title: Quality of Disease Management and Risk of Mortality in English Primary Care Practices.
abstract: OBJECTIVE
  To investigate whether better management of chronic conditions by family practices reduces mortality risk.
  
  
  METHODS
  Two random samples of 5 million patients registered with over 8,000 English family practices followed up for 4 years (2004/5-2007/8). Measures of the quality of disease management for 10 conditions were constructed for each family practice for each year. The outcome measure was an indicator taking the value 1 if the patient died during a specified year, 0 otherwise.
  
  
  METHODS
  Cross-section and multilevel panel data multiple logistic regressions were estimated. Covariates included age, gender, morbidity, hospitalizations, attributed socio-economic characteristics, and local health care supply measures.
  
  
  RESULTS
  Although a composite measure of the quality of disease management for all 10 conditions was significantly associated with lower mortality, only the quality of stroke care was significant when all 10 quality measures were entered in the regression.
  
  
  CONCLUSIONS
  The panel data results suggest that a 1 percent improvement in the quality of stroke care could reduce the annual number of deaths in England by 782 [95 percent CI: 423, 1140]. A longer study period may be necessary to detect any mortality impact of better management of other conditions.
authors.affiliation: Centre for Health Economics, University of York, York, UK.|Institut d'économie et management de la santé, Internef Bureau 532 Université de Lausanne, Lausanne, Switzerland.
authors.forename: Mark
authors.initials: M
authors.lastname: Dusheiko
authors.affiliation: Centre for Health Economics, University of York, York, UK.
authors.forename: Hugh
authors.initials: H
authors.lastname: Gravelle
authors.affiliation: Department of Economics and Related Studies, University of York, York, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Martin
authors.affiliation: Imperial College Business School, Imperial College, London, UK.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Smith
mesh_terms: D000367:Age Factors; D002908:Chronic Disease / Q000401:mortality*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D019468:Disease Management; D004739:England; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors; D013222:State Medicine / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: Disease management; chronic conditions; mortality; primary care; quality