Background: Most industrialized countries are faced with a growing population of patients with chronic diseases and multimorbidity. Evidence performance gaps have been recognized in the treatment of this vulnerable patient group. In England, the Quality and Outcomes Framework (QOF) - based on incentivized quality indicators - has been established to narrow the gap. Objective: We evaluated to what extent clinical data, extracted from electronic medical records (EMRs) of Swiss general practitioners, can be used as quality indicators in terms of a Swiss Quality and Outcomes Framework (SQOF) for diabetes care adopted from the QOF of the UK National Health Service (NHS). Methods: We searched the FIRE database (Family Medicine ICPC Research Using Electronic Medical Records) for patients suffering from diabetes type 1 or type 2. Eligible data were matched with the diabetes indicator set of the NHS QOF and compared with the results in England. Results: A total of 11 out of 17 diabetes indicators could be adopted for the SQOF; 46 practices with 1,781 diabetes patients were included. The practices fulfilled the SQOF diabetes indicator set with 46.9% overall, with highest compliance for blood pressure measurements (97.8% of all practices) and lowest compliance for influenza immunization (45.7%). Our study practices showed higher variation across all indicators and between practices compared to England, but lacking structured data limited calculation of scores and comparability. Conclusions: Our results show that it is technically feasible to establish a diabetes QOF in Swiss primary care based on EMRs. However, a high amount of missing data made it impossible to evaluate the actual quality of care. For a nationwide introduction, standards for electronic medical documentation and EMR use need to be set. It should also be acknowledged that important dimensions of suffering from one or more chronic diseases such as health-related quality of life are not reflected within a system focusing only on somatic aspects of a disease.

Yach D, Hawkes C, Gould C, Hofman KJ: The global burden of chronic diseases: overcoming impediments to prevention and control. JAMA 2004;291:2616-2622.
HSR-Europe: Health services research into European policy and practice. Final report of the HSREPP project. Utrecht, NIVEL, 2011.
Cecchini M, Sassi F, Lauer JA, Lee YY, Guajardo-Barron V, Chisholm D: Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness. Lancet 2010;376:1775-1784.
Shaw JE, Sicree RA, Zimmet PZ: Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010;87:4-14.
International Diabetes Federation: IDF Diabetes Atlas, ed 5. Brussels, Belgium, 2011. (accessed July 11, 2012).
Whiting DR, Guariguata L, Weil C, Shaw J: IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract 2011;94:311-321.
Turner R, Holman R, Stratton I, Cull C, Frighi V, Manley S, Matthews D, Neil A, McElroy H, Kohner E, Fox C, Hadden D, Wright D: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998;317:703-713.
Gæde P, Lund-Andersen H, Parving H-H, Pedersen O: Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 2008;358:580-591.
Patel A: Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the advance trial): a randomised controlled trial. Lancet 2007;370:829-840.
Cederholm J, Zethelius B, Nilsson PM, Eeg-Olofsson K, Eliasson B, Gudbjörnsdottir S: Effect of tight control of HbA1c and blood pressure on cardiovascular diseases in type 2 diabetes: an observational study from the Swedish national diabetes register (NDR). Diabetes Res Clin Pract 2009;86:74-81.
OECD: Health at a Glance 2011: OECD Indicators. OECD, 2011, DOI:10.1787/health_glance-2011-en.
Seidu S, Khunti K: Non-adherence to diabetes guidelines in primary care - the enemy of evidence-based practice. Diabetes Res Clin Pract 2012;95:301-302.
Jiwa M, Meng X, Sriram D, Hughes J, Colagiuri S, Twigg SM, Skinner T, Shaw T: The management of type 2 diabetes: a survey of Australian general practitioners. Diabetes Res Clin Pract 2012;95:326-332.
The Health and Social Care Information Centre: Quality and Outcomes Framework, GP Practice Results. (accessed July 11, 2012).
The NHS Confederation (Employers) Company Ltd: Quality and Outcomes Framework guidance for GMS contract 2009/10. Delivering investment in general practice. 2009. (accessed July 11, 2012).
Chmiel C, Bhend H, Senn O, Zoller M, Rosemann T: The fire project: a milestone for research in primary care in Switzerland. Swiss Med Wkly 2011;140:w13142.
Health and Social Care Information Centre: Quality and Outcomes Framework - 2010-11. (accessed July 11, 2012).
The NHS Confederation (Employers) Company Ltd.: Quality and Outcomes Framework for 2012/13. Guidance for PCOS and Practices. 2012. (accessed July 11, 2012).
The NHS Information Centre, Prescribing and Primary Care Services: Quality and Outcomes Framework Achievement Data 2010/11. The Health and Social Care Information Centre 2011. (accessed July 11, 2012).
Department of Health England: Public Health, Adult Social Care, and the NHS. GMS Statement of Financial Entitlements. 2010. (accessed July 9, 2013).
WONCA (ed): ICPC-2-R: International Classification of Primary Care, ed 2. New York, Oxford University Press, 2005.
WHO Collaborating Centre for Drug Statistics Methodology: Guidelines for ATC Classification and DDD Assignment 2012. Oslo, WHO, 2011.
O'Halloran J, Miller GC, Britt H: Defining chronic conditions for primary care with ICPC-2. Fam Pract 2004;21:381-386.
Lamers LM, van Vliet RC: The pharmacy-based cost group model: validating and adjusting the classification of medications for chronic conditions to the Dutch situation. Health Policy 2004;68:113-121.
NHS Information Centre: Quality and Outcomes Framework. Exception Data 2010/11. The Health and Social Care Information Centre, 2011. (accessed July 11, 2012).
Campbell SM, Kontopantelis E, Hannon K, Burke M, Barber A, Lester HE: Framework and indicator testing protocol for developing and piloting quality indicators for the UK Quality and Outcomes Framework. BMC Fam Pract 2011;12:85.
Campbell S, Reeves D, Kontopantelis E, Middleton E, Sibbald B, Roland M: Quality of primary care in England with the introduction of pay for performance. N Engl J Med 2007;357:181-190.
Kontopantelis E, Reeves D, Valderas JM, Campbell S, Doran T: Recorded quality of primary care for patients with diabetes in England before and after the introduction of a financial incentive scheme: a longitudinal observational study. BMJ Qual Saf 2013;22:53-64.
Calvert M, Shankar A, McManus RJ, Lester H, Freemantle N: Effect of the Quality and Outcomes Framework on diabetes care in the United Kingdom: retrospective cohort study. BMJ 2009;338:b1870.
Millett C, Bottle A, Ng A, Curcin V, Molokhia M, Saxena S, Majeed A: Pay for performance and the quality of diabetes management in individuals with and without co-morbid medical conditions. J R Soc Med 2009;102:369-377.
Rosemann T, Marty F, Bhend H, Wagner J, Brunner L, Zoller M: Utilisation of information technologies in ambulatory care in Switzerland. SMW 2010;140:w13088.
Hunger M, Thorand B, Schunk M, Doring A, Menn P, Peters A, Holle R: Multimorbidity and health-related quality of life in the older population: results from the German KORA-age study. Health Qual Life Outcomes 2011;9:53.
Brettschneider C, Leicht H, Bickel H, Dahlhaus A, Fuchs A, Gensichen J, Maier W, Riedel-Heller S, Schafer I, Schon G, Weyerer S, Wiese B, van den Bussche H, Scherer M, Konig HH, Altiner A, Blank W, Bullinger M, Ehreke L, Freitag M, Gerlach F, Hansen H, Heinrich S, Hofels S, von dem Knesebeck O, Krause N, Luppa M, Mayer M, Mellert C, Nutzel A, Paschke T, Petersen J, Prokein J, Romberg HP, Steinmann S, Schulz S, Wegscheider K, Weckbecker K, Werle J, Zieger M: Relative impact of multimorbid chronic conditions on health-related quality of life - results from the Multicare Cohort Study. PLoS One 2013;8:e66742.
Heath I, Hippisley-Cox J, Smeeth L: Measuring performance and missing the point? BMJ 2007;335:1075-1076.
Peytremann-Bridevaux I, Bordet J, Burnand B: Diabetes care in Switzerland: good, but perfectible: a population-based cross-sectional survey. BMC Health Serv Res 2013;13:232.
O'Connor R, Mannix M, Mullen J, Powys L, Mannion M, Nolan HA, Kearney E, Cullen W, Griffin M, Saunders J: Structured care of diabetes in general practice: a qualitative study of the barriers and facilitators. Ir Med J 2013;106:77-80.
Rothe U, Muller G, Schwarz PE, Seifert M, Kunath H, Koch R, Bergmann S, Julius U, Bornstein SR, Hanefeld M, Schulze J: Evaluation of a diabetes management system based on practice guidelines, integrated care, and continuous quality management in a federal state of Germany: a population-based approach to health care research. Diabetes Care 2008;31:863-868.
Trivedi AN, Zaslavsky AM, Schneider EC, Ayanian JZ: Trends in the quality of care and racial disparities in Medicare managed care. N Engl J Med 2005;353:692-700.
Mundet X, Cano F, Mata-Cases M, Roura P, Franch J, Birules M, Gimbert R, Llusa J, Cos X: Trends in chronic complications of type 2 diabetic patients from Spanish primary health care centres (GEDAPS study): ten year-implementation of St Vincent recommendations. Prim Care Diabetes 2012;6:11-18.
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