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Quality of Disease Management and Risk of Mortality in English Primary Care Practices

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Publication details

JournalHealth services research
DateE-pub ahead of print - 19 Jan 2015
DatePublished (current) - 2015
Early online date19/01/15
Original languageEnglish


Objective. To investigate whether better management of chronic conditions by family
practices reduces mortality risk.
Data. Two random samples of 5 million patients registered with over 8,000 English
family practices followed up for 4 years (2004/5–2007/8). Measures of the quality of
disease management for 10 conditions were constructed for each family practice for
each year. The outcome measure was an indicator taking the value 1 if the patient died
during a specified year, 0 otherwise.
Study Design. Cross-section and multilevel panel data multiple logistic regressions
were estimated. Covariates included age, gender, morbidity, hospitalizations, attributed socio-economic characteristics, and local health care supply measures.
Principal Findings. Although a composite measure of the quality of disease management for all 10 conditions was significantly associated with lower mortality, only the quality of stroke care was significant when all 10 quality measures were entered in the regression.
Conclusions. The panel data results suggest that a 1 percent improvement in the quality of stroke care could reduce the annual number of deaths in England by 78 2 (95 per cent CI: 423, 1140). A longer study period may be necessary to detect any mortality impact of better management of other conditions

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