Association between quality of primary care and hospitalization for coronary heart disease in England: National cross-sectional study

BACKGROUND: A new pay-for-performance scheme for primary care physicians was introduced in England in 2004 as part of an initiative to link the quality of primary care with physician pay. OBJECTIVE: To investigate the association between the quality of primary care and rates of hospital admissions for coronary heart disease. DESIGN: Ecological cross-sectional study using data from the Quality and Outcomes Framework for family practice, hospital admissions, and census data. PARTICIPANTS: All 303 primary care trusts in England, covering approximately 50 million people. MEASUREMENTS: Rates of elective and unplanned hospital admissions for coronary heart disease and rates of coronary angioplasty and coronary artery bypass grafting were regressed against quality-of-care measures from the Quality and Outcomes Framework, area socioeconomic scores, and disease prevalence. RESULTS: Correlations between prevalence, area socioeconomic scores, and admission rates were generally weak. The strongest relations were seen between area socioeconomic scores and elective and unplanned hospital admissions and revascularization procedures among the age group 45-74 years. Among those aged 75 years and over, the only positive association observed was between area socioeconomic scores and unplanned hospital admissions. CONCLUSIONS: The lack of an association between quality scores and admission rates suggests that improving the quality of primary care may not reduce demands on the hospital sector and that other factors are much better predictors of hospitalization for coronary heart disease.