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Proofs_Transformation accepted Dec 2020.pdf (3.16 MB)

Effectiveness of the Transformation Model, a model of care that integrates diabetes services across primary, secondary and community care: A retrospective study.

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journal contribution
posted on 2021-02-01, 15:05 authored by Emer M Brady, Danielle H Bodicoat, Francesco Zaccardi, Samuel Seidu, Iskandar Idris, Kamlesh Khunti, Azhar Farooqi, Melanie J Davies

Aims

The primary aim was to evaluate the effectiveness of a model integrating diabetes services across primary, secondary and community care (Transformation model). The secondary aim was to understand whether changes resulted from the model.


Methods

The model was implemented In Leicester, Leicestershire and Rutland (UK) across three clinical commissioning groups, the acute trust and accompanying stakeholders. One clinical commissioning group (Leicester City) implemented the entire model and was the primary evaluation population. A quasi‐experimental interrupted time series design was employed. The primary outcome was number of Type 2 diabetes‐related bed‐days per 1,000 patients.


Results

In the primary population, the mean number of Type 2 diabetes‐related bed‐days per 1,000 patients was increasing before model implementation by 0.33/month (95% confidence interval: ‐0.07, 0.72), whereas it was decreasing after implementation by a mean value of ‐0.14/month (‐0.33, 0.06); a statistically significant difference (p = 0.04). Secondary analyses showed: nationally, there was no significant change between the pre‐ and post‐periods so it is unlikely that large secular change drove the improvement; the other two Leicestershire clinical commissioning groups saw improvement or stability; underlying processes worked as hypothesised overall; diabetes biomedical markers deteriorated in the primary care population suggesting a change in case‐mix due to moving some patients out of secondary care.


Conclusions

Given that the initial aim was to shift services from secondary to primary care without causing harm, an improvement is better than expected. This observational evaluation cannot show conclusively that improvements were due to the Transformation model, but secondary analyses support this.

History

Author affiliation

Diabetes Research Centre, College of Life Sciences

Version

  • AM (Accepted Manuscript)

Published in

Diabetic medicine : a journal of the British Diabetic Association

Pagination

e14504

Publisher

Wiley

issn

0742-3071

eissn

1464-5491

Copyright date

2020

Available date

2021-12-24

Spatial coverage

England

Language

eng

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