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Quality of Disease Management and Risk of Mortality in English Primary Care Practices
Author(s) -
Dusheiko Mark,
Gravelle Hugh,
Martin Stephen,
Smith Peter C.
Publication year - 2015
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12283
Subject(s) - medicine , logistic regression , quality management , stroke (engine) , disease management , demography , disease , regression analysis , quality (philosophy) , emergency medicine , environmental health , operations management , statistics , management system , mechanical engineering , mathematics , sociology , parkinson's disease , engineering , economics , philosophy , epistemology
Objective To investigate whether better management of chronic conditions by family practices reduces mortality risk. Data 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. Study Design 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. Principal Findings 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.