ArticleBMJ open2013
Modelling factors in primary care quality improvement: a cross-sectional study of premature CHD mortality.
Article in BMJ open, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 3 of them syntheses that pooled it.
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Who cites it
13 citing papers in PubMed, 3 syntheses or guidelines pooled it, 16 citations in OpenAlex.
- Quality indicators for the primary prevention of cardiovascular disease in primary care: A systematic review.PloS one · 2024Pooled it
- Primary medical care continuity and patient mortality: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2020Pooled it
- Continuity of care with doctors-a matter of life and death? A systematic review of continuity of care and mortality.BMJ open · 2018Pooled it
- Association between continuity of care and detection of hypertension in Dutch general practice: a 10-year cohort study.BMJ open · 2026Article
- Article
- Vulnerable Groups in Primary Health Care: Brief Report of a Project Implementation in Lisbon.Portuguese journal of public health · 2025Article
- Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway.The British journal of general practice : the journal of the Royal College of General Practitioners · 2022Observational
- Continuity of care, measurement and association with hospital admission and mortality: a registry-based longitudinal cohort study.BMJ open · 2021Article
- Effect of family practice contract services on the quality of primary care in Guangzhou, China: a cross-sectional study using PCAT-AE.BMJ open · 2018Article
- Association between the General Practitioner Workforce Crisis and Premature Mortality in Hungary: Cross-Sectional Evaluation of Health Insurance Data from 2006 to 2014.International journal of environmental research and public health · 2018Article
- Population characteristics, mechanisms of primary care and premature mortality in England: a cross-sectional study.BMJ open · 2016Article
- Estimating smoking prevalence in general practice using data from the Quality and Outcomes Framework (QOF).BMJ open · 2014Observational
- Impact of continuity of care on mortality and health care costs: a nationwide cohort study in Korea.Annals of family medicineArticle
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo identify features of primary care quality improvement associated with improved health outcomes using premature coronary heart disease (CHD) mortality as an example, and to determine impacts of different modelling approaches.
designCross-sectional study of mortality rates in 229 general practices.
settingGeneral practices from three East Midlands primary care trusts.
participantsPatients registered to the practices above between April 2006 and March 2009.
main outcome measuresNumbers of CHD deaths in those aged under 75 (premature mortality) and at all ages in each practice.
resultsPopulation characteristics and markers of quality of primary care were associated with variations in premature CHD mortality. Increasing levels of deprivation, percentages of practice populations on practice diabetes registers, white, over 65 and male were all associated with increasing levels of premature CHD mortality. Control of serum cholesterol levels in those with CHD and the percentage of patients recalling access to their preferred general practitioner were both associated with decreased levels of premature CHD mortality. Similar results were found for all-age mortality. A combined measure of quality of primary care for CHD comprising 12 quality outcomes framework indicators was associated with decreases in both all-age and premature CHD mortality. The selected models suggest that practices in less deprived areas may have up to 20% lower premature CHD mortality than those with median deprivation and that improvement in the CHD care quality from 83% (lower quartile) to 86% (median) could reduce premature CHD mortality by 3.6%. Different modelling approaches yielded qualitatively similar results.
conclusionsHigh-quality primary care, including aspects of access to and continuity of care, detection and management, appears to be associated with reducing CHD mortality. The impact on premature CHD mortality is greater than on all-age CHD mortality. Determining the most useful measures of quality of primary care needs further consideration.
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