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

Research output: Contribution to journalArticlepeer-review

Published copy (DOI)


  • Evangelos Kontopantelis
  • David A Springate
  • Mark Ashworth
  • Roger T Webb
  • Iain E Buchan
  • Timothy Doran


Publication details

DateAccepted/In press - 13 Jan 2015
DatePublished (current) - 2 Mar 2015
Number of pages19
Original languageEnglish


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.

Bibliographical note

© Kontopantelis et al 2015.

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