Ethnicity and quality of diabetes care in a health system with universal coverage: Population-based cross-sectional survey in primary care

Background: The UK has a universal health care system that is free at the point of access. Over the past decade, the UK government has implemented an ambitious agenda of quality improvement initiatives in chronic disease management. Objective: To assess the quality of diabetes care and intermediate clinical outcomes within a multiethnic population after a sustained period of investment in quality improvement. Design: Population based cross-sectional survey, using electronic general practice records, carried out between November 2005 and January 2006. Patinents: Seven thousand six hundred five adults (>= 18 years) with diabetes registered with 32 primary care practices. Measurements: Percentage achievement by ethnic group (black, south Asian, or white) of the quality indicators for diabetes in a new pay-for performance contract. Results: There were only modest variations in recording of process measures of care between ethnic groups, with no significant differences in recent measurement of blood pressure, HbA1c, cholesterol, micro-albuminuria, creatinine, or retinopathy screening attendance. Blacks and south Asians were significantly less likely to meet all three national treatment targets for diabetes (HbA1c <= 7.4%, blood pressure <= 145/85 mmHg, total cholesterol <= 5 mmol/L [193 mg/dL]) than whites (25.3%, 24.8% , and 32.0%, respectively). Conclusions: Our findings suggest that substantial investment in quality improvement initiatives in the UK may have led to more systematic and equitable processes of care for diabetes but have not addressed ethnic disparities in intermediate clinical outcomes.