Investigating the relationship between quality of primary care and premature mortality in England: a spatial whole-population study

TY - JOUR

T1 - Investigating the relationship between quality of primary care and premature mortality in England

T2 - a spatial whole-population study

AU - Kontopantelis, Evangelos

AU - Springate, David A

AU - Ashworth, Mark

AU - Webb, Roger T

AU - Buchan, Iain E

AU - Doran, Timothy

N1 - © Kontopantelis et al 2015.

PY - 2015/3/2

Y1 - 2015/3/2

N2 - OBJECTIVES: To quantify the relationship between a national primary care pay-for-performance programme, the UK's Quality and Outcomes Framework (QOF), and all-cause and cause-specific premature mortality linked closely with conditions included in the framework.DESIGN: Longitudinal spatial study, at the level of the "lower layer super output area" (LSOA).SETTING: 32482 LSOAs (neighbourhoods of 1500 people on average), covering the whole population of England (approximately 53.5 million), from 2007 to 2012.PARTICIPANTS: 8647 English general practices participating in the QOF for at least one year of the study period, including over 99% of patients registered with primary care.INTERVENTION: National pay-for-performance programme incentivising performance on over 100 quality-of-care indicators.MAIN OUTCOME MEASURES: All-cause and cause-specific mortality rates for six chronic conditions: diabetes, heart failure, hypertension, ischaemic heart disease, stroke, and chronic kidney disease. We used multiple linear regressions to investigate the relationship between spatially estimated recorded quality of care and mortality.RESULTS: All-cause and cause-specific mortality rates declined over the study period. Higher mortality was associated with greater area deprivation, urban location, and higher proportion of a non-white population. In general, there was no significant relationship between practice performance on quality indicators included in the QOF and all-cause or cause-specific mortality rates in the practice locality.CONCLUSIONS: Higher reported achievement of activities incentivised under a major, nationwide pay-for-performance programme did not seem to result in reduced incidence of premature death in the population.

AB - OBJECTIVES: To quantify the relationship between a national primary care pay-for-performance programme, the UK's Quality and Outcomes Framework (QOF), and all-cause and cause-specific premature mortality linked closely with conditions included in the framework.DESIGN: Longitudinal spatial study, at the level of the "lower layer super output area" (LSOA).SETTING: 32482 LSOAs (neighbourhoods of 1500 people on average), covering the whole population of England (approximately 53.5 million), from 2007 to 2012.PARTICIPANTS: 8647 English general practices participating in the QOF for at least one year of the study period, including over 99% of patients registered with primary care.INTERVENTION: National pay-for-performance programme incentivising performance on over 100 quality-of-care indicators.MAIN OUTCOME MEASURES: All-cause and cause-specific mortality rates for six chronic conditions: diabetes, heart failure, hypertension, ischaemic heart disease, stroke, and chronic kidney disease. We used multiple linear regressions to investigate the relationship between spatially estimated recorded quality of care and mortality.RESULTS: All-cause and cause-specific mortality rates declined over the study period. Higher mortality was associated with greater area deprivation, urban location, and higher proportion of a non-white population. In general, there was no significant relationship between practice performance on quality indicators included in the QOF and all-cause or cause-specific mortality rates in the practice locality.CONCLUSIONS: Higher reported achievement of activities incentivised under a major, nationwide pay-for-performance programme did not seem to result in reduced incidence of premature death in the population.

U2 - 10.1136/bmj.h904

DO - 10.1136/bmj.h904

M3 - Article

C2 - 25733592

SN - 0959-8138

VL - 350

JO - BMJ

JF - BMJ

M1 - h904

ER -