Department of Health Sciences, University of Leicester, Leicester, UK.
BMJ Open. 2013 Oct 22;3(10):e003391. doi: 10.1136/bmjopen-2013-003391.
To 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.
Cross-sectional study of mortality rates in 229 general practices.
General practices from three East Midlands primary care trusts.
Patients registered to the practices above between April 2006 and March 2009.
Numbers of CHD deaths in those aged under 75 (premature mortality) and at all ages in each practice.
Population 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.
High-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.
以早发冠心病（CHD）死亡率为例，确定与改善健康结果相关的初级保健质量改进特征，并确定不同建模方法的影响。
对 229 家普通诊所死亡率的横断面研究。
来自三个东米德兰兹初级保健信托的普通诊所。
上述实践中 2006 年 4 月至 2009 年 3 月期间注册的患者。
每个实践中年龄在 75 岁以下（早逝）和所有年龄段的 CHD 死亡人数。
人口特征和初级保健质量指标与早发性 CHD 死亡率的变化相关。贫困程度的增加、实践人群中在实践糖尿病登记册上的百分比、白人、65 岁以上和男性比例的增加均与早发性 CHD 死亡率的增加相关。在患有 CHD 的人群中控制血清胆固醇水平以及记住可获得首选全科医生的患者比例均与早发性 CHD 死亡率的降低相关。所有年龄段的死亡率也得出了类似的结果。包括 12 个质量框架指标在内的初级保健质量综合衡量指标与所有年龄段和早发性 CHD 死亡率的降低相关。选定的模型表明，较不贫困地区的实践可能比处于中等贫困水平的实践的早发性 CHD 死亡率低 20%，而将 CHD 护理质量从 83%（较低的四分位数）提高到 86%（中位数）可以降低 3.6%的早发性 CHD 死亡率。不同的建模方法产生了定性相似的结果。
高质量的初级保健，包括获得和连续性护理、检测和管理等方面，似乎与降低 CHD 死亡率相关。对早发性 CHD 死亡率的影响大于对所有年龄段 CHD 死亡率的影响。进一步考虑确定初级保健质量的最有用措施。
