Economics of Social and Health Care Research Unit, Centre for Health Economics, University of York, York, YO10 5DD, United Kingdom.
Economics of Social and Health Care Research Unit, Centre for Health Economics, University of York, York, YO10 5DD, United Kingdom; Centre for Health Economics Research and Evaluation, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia.
Soc Sci Med. 2022 May;301:114936. doi: 10.1016/j.socscimed.2022.114936. Epub 2022 Mar 19.
We examine the relationship between general practice list size and measures of clinical quality and patient satisfaction. Using data on all English practices from 2005/6 to 2016/17, we estimate practice level models with rich data on patient demographics, deprivation, and morbidity. We use lagged list size to allow for potential simultaneity bias from the effect of quality on list size. We compare results from three different estimation methods: pooled ordinary least squares, random practice effects, fixed practice effects. With all three estimation methods increased list size is associated with reductions in all four measures of patient satisfaction. Increases in list size are associated with worse performance on three clinical quality indicators and better performance on three, though the precision and size of the associations varies with the estimation method. The absolute values of the elasticities of the ten quality indicators with respect to list size are small: in all cases a 10% change in list size would change quality by less than 1%. The lack of evidence that large practices have markedly better quality suggests that encouraging practices to form larger, but looser, groupings, may not, in itself, improve their performance.
我们考察了普通科医生名单规模与临床质量和患者满意度衡量标准之间的关系。我们使用了 2005/6 年至 2016/17 年所有英国诊所的数据，对具有丰富患者人口统计学、贫困和发病数据的诊所水平模型进行了估计。我们使用滞后名单规模，以避免质量对名单规模的影响产生的潜在同期偏差。我们比较了三种不同估计方法的结果：普通最小二乘法、随机实践效应、固定实践效应。在所有三种估计方法中，名单规模的增加与所有四项患者满意度衡量标准的降低有关。名单规模的增加与三项临床质量指标的较差表现和三项质量指标的较好表现有关，尽管关联的精度和大小因估计方法而异。十个质量指标中十个质量指标的弹性绝对值相对较小：在所有情况下，名单规模变化 10%将使质量变化小于 1%。没有证据表明大型实践具有明显更好的质量，这表明鼓励实践形成更大但更松散的分组本身并不能提高其绩效。
