The Public Health Impact score: a new measure of public health effectiveness for general practices in England

Ashworth, Mark; Schofield, Peter; Doran, Tim; Cookson, Richard; Sutton, Matthew; Seed, Paul T.; Howe, Amanda; Fleetcroft, Robert
April 2013
British Journal of General Practice;Apr2013, Vol. 63 Issue 609, pe291
Academic Journal
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) payfor- 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 (ß = 0.77) and the proportion of patients aged =65 years (ß = 0.22). General practices that were less successful at achieving their maximum potential PHI score were those with a lower prevalence of relevant conditions (ß = 0.29), larger list sizes (ß = -0.16), greater area deprivation (ß = -0.15), and a larger proportion of patients aged =65 years (ß = -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-forperformance scheme are not closely aligned to the public health impact of practices.


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