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@article{Gunn:2021:10.1136/bmjdrc-2020-002069,
author = {Gunn, LH and Vamos, EP and Majeed, A and Normahani, P and Jaffer, U and Molina, G and Valabhji, J and McKay, AJ},
doi = {10.1136/bmjdrc-2020-002069},
journal = {BMJ Open Diabetes Research and Care},
title = {Associations between attainment of incentivised primary care indicators and incident lower limb amputation among those with type 2 diabetes: a population-based historical cohort study},
url = {http://dx.doi.org/10.1136/bmjdrc-2020-002069},
volume = {9},
year = {2021}
}

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TY  - JOUR
AB  - Introduction England has invested considerably in diabetes care through such programs as the Quality and Outcomes Framework (QOF) and National Diabetes Audit (NDA). Associations between program indicators and clinical endpoints, such as amputation, remain unclear. We examined associations between primary care indicators and incident lower limb amputation.Research design and methods This population-based retrospective cohort study, spanning 2010–2017, was comprised of adults in England with type 2 diabetes and no history of lower limb amputation. Exposures at baseline (2010–2011) were attainment of QOF glycated hemoglobin (HbA1c), blood pressure and total cholesterol indicators, and number of NDA processes completed. Propensity score matching was performed and multivariable Cox proportional hazards models, adjusting for disease-related, comorbidity, lifestyle, and sociodemographic factors, were fitted using matched samples for each exposure.Results 83 688 individuals from 330 English primary care practices were included. Mean follow-up was 3.9 (SD 2.0) years, and 521 (0.6%) minor or major amputations were observed (1.62 per 1000 person-years). HbA1c and cholesterol indicator attainment were associated with considerably lower risks of minor or major amputation (adjusted HRs; 95% CIs) 0.61 (0.49 to 0.74; p<0.0001) and 0.67 (0.53 to 0.86; p=0.0017), respectively). No evidence of association between blood pressure indicator attainment and amputation was observed (adjusted HR 0.88 (0.73 to 1.06; p=0.1891)). Substantially lower amputation rates were observed among those completing a greater number of NDA care processes (adjusted HRs 0.45 (0.24 to 0.83; p=0.0106), 0.67 (0.47 to 0.97; p=0.0319), and 0.38 (0.20 to 0.70; p=0.0022) for comparisons of 4–6 vs 0–3, 7–9 vs 0–3, and 7–9 vs 4–6 processes, respectively). Results for major-only amputations were similar for HbA1c and blood pressure, though cholesterol indicator a
AU  - Gunn,LH
AU  - Vamos,EP
AU  - Majeed,A
AU  - Normahani,P
AU  - Jaffer,U
AU  - Molina,G
AU  - Valabhji,J
AU  - McKay,AJ
DO  - 10.1136/bmjdrc-2020-002069
PY  - 2021///
SN  - 2052-4897
TI  - Associations between attainment of incentivised primary care indicators and incident lower limb amputation among those with type 2 diabetes: a population-based historical cohort study
T2  - BMJ Open Diabetes Research and Care
UR  - http://dx.doi.org/10.1136/bmjdrc-2020-002069
UR  - http://hdl.handle.net/10044/1/89348
VL  - 9
ER  -

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