Kasteridis Panagiotis, Mason Anne R, Goddard Maria K, Jacobs Rowena, Santos Rita, McGonigal Gerard
Centre for Health Economics, University of York, York, United Kingdom.
Department of Medicine for the Elderly, York Teaching Hospital NHS Foundation Trust, York, United Kingdom.
PLoS One. 2015 Mar 27;10(3):e0121506. doi: 10.1371/journal.pone.0121506. eCollection 2015.
To test the impact of a UK pay-for-performance indicator, the Quality and Outcomes Framework (QOF) dementia review, on three types of hospital admission for people with dementia: emergency admissions where dementia was the primary diagnosis; emergency admissions for ambulatory care sensitive conditions (ACSCs); and elective admissions for cataract, hip replacement, hernia, prostate disease, or hearing loss.
Count data regression analyses of hospital admissions from 8,304 English general practices from 2006/7 to 2010/11. We identified relevant admissions from national Hospital Episode Statistics and aggregated them to practice level. We merged these with practice-level data on the QOF dementia review. In the base case, the exposure measure was the reported QOF register. As dementia is commonly under-diagnosed, we tested a predicted practice register based on consensus estimates. We adjusted for practice characteristics including measures of deprivation and uptake of a social benefit to purchase care services (Attendance Allowance).
In the base case analysis, higher QOF achievement had no significant effect on any type of hospital admission. However, when the predicted register was used to account for under-diagnosis, a one-percentage point improvement in QOF achievement was associated with a small reduction in emergency admissions for both dementia (-0.1%; P=0.011) and ACSCs (-0.1%; P=0.001). In areas of greater deprivation, uptake of Attendance Allowance was consistently associated with significantly lower emergency admissions. In all analyses, practices with a higher proportion of nursing home patients had significantly lower admission rates for elective and emergency care.
In one of three analyses at practice level, the QOF review for dementia was associated with a small but significant reduction in unplanned hospital admissions. Given the rising prevalence of dementia, increasing pressures on acute hospital beds and poor outcomes associated with hospital stays for this patient group, this small change may be clinically and economically relevant.
测试英国按绩效付费指标——质量与结果框架（QOF）痴呆症评估，对痴呆症患者三种类型住院情况的影响：痴呆症为主要诊断的急诊住院；非卧床护理敏感疾病（ACSCs）的急诊住院；白内障、髋关节置换、疝气、前列腺疾病或听力损失的择期住院。
对2006/7至2010/11年间来自8304家英国普通诊所的住院数据进行计数数据回归分析。我们从国家医院事件统计中识别出相关住院病例，并将其汇总到诊所层面。我们将这些数据与QOF痴呆症评估的诊所层面数据合并。在基础案例中，暴露指标是报告的QOF登记册。由于痴呆症通常诊断不足，我们基于共识估计测试了一个预测的诊所登记册。我们对诊所特征进行了调整，包括贫困程度和购买护理服务的社会福利（护理津贴）的接受情况。
在基础案例分析中，较高的QOF成就对任何类型的住院情况均无显著影响。然而，当使用预测登记册来考虑诊断不足时，QOF成就提高一个百分点与痴呆症急诊住院（-0.1%；P=0.011）和ACSCs急诊住院（-0.1%；P=0.001）的小幅减少相关。在贫困程度较高的地区，护理津贴的接受情况始终与显著较低的急诊住院率相关。在所有分析中，养老院患者比例较高的诊所，其择期和急诊护理的住院率显著较低。
在诊所层面的三项分析中的一项中，QOF痴呆症评估与计划外住院的小幅但显著减少相关。鉴于痴呆症患病率不断上升、急性医院病床压力增加以及该患者群体住院相关的不良后果，这一微小变化可能在临床和经济方面具有相关性。
