The effect of improving processes of care on patient outcomes: evidence from the United Kingdom's quality and outcomes framework.

Medical Care
Andrew M Ryan, Tim Doran

Abstract

Despite the extensive use of process of care measures in pay-for-performance programs, little is known about the effect of improving process performance on patient outcomes. Retrospective longitudinal analysis of data extracted from 7228 family practices in the United Kingdom's Quality and Outcomes Framework pay-for-performance program. We estimated the proportion of the change in outcome performance over time which was attributable to change in process performance for 5 chronic conditions (diabetes, coronary heart disease, stroke, epilepsy, and hypertension). Our analytic strategy accounted for bias resulting from unmeasured processes of care and severity of illness. The estimated improvement in composite outcomes that was attributable to improved process was 29.6% for diabetes, 25.6% for coronary heart disease, 34.7% for stroke, 29.1% for epilepsy, and 17.7% for hypertension. The relationship between processes and outcomes varied little across patient and practice characteristics. Improvement in process performance in English family practices led to improvements in patient outcomes. Although the effect was modest at the practice-level, process improvements seem to have led to substantial improvements in population health.

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Citations

Dec 26, 2012·Current Diabetes Reports·Tim Doran, Evangelos Kontopantelis
Jul 27, 2012·The New England Journal of Medicine·Jordan M VanLare, Patrick H Conway
Sep 22, 2012·Family Practice·Kirsten KirschnerRichard Grol
Jan 22, 2013·International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care·P ColaisM Davoli
Oct 24, 2013·World Journal of Gastroenterology : WJG·Adam V Weizman, Geoffrey C Nguyen
Oct 24, 2013·World Journal of Gastroenterology : WJG·Adam V Weizman, Geoffrey C Nguyen
Feb 14, 2014·International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care·Jonathan SicsicCarine Franc
Oct 18, 2013·British Medical Bulletin·David M G Goodridge, Simon D Shorvon
Apr 17, 2015·Rheumatology·Victoria Navarro-CompánDésirée van der Heijde
Dec 3, 2014·Health Policy·Olivier Saint-Lary, Jonathan Sicsic
Jul 3, 2013·American Journal of Surgery·Russell B HawkinsKuoJen Tsao
Jun 23, 2016·The European Journal of Health Economics : HEPAC : Health Economics in Prevention and Care·Jonathan Sicsic, Carine Franc
Jan 9, 2016·Medical Care Research and Review : MCRR·Adam A Markovitz, Andrew M Ryan
Jul 5, 2017·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Christoph KronenbergRowena Jacobs
Jul 28, 2015·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Olivier Saint-LaryIrène François-Purssell
Jul 3, 2013·The Journal of Clinical Hypertension·J Rick Turner
Feb 14, 2014·BMJ Quality & Safety·Adam A PowellHanna E Bloomfield
Jul 5, 2018·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·John RobsonSotiris Antoniou
Jul 8, 2015·The Journal of Trauma and Acute Care Surgery·Lynne MooreJean Lapointe

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