Investigating the relationship between quality of primary care and premature mortality in England: a spatial whole-population study.
Investigating the relationship between quality of primary care and premature mortality in England: a spatial whole-population study.
复制标题
DOI：
10.1136/bmj.h904
复制
发表时间：
2015-03-02
期刊：
影响因子：
--
通讯作者：
Doran T
中科院分区：
文献类型：
--
作者：
Kontopantelis E;Springate DA;Ashworth M;Webb RT;Buchan IE;Doran T
目标 量化国家初级保健按绩效付费计划、英国质量和结果框架 (QOF) 以及与框架中包含的条件密切相关的全因和特定原因过早死亡率之间的关系。在“下层超级输出区”（LSOA）层面设计纵向空间研究。从 2007 年到 2012 年，设置了 32482 个 LSOA（平均有 1500 人的社区），覆盖了英格兰的整个人口（约 5350 万）。参与者 8647 名英国全科医生在研究期间至少一年的 QOF 中参与，其中包括超过 99% 的初级保健注册患者。干预措施 国家按绩效付费计划激励 100 多项护理质量指标的绩效。主要结果衡量六种慢性疾病的全因和特定原因死亡率：糖尿病、心力衰竭、高血压、缺血性心脏病、中风和慢性肾病。我们使用多元线性回归来研究空间估计记录的护理质量与死亡率之间的关系。结果 研究期间全因死亡率和特定原因死亡率均有所下降。较高的死亡率与较大的贫困地区、城市位置和较高的非白人人口比例有关。一般来说，QOF 中包含的质量指标的实践绩效与实践地点的全因或特定原因死亡率之间没有显着关系。结论 在一项重大的、全国性的按绩效付薪计划的激励下，所报告的活动取得的较高成就似乎并没有导致人口过早死亡发生率的降低。
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.
登录
查看更多内容
DOI：
10.1136/bmj.d3590
发表时间：
2011-06-28
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Doran T;Kontopantelis E;Valderas JM;Campbell S;Roland M;Salisbury C;Reeves D
通讯作者：
Reeves D
影响因子：
4.8
作者：
Drukker, David M.;Prucha, Ingmar R.;Raciborski, Rafal
通讯作者：
Raciborski, Rafal
影响因子：
158.5
作者：
Campbell, Stephen M.;Reeves, David;Roland, Martin
通讯作者：
Roland, Martin
影响因子：
8.2
作者：
Andersson, C.;van Gaal, L.;Torp-Pedersen, C.
通讯作者：
Torp-Pedersen, C.
影响因子：
168.9
作者：
Currie, Craig J.;Peters, John R.;Poole, Chris D.
通讯作者：
Poole, Chris D.