TY - JOUR
T1 - Variations in achievement of evidence-based, high-impact quality indicators in general practice
T2 - An observational study
AU - ASPIRE programme team
AU - Willis, Thomas A.
AU - West, Robert
AU - Rushforth, Bruno
AU - Stokes, Tim
AU - Glidewell, Liz
AU - Carder, Paul
AU - Faulkner, Simon
AU - Foy, Robbie
AU - Clamp, Susan
AU - Farrin, Amanda
AU - Hartley, Suzanne
AU - Hulme, Claire
AU - Lawton, Rebecca
AU - McEachan, Rosie
AU - Rathfelder, Martin
AU - Richardson, Judith
AU - Ward, Vicky
AU - Watt, Ian
N1 - The ASPIRE programme team comprises Susan Clamp, Amanda Farrin, Suzanne Hartley, Claire Hulme, Rebecca Lawton, Rosie McEachan, Martin Rathfelder, Judith Richardson, Vicky Ward, and Ian Watt, in addition to the named authors. This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-1209-10040); Principal Investigator: RF.
PY - 2017/7/13
Y1 - 2017/7/13
N2 - Background: There are widely recognised variations in the delivery and outcomes of healthcare but an incomplete understanding of their causes. There is a growing interest in using routinely collected 'big data' in the evaluation of healthcare. We developed a set of evidence-based 'high impact' quality indicators (QIs) for primary care and examined variations in achievement of these indicators using routinely collected data in the United Kingdom (UK). Methods: Cross-sectional analysis of routinely collected, electronic primary care data from a sample of general practices in West Yorkshire, UK (n = 89). The QIs covered aspects of care (including processes and intermediate clinical outcomes) in relation to diabetes, hypertension, atrial fibrillation, myocardial infarction, chronic kidney disease (CKD) and 'risky' prescribing combinations. Regression models explored the impact of practice and patient characteristics. Clustering within practice was accounted for by including a random intercept for practice. Results: Median practice achievement of the QIs ranged from 43.2% (diabetes control) to 72.2% (blood pressure control in CKD). Considerable between-practice variation existed for all indicators: the difference between the highest and lowest performing practices was 26.3 percentage points for risky prescribing and 100 percentage points for anticoagulation in atrial fibrillation. Odds ratios associated with the random effects for practices emphasised this; there was a greater than ten-fold difference in the likelihood of achieving the hypertension indicator between the lowest and highest performing practices. Patient characteristics, in particular age, gender and comorbidity, were consistently but modestly associated with indicator achievement. Statistically significant practice characteristics were identified less frequently in adjusted models. Conclusions: Despite various policy and improvement initiatives, there are enduring inappropriate variations in the delivery of evidence-based care. Much of this variation is not explained by routinely collected patient or practice variables, and is likely to be attributable to differences in clinical and organisational behaviour.
AB - Background: There are widely recognised variations in the delivery and outcomes of healthcare but an incomplete understanding of their causes. There is a growing interest in using routinely collected 'big data' in the evaluation of healthcare. We developed a set of evidence-based 'high impact' quality indicators (QIs) for primary care and examined variations in achievement of these indicators using routinely collected data in the United Kingdom (UK). Methods: Cross-sectional analysis of routinely collected, electronic primary care data from a sample of general practices in West Yorkshire, UK (n = 89). The QIs covered aspects of care (including processes and intermediate clinical outcomes) in relation to diabetes, hypertension, atrial fibrillation, myocardial infarction, chronic kidney disease (CKD) and 'risky' prescribing combinations. Regression models explored the impact of practice and patient characteristics. Clustering within practice was accounted for by including a random intercept for practice. Results: Median practice achievement of the QIs ranged from 43.2% (diabetes control) to 72.2% (blood pressure control in CKD). Considerable between-practice variation existed for all indicators: the difference between the highest and lowest performing practices was 26.3 percentage points for risky prescribing and 100 percentage points for anticoagulation in atrial fibrillation. Odds ratios associated with the random effects for practices emphasised this; there was a greater than ten-fold difference in the likelihood of achieving the hypertension indicator between the lowest and highest performing practices. Patient characteristics, in particular age, gender and comorbidity, were consistently but modestly associated with indicator achievement. Statistically significant practice characteristics were identified less frequently in adjusted models. Conclusions: Despite various policy and improvement initiatives, there are enduring inappropriate variations in the delivery of evidence-based care. Much of this variation is not explained by routinely collected patient or practice variables, and is likely to be attributable to differences in clinical and organisational behaviour.
UR - http://www.scopus.com/inward/record.url?scp=85023765378&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0177949
DO - 10.1371/journal.pone.0177949
M3 - Article
C2 - 28704407
AN - SCOPUS:85023765378
SN - 1932-6203
VL - 12
JO - PLoS ONE
JF - PLoS ONE
IS - 7
M1 - e0177949
ER -
