Quality of Disease Management and Risk of Mortality in English Primary Care Practices.

TitreQuality of Disease Management and Risk of Mortality in English Primary Care Practices.
Publication TypeJournal Article
Year of Publication2015
AuthorsDusheiko, M, Gravelle, H, Martin, S, Smith, PC
JournalHealth Services Research
Date Published10/2015
ISBN Number1475-6773 (Electronic)
Mots-clésAge Factors, Chronic Disease, Comorbidity, Cross-Sectional Studies, Disease Management, England, Female, Health Services Accessibility, Hospitalization, Humans, Logistic Models, Male, Primary Health Care, Quality Indicators, Health Care, Quality of Health Care, Sex Factors, Socioeconomic Factors, State Medicine, Treatment Outcome

OBJECTIVE: To investigate whether better management of chronic conditions by family practices reduces mortality risk.

DATA: Two random samples of 5 million patients registered with over 8,000 English family practices followed up for 4 years (2004/5-2007/8). Measures of the quality of disease management for 10 conditions were constructed for each family practice for each year. The outcome measure was an indicator taking the value 1 if the patient died during a specified year, 0 otherwise.

STUDY DESIGN: Cross-section and multilevel panel data multiple logistic regressions were estimated. Covariates included age, gender, morbidity, hospitalizations, attributed socio-economic characteristics, and local health care supply measures.

PRINCIPAL FINDINGS: Although a composite measure of the quality of disease management for all 10 conditions was significantly associated with lower mortality, only the quality of stroke care was significant when all 10 quality measures were entered in the regression.

CONCLUSIONS: The panel data results suggest that a 1 percent improvement in the quality of stroke care could reduce the annual number of deaths in England by 782 [95 percent CI: 423, 1140]. A longer study period may be necessary to detect any mortality impact of better management of other conditions.



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Alternate JournalHealth Serv Res
Citation Key / SERVAL ID6054
Peer reviewRefereed
PubMed ID25597263
PubMed Central IDPMC4600356
Grant List / / Department of Health / United Kingdom


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