Variations in achievement of evidence-based, high-impact quality indicators in general practice: An observational study

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...

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Bibliographic Details
Published in:PloS one Vol. 12; no. 7; p. e0177949
Main Authors: Willis, Thomas A., West, Robert, Rushforth, Bruno, Stokes, Tim, Glidewell, Liz, Carder, Paul, Faulkner, Simon, Foy, Robbie
Format: Journal Article
Language:English
Published: United States Public Library of Science 13.07.2017
Public Library of Science (PLoS)
Subjects:
Age
Aged
Aged, 80 and over
Anticoagulants
Atrial Fibrillation - therapy
Blood pressure
Cardiac arrhythmia
Clinical medicine
Clustering
Comorbidity
Cross-Sectional Studies
Data management
Diabetes
Diabetes mellitus
Diabetes Mellitus - therapy
Disease control
Family medicine
Fibrillation
General Practice - standards
Health care
Health sciences
Heart attacks
Humans
Hypertension
Hypertension - therapy
Indicators
Information management
Kidney transplantation
Medical care
Medicine and Health Sciences
Middle Aged
Myocardial infarction
Myocardial Infarction - therapy
Observational studies
Organizational aspects
Patients
Physicians
Practice Patterns, Physicians' - standards
Primary care
Primary Health Care - standards
Quality
Quality control
Quality Indicators, Health Care
R&D
Regression Analysis
Regression models
Renal Insufficiency, Chronic - therapy
Research & development
Statistical analysis
United Kingdom
United Kingdom > UK
England
ISSN:1932-6203, 1932-6203
Online Access:Get full text
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Summary: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). 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. 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. 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.
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Competing Interests: The authors have declared that no competing interests exist.
Conceptualization: TAW BR LG TS RF.Data curation: SF RW.Formal analysis: RW.Funding acquisition: RF.Investigation: TAW SF.Methodology: TAW BR SF RF.Project administration: TAW.Resources: PC SF.Software: SF.Supervision: TAW RF.Validation: TAW BR RF.Visualization: TAW RW.Writing – original draft: TAW.Writing – review & editing: TAW BR RW TS LG RF.
Membership of the ASPIRE programme team is provided in the Acknowledegements
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0177949