Association between quality of primary care and hospitalization for coronary heart disease in England: national cross-sectional study.
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.


METHODS
Ecological cross-sectional study using data from the Quality and Outcomes Framework for family practice, hospital admissions, and census data.


METHODS
All 303 primary care trusts in England, covering approximately 50 million people.


METHODS
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.
Bottle
Alex
A
Dr Foster Unit, Department of Primary Care & Social Medicine, Imperial College London, London, UK. robert.bottle@imperial.ac.uk
Gnani
Shamini
S
Saxena
Sonia
S
Aylin
Paul
P
Mainous
Arch G
AG
Majeed
Azeem
A
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D002391:Catchment Area, Health; D054869:Clinical Audit; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000175:diagnosis / Q000628:therapy*; D003430:Cross-Sectional Studies; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004739:England; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012052:Reimbursement, Incentive; D012959:Socioeconomic Factors; D035862:Vulnerable Populations