title: The influence of primary care quality on hospital admissions for people with dementia in England: a regression analysis.
abstract: OBJECTIVE
  To test the impact of a UK pay-for-performance indicator, the Quality and Outcomes Framework (QOF) dementia review, on three types of hospital admission for people with dementia: emergency admissions where dementia was the primary diagnosis; emergency admissions for ambulatory care sensitive conditions (ACSCs); and elective admissions for cataract, hip replacement, hernia, prostate disease, or hearing loss.
  
  
  METHODS
  Count data regression analyses of hospital admissions from 8,304 English general practices from 2006/7 to 2010/11. We identified relevant admissions from national Hospital Episode Statistics and aggregated them to practice level. We merged these with practice-level data on the QOF dementia review. In the base case, the exposure measure was the reported QOF register. As dementia is commonly under-diagnosed, we tested a predicted practice register based on consensus estimates. We adjusted for practice characteristics including measures of deprivation and uptake of a social benefit to purchase care services (Attendance Allowance).
  
  
  RESULTS
  In the base case analysis, higher QOF achievement had no significant effect on any type of hospital admission. However, when the predicted register was used to account for under-diagnosis, a one-percentage point improvement in QOF achievement was associated with a small reduction in emergency admissions for both dementia (-0.1%; P=0.011) and ACSCs (-0.1%; P=0.001). In areas of greater deprivation, uptake of Attendance Allowance was consistently associated with significantly lower emergency admissions. In all analyses, practices with a higher proportion of nursing home patients had significantly lower admission rates for elective and emergency care.
  
  
  CONCLUSIONS
  In one of three analyses at practice level, the QOF review for dementia was associated with a small but significant reduction in unplanned hospital admissions. Given the rising prevalence of dementia, increasing pressures on acute hospital beds and poor outcomes associated with hospital stays for this patient group, this small change may be clinically and economically relevant.
authors: Centre for Health Economics, University of York, York, United Kingdom.
authors: Panagiotis
authors: P
authors: Kasteridis
authors: Centre for Health Economics, University of York, York, United Kingdom.
authors: Anne R
authors: AR
authors: Mason
authors: Centre for Health Economics, University of York, York, United Kingdom.
authors: Maria K
authors: MK
authors: Goddard
authors: Centre for Health Economics, University of York, York, United Kingdom.
authors: Rowena
authors: R
authors: Jacobs
authors: Centre for Health Economics, University of York, York, United Kingdom.
authors: Rita
authors: R
authors: Santos
authors: Department of Medicine for the Elderly, York Teaching Hospital NHS Foundation Trust, York, United Kingdom.
authors: Gerard
authors: G
authors: McGonigal
mesh_terms: D003704:Dementia / Q000453:epidemiology*; D004739:England / Q000453:epidemiology; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011787:Quality of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D012044:Regression Analysis