National Diabetes Audit - PCT Summary Year 2009/10

Transcription

1 Diabetes Audit - Summary Year 2009/10 Bradford & Airedale Teaching (5NY) What is the 's participation rate? This year 82 practices (98.8%) from Bradford & Airedale Teaching have submitted data to the Diabetes Audit (NDA). This ranks Bradford & Airedale Teaching 23 rd out of 151 s for participation rate. Table 1. participation rate for 2009/10 Number of registered practices Number of practices participating Participation rate SHA participation rate Quartile ranking within SHA participation rate quartile ranking * % 89.2% % 1 * s in quartile 1 are in the 25% of s who have achieved the highest scores and s in quartile 4 are in the 25% of s with the lowest scores. quartile ranking provides a score relative to or benchmarked against the other s. Table 2. participation rate by Audit Year 2006/7 2007/8 2008/9 2009/ % 3.4% 96.4% 98.8% The following tables and figures in this report show key findings for Bradford & Airedale Teaching from the 2009/10 NDA. Further information is available from the NDA dashboard ( and the online NDA toolkit - PIANO ( The NDA Executive Summary and Paediatric Report can be downloaded from

2 Prevalence (%) What percentage of patients are on the diabetes register? All patients with diabetes should be on the practice diabetes register The NDA receives information on patients with diabetes from both primary and secondary care. The table below shows where patients identified by secondary care (2 o ) are not found on the primary care (1 o ) diabetes register. The figures are only for data relating to the 82 practices participating in the NDA. Table 3. Diabetes registrations by type and source for Bradford & Airedale Teaching Total number of registrations NDA Registrations Registrations Registrations from 2 o care unrecorded in 1 o Percentage of patients unrecorded in 1 o from 1 o care care care Type % Type % All diabetes * % * All diabetes includes MODY, other specifed and unspecified Table 4 shows the 'all ages' prevalence of diabetes by type of diabetes for the and compares it with the national prevalence (from all data received) and last year's result. Table 4. Diabetes prevalence by type Type % 0.01% Type % 0.19% 3.87% 0.22% All diabetes * 4.88% 0.21% 4.35% 0.22% * All diabetes includes MODY, other specifed and unspecified Prevalence of diabetes Change since Change since The range of diabetes prevalence in the participating practices at the is shown in figure 1. Please note that this data is not age/sex standardised and variations in population profile may explain some of the variation in diabetes prevalence. 1 Figure 1. Diabetes prevalence (%) by practice 5% - 2 -

3 A significant number of people with diabetes remain undiagnosed The Association of Public Health Observatories (APHO) diabetes prevalence model 1, developed by the Yorkshire and Humber Public Health Observatory (YHPHO), predicts the expected number (diagnosed and undiagnosed) of people aged 16 years and above with diabetes in a given population based on the age, sex, ethnicity and deprivation of that population. Diabetes population predictions are available for Primary Care Trusts in England and Local Health Boards in Wales. Table 5 compares the number of registered patients with the number predicted for Bradford & Airedale Teaching by the APHO model for patients aged 16 and over. Table 5. Registered and expected diabetes prevalence for Bradford & Airedale Teaching prevalence * APHO Expected Registered / Median score prevalence * Expected ** (%) across all s 6.14% 8.1% % 2 * In patients aged 16 years quartile ranking ** People diagnosed with diabetes expressed as a percentage of people expected to have diabetes The APHO model suggests that there are over 8200 patients in the participating practices with undiagnosed diabetes. If we extrapolate this figure to the as a whole, by assuming a similar registered diabetes prevalence in the non-participating practices, then the model suggests that there could be over 8300 patients in the with undiagnosed diabetes. Undiagnosed diabetes may lead to complications that could be avoided with treatment

4 Care Process What percentage of patients receive care processes? All patients aged 12 years and over should should receive all of the nine, Institute for Clinical Excellence (NICE) recommended, care processes (the core annual review bundle ). The overall results for the 82 participating practices in the are shown in table 6. Table 6. Percentage of patients receiving NICE recommended care processes by care process type Care Process recorded HbA1c * BMI Blood Pressure Urinary Albumin Blood Creatinine Cholesterol Eye Screening Foot Exam Smoking Review All Care Processes ** * Applies to all ages Percentage of all patients in ** People registered with diabetes receiving all nine key processes of care Change since Median score across all s 95.1% 0.4% 92.3% % % -0.1% % 2.3% % % % % % % -0.4% 83.8% % -4.1% 86.6% % -12.5% 52.5% 4 quartile ranking RAG score 2 RAG (Red-Amber-Green) score key: < > 9 Figure 2 shows the range of scores for each care process across all the participating practices (inter-practice variation). Figure 2. Box plot showing range of care process percent recorded HbA1c BMI Blood Pressure Urinary Albumin Blood Creatinine Cholesterol Eye Screening Foot Exam Smoking Review All Care Processes Percentage of registered patients Key: - 4 -

5 Percent of registered patients Percent of registered patients Pecent of registered patients The spread of scores for the participating practices (inter-practice variation) for HbA1c is shown in figure 3. In figures 3, 4, and 5 the red line highlights the national average score Figure 3. HbA1c Care Process by The spread of scores for the participating practices for Blood Pressure is shown in figure 4. Figure 4. Blood Pressure Care Process by The spread of scores for the participating practices for All Care Processes is shown in figure 5. Figure 5. All Care Processes by

6 Target What percentage of patients have achieved set treatment targets? Healthcare professionals and patients should work in partnership to ensure patients achieve their NICE recommended treatment targets for glucose control, blood pressure and blood cholesterol. The overall results for the 82 participating practices in the are shown in table 7. All percentage figures relate to the total number of patients with a target value recorded. Table 7. Treatment target achievement rates by treatment target type Target HbA1c < 6.5% HbA1c 7.5% HbA1c 10. Cholesterol < 4mmol/l Targeted BP * Percentage achieved for all patients in Change since Median score across all s 20.2% -4.4% 24.9% % -1.7% 63.9% % 0.1% 92.6% % % % 0.3% 50.7% 3 quartile ranking RAG score 2 * Blood pressure target of <140/80 applied to those patients without recorded eye, kidney or vascular disease (EKV-) and blood pressure target <130/80 applied to those patients with recorded eye, kidney or vascular disease RAG (Red-Amber-Green) score key: < > 9 Figure 6 shows the range of scores for each target across the participating practices (inter-practice variation). Please note practices are only included in the box plot if they have at least 20 patients with a recorded value for the target. Figure 6. Box plot showing range of Target achieved values HbA1c < 6.5% HbA1c 7.5% HbA1c 10. Chol < 4 mmol/l Targeted BP Percentage of registered patients Key: - 6 -

7 Percent of registered patients Percent of registered patients Percemt of registered patients Target achievement rates (%) for the NICE HbA1c 7.5 per cent (59mmol/mol) target is shown in figure 7. In figures 7, 8, and 9 the red line highlights the national average score Figure 7. HbA1c 7.5% Target achievement rate by practice Target achievement rates (%) for the NICE Cholesterol < 4mmol/l target is shown in figure 8. Figure 8. Cholesterol < 4.0mmol/l Target achievement rate by practice Target achievement rates (%) for the Targeted BP target is shown in figure Figure 9. Targeted BP achievement rate by practice - 7 -

8 What is the annual rate of specific complications? The onset of complications can be delayed by good blood sugar control The complication prevalence rate in table 8 is based on an admission to hospital with one of the listed conditions at any time in the last 5 years, for patients with diabetes from Bradford & Airedale Teaching. Table 8. '5 year' complication prevalence in people with diabetes by complication type Complication Ketoacidosis Angina Myocardial Infarction Cardiac Failure Stroke Renal Failure Treatment Retinopathy Treatment Minor Amputation Major Amputation 5 year prevalence Median across all s quartile ranking 1.18% 1.51% % % % 3.53% % 1.97% % % 0.55% % 0.41% % 0.23% 1 The complications of diabetes are the final outcomes of care. Of all aspects of diabetes they have the greatest costs to the patient and the health service. The treatment targets are sometimes called intermediate outcomes because their achievement reduces the risk of developing complications. Apart from Diabetic Ketoacidosis (DKA) in Type 1 diabetes, which is an immediate consequence of treatment failure, the other complications arise only after many years of exposure to high blood glucose, blood pressure and high cholesterol. The prevalence of complications is ascertained by determining which people with diabetes identified in the NDA have had relevant admissions recorded in the Hospital Episodes Statistics database (HES) and Patient Episode Database for Wales (PEDW). Data submitted to the NDA from practice and outpatients units is linked to data from the Hospital Episode Statistics (HES) database for England and the Patient Episode Database for Wales (PEDW). Complication prevalence is defined as the number of people who have had one or more records of a specific complication over the defined time period. Complication incidence is defined as the total number of times a specific complication has occurred within the defined time period

9 References 1. APHO Diabetes Prevalence Model For more information please see: 2. Red Amber Green (RAG) score The boundaries for the RAG scores are defined by NICE recommended treatment targets. This provides an absolute score against this national target which is not dependent on the achievement rates at other units