patients with type 2 diabetes with HbA(1c) levels of <or=7.5%; odds ratio 1.05 (95% confidence interval 1.01 to 1.09; P=0.02).

conclusionsThe management of people with diabetes has improved since the late 1990s, but the impact of the quality and outcomes framework on care is not straightforward; upper thresholds may need to be removed or targets made more challenging if people are to benefit. Many patients in whom care may be suboptimal may not be captured in the quality and outcomes framework assessment.

Indexed as

Blood GlucoseBlood PressureCholesterolCohort StudiesDiabetes Mellitus, Type 1Diabetes Mellitus, Type 2Glycated HemoglobinHumansHypoglycemic AgentsQuality of Health CareRetrospective StudiesTreatment OutcomeUnited KingdomBlood GlucoseCholesterolGlycated HemoglobinHypoglycemic Agents

Identifiers

PMID19474024
PMCPMC2687510
OpenAlexW1980781241

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.