National Diabetes Audit - PCT Summary
Year 2009/10
Bradford & Airedale Teaching PCT (5NY)
What is the PCT's Practice participation rate?
This year 82 practices (98.8%) from Bradford & Airedale Teaching PCT have submitted data to the National
Diabetes Audit (NDA). This ranks Bradford & Airedale Teaching PCT 23rd out of 151 PCTs for participation rate.
Table 1. Practice participation rate for 2009/10
Number of
registered
practices
83
Number of
PCT
SHA
practices
Participation participation
participating rate
rate
98.8%
89.2%
82
Quartile
National
ranking within participation
SHA
rate
77.9%
1
National
quartile
ranking*
1
* PCTs in quartile 1 are in the 25% of PCTs who have achieved the highest scores and PCTs in quartile 4 are in the 25% of PCTs with
the lowest scores. National quartile ranking provides a score ‘relative to’ or ‘benchmarked against’ the other PCTs.
Table 2. Practice participation rate by Audit Year
2006/7
38.4%
2007/8
3.4%
2008/9
96.4%
2009/10
98.8%
The following tables and figures in this report show key findings for Bradford & Airedale Teaching PCT from the
2009/10 NDA. Further information is available from the NDA dashboard (http://www.ic.nhs.uk/ndaanalysis)
and the online NDA toolkit - PIANO (http://www.ic.nhs.uk/ndatoolkit). The NDA Executive Summary and
Paediatric Report can be downloaded from http://www.ic.nhs.uk/nda.
-1NDA Summary 2009/10 - Bradford & Airedale Teaching PCT
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 (2o) are not found on the primary care (1o) 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 PCT
NDA Registrations
Total number
of registrations
Type 1
Type 2
All diabetes*
Registrations
from 1o care
1723
24224
26327
Registrations
Percentage of
from 2o care
patients
o
unrecorded in 1 unrecorded in 1o
care
care
1715
24218
26307
8
6
20
0.46%
0.02%
0.08%
* All diabetes includes MODY, other specifed and unspecified
Table 4 shows the 'all ages' prevalence of diabetes by type of diabetes for the PCT and compares it with the
national prevalence (from all data received) and last year's result.
Table 4. Diabetes prevalence by type
PCT
2009-10
Type 1
Type 2
All diabetes*
0.32%
4.49%
4.88%
Prevalence of diabetes
National
Change since
2008-9
↑
↑
↑
0.01%
0.19%
0.21%
2009-10
0.40%
3.87%
4.35%
Change since
2008-9
−
↑
↑
0.00%
0.22%
0.22%
* All diabetes includes MODY, other specifed and unspecified
The range of diabetes prevalence in the participating practices at the PCT 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.
Figure 1. Diabetes prevalence (%) by practice
Prevalence (%)
10%
5%
0%
Practice
-2NDA Summary 2009/10 - Bradford & Airedale Teaching PCT
A significant number of people with diabetes remain undiagnosed
The Association of Public Health Observatories (APHO) diabetes prevalence model1, 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 PCT by the APHO model for patients aged 16 and over.
Table 5. Registered and expected diabetes prevalence for Bradford & Airedale Teaching PCT
PCT
prevalence*
APHO Expected Registered /
Median score
*
**
prevalence
Expected (%) across all PCTs
6.14%
*
8.1%
76.0%
National quartile
ranking
73.8%
2
In patients aged ≥ 16 years
**
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 PCT 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 PCT with undiagnosed diabetes. Undiagnosed diabetes may lead to complications that could be avoided
with treatment.
-3NDA Summary 2009/10 - Bradford & Airedale Teaching PCT
What percentage of patients receive care processes?
All patients aged 12 years and over should should receive all of the nine, National Institute for Clinical
Excellence (NICE) recommended, care processes (the core annual review ‘bundle’).
The overall results for the 82 participating practices in the PCT are shown in table 6.
Table 6. Percentage of patients receiving NICE recommended care processes by care process type
Percentage of
all patients in Change since Median score
PCT
2008-9
across all PCTs
↑ 0.4%
95.1%
92.3%
93.1%
90.0%
−
0.0%
96.6%
95.0%
↓ -0.1%
79.8%
75.0%
↑ 2.3%
94.3%
92.7%
↑ 1.0%
92.8%
91.4%
−
0.0%
61.0%
78.8%
↓ -18.0%
80.4%
83.8%
↓ -0.4%
82.7%
86.6%
↓ -4.1%
↓
-12.5%
38.7%
52.5%
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
**
National
quartile
ranking
RAG score2
1
1
1
1
1
1
4
4
4
4
RAG (Red-Amber-Green) score key:
< 70%
70%-90%
> 90%
People registered with diabetes receiving all nine key processes of care
Figure 2 shows the range of scores for each care process across all the participating practices (inter-practice
variation).
Care Process
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
0.0%
20.0%
40.0%
60.0%
80.0%
Percentage of registered patients
Key:
-4NDA Summary 2009/10 - Bradford & Airedale Teaching PCT
100.0%
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.
Pecent of registered patients
Figure 3. HbA1c Care Process by Practice
100%
80%
60%
40%
20%
0%
Practice
The spread of scores for the participating practices for Blood Pressure is shown in figure 4.
Percent of registered patients
Figure 4. Blood Pressure Care Process by Practice
100%
80%
60%
40%
20%
0%
Practice
The spread of scores for the participating practices for All Care Processes is shown in figure 5.
Percent of registered patients
Figure 5. All Care Processes by Practice
100%
80%
60%
40%
20%
0%
Practice
-5NDA Summary 2009/10 - Bradford & Airedale Teaching PCT
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 PCT 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
Percentage
achieved for
all patients in Change since Median score
PCT
2008-9
across all PCTs
20.2%
24.9%
↓ -4.4%
58.1%
63.9%
↓ -1.7%
91.8%
92.6%
↑ 0.1%
36.7%
40.1%
↑ 1.0%
↑ 0.3%
49.6%
50.7%
Target
HbA1c < 6.5%
HbA1c ≤ 7.5%
HbA1c ≤ 10.0%
Cholesterol < 4mmol/l
Targeted BP*
* 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
National
quartile
ranking
4
4
3
4
3
RAG score2
RAG (Red-Amber-Green) score key:
< 70%
70%-90%
> 90%
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%
Target
HbA1c ≤ 7.5%
HbA1c ≤ 10.0%
Chol < 4 mmol/l
Targeted BP
0%
20%
40%
60%
80%
Percentage of registered patients
Key:
-6NDA Summary 2009/10 - Bradford & Airedale Teaching PCT
100%
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
100%
80%
60%
40%
20%
0%
Practice
Percent of registered patients
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
100%
80%
60%
40%
20%
0%
Practice
Percent of registered patients
Target achievement rates (%) for the Targeted BP target is shown in figure 9.
Figure 9. Targeted BP
achievement rate by practice
100%
80%
60%
40%
20%
0%
Practice
-7NDA Summary 2009/10 - Bradford & Airedale Teaching PCT
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 PCT.
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
1.18%
10.39%
2.80%
3.59%
2.19%
0.52%
0.69%
0.35%
0.17%
Median
across all
PCTs
1.51%
7.90%
2.27%
3.53%
1.97%
0.60%
0.55%
0.41%
0.23%
National
quartile
ranking
1
4
4
3
3
2
3
2
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.
-8NDA Summary 2009/10 - Bradford & Airedale Teaching PCT
References
1.
APHO Diabetes Prevalence Model
For more information please see:
http://www.yhpho.org.uk/default.aspx?RID=81090
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.
-9NDA Summary 2009/10 - Bradford & Airedale Teaching PCT