Associations between ED attendance volumes and primary care quality
| All ED attendances | Self-referred discharged attendances | GP treatable attendances | No treatment and no follow-up attendances | |
| IRR (95% CI) | IRR (95% CI) | IRR (95% CI) | IRR 95% CI) | |
| Clinical QOF score achievement† | 0.987* (0.975 to 0.998) | 0.977* (0.954 to 1.000) | 0.982 (0.950 to 1.014) | 0.966 (0.924 to 1.010) |
| Proportion of patients that would recommend the practice† | 0.995 (0.983 to 1.007) | 0.978 (0.954 to 1.002) | 0.978 (0.951 to 1.006) | 0.978 (0.943 to 1.015) |
| Proportion of patients reporting good overall experience† | 1.007 (0.989 to 1.026) | 1.014 (0.983 to 1.047) | 1.020 (0.984 to 1.058) | 1.018 (0.973 to 1.065) |
| Proportion of patients that could see their preferred GP† | 0.998 (0.993 to 1.004) | 1.006 (0.994 to 1.017) | 1.005 (0.993 to 1.018) | 1.012 (0.996 to 1.029) |
| Proprtion of patients reporting easy phone access† | 0.987*** (0.981 to 0.994) | 0.985* (0.970 to 0.999) | 0.978** (0.963 to 0.994) | 0.976* (0.955 to 0.998) |
| Proprtion of patients that were able to get an appointment to see or speak to someone† | 0.978*** (0.967 to 0.990) | 0.963** (0.941 to 0.985) | 0.963* (0.934 to 0.993) | 0.934*** (0.898 to 0.971) |
| Proportion of patients that were able to get a same day appointment† | 0.997 (0.991 to 1.003) | 0.992 (0.981 to 1.004) | 0.992 (0.977 to 1.006) | 0.990 (0.972 to 1.009) |
| N | 7521 | 7521 | 7521 | 7521 |
| Pseudo-R2 | 0.045 | 0.039 | 0.047 | 0.042 |
| Number of primary care quality sensitive attendances | 346 334 | 187 815 | 74 464 | 44 002 |
| Proportion of attendances sensitive to primary care quality (%) | 2.48 | 3.70 | 4.10 | 5.26 |
*P< 0.05, **P< 0.01, ***P< 0.001. The reported pseudo-R2 statistic is McFadden’s pseudo R2 calculated as one minus the ratio of the log-likelihood of the estimated model to the log-likelihood of a model containing no covariates.
†These variables are scaled so that the IRRs reflect the effects of 10 percentage point differences. Models also include practice and population characteristics, coefficients for which are presented in table 2 and indicators for the 13 NHS England local offices in which a general practice is located (NHS England region: London (n=1354), Wessex (n=303), Cheshire and Merseyside (n=379), Cumbria and North East (n=450), Lancashire and Greater Manchester (n=704), Yorkshire and Humber (n=743), Central Midlands (n=550), East (n=533), North Midlands (n=489), West Midlands (n=653), South Central (n=414), South East (n=563); South West (n=386)).
ED, emergency department; GP, general practitioner; IRR, incidence rate ratio; QOF, Quality and Outcomes Framework.