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U.K. Initiative Has Unclear Effects on Diabetes Care

The quality and outcomes framework introduced in 2004 may have had detrimental effects

WEDNESDAY, May 27 (HealthDay News) -- Since the late 1990s, the management of diabetes has improved in the United Kingdom, but it may not be a direct result of the quality and outcomes framework introduced in 2004, according to a study published online May 27 in BMJ.

Melanie Calvert, Ph.D., of the University of Birmingham in the United Kingdom, and colleagues analyzed data from 147 general practices to compare annual diabetes prevalence and achievement of process and clinical outcomes during the three-year periods before and after introduction of the quality and outcomes framework.

Although process and clinical outcome measures improved during all six years, the researchers found that improvements in control of blood sugar, cholesterol, and blood pressure slowed after introduction of the quality and outcomes framework, especially in the up to two-thirds of patients with type 1 diabetes and one-third of patients with type 2 diabetes who did not meet the new diagnostic case definition. They also found that the quality and outcomes framework was not associated with improved management of type 1 diabetes or a decline in HbA1c levels above 10 percent among type 2 diabetics.

"Pay for performance may have contributed to the improvement in diabetes care but the relative importance of the quality and outcomes framework to other national quality improvement strategies is unclear," the authors write. "Our work and that of others highlights the potential unintended consequences of the scheme."

This study was sponsored by Pfizer; four authors reported financial relationships with several companies that manufacture therapies for diabetes.

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