ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2003
Quality measurement of care for people with type 2 diabetes in Tayside, Scotland: implications for the new UK general practice contract.
Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2003. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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The trial behind it
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Who cites it
8 citing papers in PubMed.
- Randomised controlled trial of near-patient testing for glycated haemoglobin in people with type 2 diabetes mellitus.The British journal of general practice : the journal of the Royal College of General Practitioners · 2006Trial
- Control, compare and communicate: designing control charts to summarise efficiently data from multiple quality indicators.Quality & safety in health care · 2005Article
- On professionalism.The British journal of general practice : the journal of the Royal College of General Practitioners · 2003Article
- Desert docs.The British journal of general practice : the journal of the Royal College of General Practitioners · 2003Article
- Worth doing badly? Sexual health promotion in primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2003Article
- Postcard 6... Community care. Social entrepreneurs are creating better communities.The British journal of general practice : the journal of the Royal College of General Practitioners · 2003Article
- Hippocrates appraises 21st century doctors.The British journal of general practice : the journal of the Royal College of General Practitioners · 2003Article
- Reflections on annual appraisal.The British journal of general practice : the journal of the Royal College of General Practitioners · 2003Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe new United Kingdom general practice contract proposes that up to a third of general practitioners' income will come from achieving quality targets.
aimTo examine selected quality markers in terms of their robustness to case-mix variation and chance effects, and in the attribution of quality to practices. STUDY DESIGN AND
methodsData were extracted from a population-based diabetes clinical information system in Tayside, Scotland, for patients with type 2 diabetes registered in 67 practices with complete ascertainment.
resultsMost practices would have received relatively high levels of payment for the process measures examined. Outcome measures appeared more challenging. Case-mix adjustment for age, sex, and postcode-assigned deprivation altered measured performance by up to 7%, but payment by up to 14%. Despite no strong evidence of any real difference in quality, chance effects meant that there was greater apparent variability for smaller practices from year to year. Hospital attendance was common, but highly variable between practices.
conclusionCase-mix adjustment to allow fairer comparison is routine in national performance indicators, and ignoring it risks making the new contract quality framework inequitable. Because of chance effects, smaller practices may have greater year-to-year variability in income. Reflecting National Health Service structure, the new contract provides no incentives for integrated care and offers a perverse incentive to refer more patients to hospital. There are trade-offs between the validity of measures, and the cost and bureaucracy of collecting data. The planned evaluation of the new contrast should examine the effectiveness and equity of the quality framework, and rapidly act on deficiencies found.
Indexed as
Identifiers
15103879PMC1314694What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.