Abstract
BACKGROUND
A new pay-for-performance scheme for primary care physicians was introduced in England in 2004 as part of an initiative to link the quality of primary care with physician pay.
OBJECTIVE
To investigate the association between the quality of primary care and rates of hospital admissions for coronary heart disease.
DESIGN
Ecological cross-sectional study using data from the Quality and Outcomes Framework for family practice, hospital admissions, and census data.
PARTICIPANTS
All 303 primary care trusts in England, covering approximately 50 million people.
MEASUREMENTS
Rates of elective and unplanned hospital admissions for coronary heart disease and rates of coronary angioplasty and coronary artery bypass grafting were regressed against quality-of-care measures from the Quality and Outcomes Framework, area socioeconomic scores, and disease prevalence.
RESULTS
Correlations between prevalence, area socioeconomic scores, and admission rates were generally weak. The strongest relations were seen between area socioeconomic scores and elective and unplanned hospital admissions and revascularization procedures among the age group 45–74 years. Among those aged 75 years and over, the only positive association observed was between area socioeconomic scores and unplanned hospital admissions.
CONCLUSIONS
The lack of an association between quality scores and admission rates suggests that improving the quality of primary care may not reduce demands on the hospital sector and that other factors are much better predictors of hospitalization for coronary heart disease.
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Conflict of Interest
The Dr Foster Unit (but not the rest of the department of primary care and social medicine) is funded by a grant from Dr Foster Ltd (an independent health service research organization).
We have Section 60 approval from the Security and Confidentiality Advisory Group to hold confidential data and analyze them for research purposes. We also have approval from St Mary’s Local Research Ethics Committee.
AB, SG and AM conceived the study. AB performed all analyses. All authors wrote the manuscript. AB is the guarantor for the study.
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Appendix
Appendix
Appendix Box 1. Quality and Outcomes Framework Indicators for CHD Management in 2004–2005 with Number of Points Available in Parentheses
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Bottle, A., Gnani, S., Saxena, S. et al. Association Between Quality of Primary Care and Hospitalization for Coronary Heart Disease in England: National Cross-sectional Study. J GEN INTERN MED 23, 135–141 (2008). https://doi.org/10.1007/s11606-007-0390-2
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DOI: https://doi.org/10.1007/s11606-007-0390-2