Document Detail

The Public Health Impact score: a new measure of public health effectiveness for general practices in England.
MedLine Citation:
PMID:  23540486     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Health policy in the UK is increasingly focused on the measurement of outcomes rather than structures and processes of health care.
AIM: To develop a measure of the effectiveness of primary care in terms of population health outcomes.
DESIGN AND SETTING: A cross-sectional study of general practices in England.
METHOD: Twenty clinical quality of care indicators for which there was evidence of mortality reduction were identified from the national Quality and Outcomes Framework (QOF) pay-for-performance scheme. The number of lives saved by 8136 English practices (97.97% of all practices) in 2009/2010 was estimated, based on their performance on these measures, and a public health impact measure, the PHI score, was constructed. Multilevel regression models were used to identify practice and population predictors of PHI scores.
RESULTS: The mean estimated PHI score was 258.9 (standard deviation [SD] = 73.3) lives saved per 100 000 registered patients, per annum. This represents 75.7% of the maximum potential PHI score of 340.9 (SD = 91.8). PHI and QOF scores were weakly correlated (Pearson r = 0.28). The most powerful predictors of PHI score were the prevalence of the relevant clinical conditions (β = 0.77) and the proportion of patients aged ≥65 years (β = 0.22). General practices that were less successful at achieving their maximum potential PHI score were those with a lower prevalence of relevant conditions (β = 0.29), larger list sizes (β = -0.16), greater area deprivation (β = -0.15), and a larger proportion of patients aged ≥65 years (β = -0.13).
CONCLUSION: The PHI score is a potential alternative metric of practice performance, measuring the estimated mortality reduction in the registered population. Rewards under the QOF pay-for-performance scheme are not closely aligned to the public health impact of practices.
Mark Ashworth; Peter Schofield; Tim Doran; Richard Cookson; Matthew Sutton; Paul T Seed; Amanda Howe; Robert Fleetcroft
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The British journal of general practice : the journal of the Royal College of General Practitioners     Volume:  63     ISSN:  1478-5242     ISO Abbreviation:  Br J Gen Pract     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-04-01     Completed Date:  2014-01-21     Revised Date:  2014-04-01    
Medline Journal Info:
Nlm Unique ID:  9005323     Medline TA:  Br J Gen Pract     Country:  England    
Other Details:
Languages:  eng     Pagination:  e291-9     Citation Subset:  IM    
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MeSH Terms
Cross-Sectional Studies
England / epidemiology
General Practice* / standards
Outcome Assessment (Health Care)
Primary Health Care*
Public Health* / standards
Quality Improvement
Quality Indicators, Health Care / standards*
Quality of Health Care
Quality-Adjusted Life Years
Retrospective Studies
Grant Support
CDF-2011-04-016//Department of Health

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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