Investigating the relationship between quality of primary care and premature mortality in England: a spatial whole-population study.
OBJECTIVE
To quantify the relationship between a national primary care pay-for-performance programme, the UK's Quality and Outcomes Framework (QOF), and all-cause and cause-specific premature mortality linked closely with conditions included in the framework.


METHODS
Longitudinal spatial study, at the level of the "lower layer super output area" (LSOA).


METHODS
32482 LSOAs (neighbourhoods of 1500 people on average), covering the whole population of England (approximately 53.5 million), from 2007 to 2012.


METHODS
8647 English general practices participating in the QOF for at least one year of the study period, including over 99% of patients registered with primary care.


METHODS
National pay-for-performance programme incentivising performance on over 100 quality-of-care indicators.


METHODS
All-cause and cause-specific mortality rates for six chronic conditions: diabetes, heart failure, hypertension, ischaemic heart disease, stroke, and chronic kidney disease. We used multiple linear regressions to investigate the relationship between spatially estimated recorded quality of care and mortality.


RESULTS
All-cause and cause-specific mortality rates declined over the study period. Higher mortality was associated with greater area deprivation, urban location, and higher proportion of a non-white population. In general, there was no significant relationship between practice performance on quality indicators included in the QOF and all-cause or cause-specific mortality rates in the practice locality.


CONCLUSIONS
Higher reported achievement of activities incentivised under a major, nationwide pay-for-performance programme did not seem to result in reduced incidence of premature death in the population.
Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, UK NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester e.kontopantelis@manchester.ac.uk.
Evangelos
E
Kontopantelis
NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester Centre for Biostatistics, Institute of Population Health, University of Manchester.
David A
DA
Springate
Primary Care and Public Health Sciences, King's College London, London, UK.
Mark
M
Ashworth
Centre for Mental Health and Risk, University of Manchester.
Roger T
RT
Webb
Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, UK.
Iain E
IE
Buchan
Department of Health Sciences, University of York, York, UK.
Tim
T
Doran
D002423:Cause of Death; D002908:Chronic Disease / Q000401:mortality / Q000628:therapy*; D004739:England / Q000453:epidemiology; D058006:General Practice / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D061213:Mortality, Premature; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D011364:Professional Practice / Q000592:standards / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D012052:Reimbursement, Incentive / Q000592:standards / Q000706:statistics & numerical data; D012111:Residence Characteristics / Q000706:statistics & numerical data