The impact of a diabetes local enhanced service on quality outcome framework diabetes outcomes.

Choudhury, Sopna, Hussain, Shakir, Yao, Guiqing, Hill, Jill, Malik, Waqar and Taheri, Shahrad (2013) The impact of a diabetes local enhanced service on quality outcome framework diabetes outcomes. PloS one, 8 (12). e83738. ISSN 1932-6203.


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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).


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.


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.


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.

Item Type: Article
Subjects: WA Patients. Primary care. Medical profession. Forensic medicine
WK Endocrine system. Endocrinology
Divisions: Ambulatory Care > Diabetes
Related URLs:
Depositing User: Preeti Puligari
Date Deposited: 28 Nov 2014 13:40
Last Modified: 28 Nov 2014 13:40

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