Identifying poorly performing general practices in England: a longitudinal study using data from the quality and outcomes framework.
J Health Serv Res Policy
; 16(1): 21-7, 2011 Jan.
Article
en En
| MEDLINE
| ID: mdl-21186318
ABSTRACT
OBJECTIVE:
to determine the characteristics of general practices which perform poorly in terms of Quality and Outcome (QOF) performance indicators in England's NHS.METHOD:
retrospective, four year longitudinal study, 2005 to 2008. Data were obtained from 8515 practices (99% of practices in England) in year 1, 8264 (98%) in year 2, 8192 (98%) in year 3 and 8256 (99%) in year 4. OUTCOMEMEASURES:
QOF performance scores; social deprivation (IMD-2007) and ethnicity from the 2001 national census; general practice characteristics.RESULTS:
we identified a cohort of 212 (2.7%) practices which remained in the lowest decile for total QOF scores in the four years following the introduction of the QOF. A total of 705,386 patients were registered at these practices in year 4. These practices were more likely to be singlehanded (odds ratio [OR], 13.8), non-training practices (OR, 3.9) and located in deprived areas (OR, 2.6; most vs least deprived quintiles). General practitioners (GPs) in these practices were more often aged ≥ 65 years or more (OR, 7.3; mean GP age ≥ 65 years vs <45 years), male (OR 2.0), UK qualified (OR 2.0) with small list sizes (OR 3.2; list size <1000 vs 1500-2000 patients). We identified individual QOF indicators which were poorly achieved. The reported prevalence of most chronic diseases was lower in the poorly performing cohort.CONCLUSIONS:
a small minority of practices have remained poor performers in terms of measurable performance indicators over a four-year period. The strongest predictors of poor QOF performance were singlehanded and small practices, and practices staffed by elderly GPs.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Medicina Estatal
/
Evaluación de Resultado en la Atención de Salud
/
Indicadores de Calidad de la Atención de Salud
/
Medicina General
Tipo de estudio:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Aged
/
Humans
/
Male
País/Región como asunto:
Europa
Idioma:
En
Revista:
J Health Serv Res Policy
Asunto de la revista:
SAUDE PUBLICA
/
SERVICOS DE SAUDE
Año:
2011
Tipo del documento:
Article
País de afiliación:
Reino Unido