Publications
338 results found
Greaves F, Millett C, Pape UJ, et al., 2012, Association between primary care organisation population size and quality of commissioning in England: an observational study, BRITISH JOURNAL OF GENERAL PRACTICE, Vol: 62, Pages: 28-29, ISSN: 0960-1643
<B>Background</B> <P></P>The ideal population size of healthcare commissioning organisations is not known. <P></P> <B>Aim</B> <P></P>To investigate whether there is a relationship between the size of commissioning organisations and how well they perform on a range of performance measures. <P></P> <B>Design and setting</B> <P></P>Cross-sectional, observational study of performance in all 152 primary care trusts (PCTs) in England. <P></P> <B>Method</B> <P></P>Comparison of PCT size against 36 indicators of commissioning performance, including measures of clinical and preventative effectiveness, patient centredness, access, cost, financial ability, and engagement. <P></P> <B>Results</B> <P></P>Fourteen of the 36 indicators have an unadjusted relationship (<I>P</I><0.05) with size of the PCT. With 10 indicators, there was increasing quality with larger size. However, when population factors including deprivation, ethnicity, rurality, and age were included in the analysis, there was no relationship between size and performance for any measure. <P></P> <B>Conclusion</B> <P></P>There is no evidence to suggest that there is an optimum size for PCT performance. Observed variations in PCT performance with size were explained by the characteristics of the populations they served. These findings suggest that configuration of clinical commissioning groups should be geared towards producing organisations that can function effectively across their key responsibilities, rather than being based on the size of their population alone.
Alsanjari ON, de Lusignan S, van Vlymen J, et al., 2012, Trends and transient change in end-digit preference in blood pressure recording: studies of sequential and longitudinal collected primary care data, INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Vol: 66, Pages: 37-43, ISSN: 1368-5031
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- Citations: 22
Greaves F, Pape U, King D, et al., 2012, Associations between internet-based patient ratings and conventional surveys of patient experience in the English NHS: an observational study, BMJ Qual Saf
Gibbons DC, Bindman AB, Soljak MA, et al., 2012, Defining primary care sensitive conditions: a necessity for effective primary care delivery?, JRSM, Vol: 105, Pages: 422-428
Primary care is a major component of England's National Health Service (NHS), responsible for approximately 300 million consultations per year with GPs in England, which represents 70–90% of all patient contacts with the NHS. In addition to providing healthcare to the registered population, GPs are charged with coordination and gatekeeping of access to services provided by secondary care, tertiary care and other allied healthcare providers. As GPs will be assuming a key role in commissioning health services in England, there is a clear opportunity to re-model care delivery to maximize outcomes, cost efficiency and patient access by focusing on diseases that are most amenable to management in primary care. It is essential that there is evidence to inform what conditions are most sensitive to management in primary care – commonly referred to as primary care sensitive conditions or ambulatory care sensitive conditions. Such definitions would aid resource planning, drafting of local management protocols and simplification of the interface between primary and secondary care for a number of chronic conditions. Indeed, inappropriate utilization of secondary care resources is likely to represent a significant opportunity cost to healthcare providers and may be less desirable for patients.
Vamos E, Harris M, Millett C, et al., 2012, Association of Systolic and diastolic blood pressure levels and all-cause mortality in people with newly diagnosed Type 2 diabetes: a retrospective cohort study, British Medical Journal, Vol: BMJ 2012; 345
Greaves F, Pape UJ, Lee H, et al., 2012, Patients’ ratings of family physicians on the internet: usage and associations with conventional measures of quality in the English NHS, Medicine X. Stanford, US
Bhan N, Srivastava S, Agrawal S, et al., 2012, Are socioeconomic disparities in tobacco consumption increasing in India? A repeated cross-sectional multilevel analysis, BMJ OPEN, Vol: 2, ISSN: 2044-6055
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- Citations: 30
Lee JT, Netuveli G, Majeed A, et al., 2011, The effects of pay for performance on disparities in stroke, hypertension, and coronary heart disease management: interrupted time series study, PLoS One, Vol: 6, Pages: 1-8, ISSN: 1932-6203
BackgroundThe Quality and Outcomes Framework (QOF), a major pay-for-performance programme, was introduced into United Kingdom primary care in April 2004. The impact of this programme on disparities in health care remains unclear. This study examines the following questions: has this pay for performance programme improved the quality of care for coronary heart disease, stroke and hypertension in white, black and south Asian patients? Has this programme reduced disparities in the quality of care between these ethnic groups? Did general practices with different baseline performance respond differently to this programme?Methodology/Principal FindingsRetrospective cohort study of patients registered with family practices in Wandsworth, London during 2007. Segmented regression analysis of interrupted time series was used to take into account the previous time trend. Primary outcome measures were mean systolic and diastolic blood pressure, and cholesterol levels. Our findings suggest that the implementation of QOF resulted in significant short term improvements in blood pressure control. The magnitude of benefit varied between ethnic groups with a statistically significant short term reduction in systolic BP in white and black but not in south Asian patients with hypertension. Disparities in risk factor control were attenuated only on few measures and largely remained intact at the end of the study period.Conclusions/SignificancePay for performance programmes such as the QOF in the UK should set challenging but achievable targets. Specific targets aimed at reducing ethnic disparities in health care may also be needed.
Millett C, Lee JT, Gibbons DC, et al., 2011, Increasing the age for the legal purchase of tobacco in England: impacts on socio-economic disparities in youth smoking, THORAX, Vol: 66, Pages: 862-865, ISSN: 0040-6376
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- Citations: 32
Dalton ARH, Bottle RA, Okoro C, et al., 2011, UPTAKE OF THE NHS HEALTH CHECKS PROGRAMME IN A DEPRIVED, CULTURALLY DIVERSE SETTING: CROSS SECTIONAL STUDY, JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, Vol: 65, Pages: A21-A21, ISSN: 0143-005X
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- Citations: 5
Dalton ARH, Bottle A, Okoro C, et al., 2011, Uptake of the NHS Health Checks programme in a deprived, culturally diverse setting: cross-sectional study, JOURNAL OF PUBLIC HEALTH, Vol: 33, Pages: 422-429, ISSN: 1741-3842
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- Citations: 97
Vamos EP, Pape U, Bottle A, et al., 2011, Association of practice size and pay-for-performance with quality of diabetes management in primary care., CMAJ
Millett C, Polansky JR, Glantz SA, 2011, Government Inaction on Ratings and Government Subsidies to the US Film Industry Help Promote Youth Smoking, PLOS MEDICINE, Vol: 8, ISSN: 1549-1277
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- Citations: 4
Lee JT, Glantz SA, Millett C, 2011, Effect of Smoke-Free Legislation on Adult Smoking Behaviour in England in the 18 Months following Implementation, PLOS ONE, Vol: 6, ISSN: 1932-6203
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- Citations: 14
Laverty AA, Bottle A, Majeed A, et al., 2011, Blood pressure monitoring and control by cardiovascular disease status in UK primary care: 10 year retrospective cohort study 1998-2007, JOURNAL OF PUBLIC HEALTH, Vol: 33, Pages: 302-309, ISSN: 1741-3842
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- Citations: 15
Dalton ARH, Alshamsan R, Majeed A, et al., 2011, Exclusion of patients from quality measurement of diabetes care in the UK pay-for-performance programme, DIABETIC MEDICINE, Vol: 28, Pages: 525-531, ISSN: 0742-3071
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- Citations: 26
Millett C, Everett CJ, Matheson EM, et al., 2011, Caution in Generalizing Part D Results to Medicare Population <i>Reply</i>, ARCHIVES OF INTERNAL MEDICINE, Vol: 171, Pages: 367-367, ISSN: 0003-9926
Millett C, Majeed A, Huckvale C, et al., 2011, Going local: Devolving national pay for performance programmes, BMJ, Vol: 342, Pages: 475-477
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- Citations: 15
Dalton ARH, Bottle A, Okoro C, et al., 2011, Implementation of the NHS Health Checks programme: baseline assessment of risk factor recording in an urban culturally diverse setting, FAMILY PRACTICE, Vol: 28, Pages: 34-40, ISSN: 0263-2136
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- Citations: 25
Alshamsan R, Majeed A, Vamos EP, et al., 2011, Ethnic Differences in Diabetes Management in Patients With and Without Comorbid Medical Conditions: A cross-sectional study, Diabetes Care
Millett C, Majeed A, Huckvale C, et al., 2011, Going local: devolving national pay for performance programmes., BMJ, Vol: 342
Dalton ARH, Soljak M, Samarasundera E, et al., 2011, Prevalence of cardiovascular disease risk amongst the population eligible for the NHS Health Check Programme
Background: The National Health Service (NHS) Health Check Programme aims to identify and manage patients in England aged 40–74 years with a 10-year cardiovascular disease (CVD) risk score over 20%. We aimed to assess the prevalence of high CVD risk in the English population, using the two CVD risk scores and the 20% cut off mandated in national policy, and the prevalence of risk factors within this population. Design: Modelling study using patients registered in general practice in England. Methods: Using data from the Health Survey for England, we modelled the prevalence of high CVD risk in general practice populations. Results: Of those eligible for an NHS Health Check, 10.5% (2,012,000) had a risk score greater than 20% using the QRISK2 risk score; 22.0% (4,267,000) using Joint British Societies’ (JBS2) score. There was a median of 206 (range 0–1693) and 447 (0–3321) patients per practice at high risk respectively, with wide geographic variation. Within the high-risk population, there was a high prevalence of CVD risk factors; in the QRISK2 population, for example 82.6% were physically inactive. To reduce risk in those at high CVD risk, we estimate the total costs of the Programme to be £176 million using QRISK2 or £378 million using JBS2. Conclusions: A large number of high-risk patients will be identified by the Programme; health service commissioners must ensure the adequate provision and the targeted allocation of risk reduction services for the Programme to be effective. The NHS must consider whether extra costs using JBS2 are warranted. The Programme must be fully monitored to ensure its cost effectiveness and appropriate outcomes such as the numbers at high risk assessed.
de Lusignan S, Nitsch D, Belsey J, et al., 2011, Disparities in testing for renal function in UK primary care: cross-sectional study, Family Practice
Dalton ARH, Bottle A, Soljak M, et al., 2011, The comparison of cardiovascular risk scores using two methods of substituting missing risk factor data in patient medical records, Informatics in Primary Care, Vol: 19, Pages: 225-232
<B>Background</B>: Targeted screening for cardiovascular disease (CVD) can be carried out using existing data from patient medical records. However, electronic medical records in UK general practice contain missing risk factor data for which values must be estimated to produce risk scores.<P></P><B>Objective</B>: To compare two methods of substituting missing risk factor data; multiple imputation and the use of default National Health Survey values.<P></P><B>Methods</B>: We took patient-level data from patients in 70 general practices in Ealing, North West London. We substituted missing risk factor data using the two methods, applied two risk scores (QRISK2 and JBS2) to the data and assessed differences between methods.<P></P><B>Results</B>: Using multiple imputation, mean CVD risk scores were similar to those using default national survey values, a simple method of imputation. There were fewer patients designated as high risk (>20%) using multiple imputation, although differences were again small (10.3% compared with 11.7%; 3.0% compared with 3.4% in women). Agreement in high-risk classification between methods was high (Kappa = 0.91 in men; 0.90 in women).<P></P><B>Conclusions</B>: A simple method of substituting missing risk factor data can produce reliable estimates of CVD risk scores. Targeted screening for high CVD risk, using pre-existing electronic medical record data, does not require multiple imputation methods in risk estimation.
Moreno-Serra R, Millett C, Smith PC, 2011, Towards Improved Measurement of Financial Protection in Health, PLoS Medicine, Vol: 8
Vamos EP, Bottle A, Edmonds ME, et al., 2010, Changes in the incidence of lower extremity amputations in people with and without diabetes in England between 2004 and 2008, Diabetes Care, Vol: 33, Pages: 2592-2597, ISSN: 1935-5548
OBJECTIVE — To describe recent trends in the incidence of nontraumatic amputationsamong individuals with and without diabetes and estimate the relative risk of amputationsamong individuals with diabetes in England.RESEARCH DESIGN AND METHODS — We identified all patients aged 16 yearswho underwent any nontraumatic amputation in England between 2004 and 2008 using nationalhospital activity data from all National Health Service hospitals. Age- and sex-specificincidence rates were calculated using the total diabetes population in England every year. To testfor time trend, we fitted Poisson regression models.RESULTS — The absolute number of diabetes-related amputations increased by 14.7%, andthe incidence decreased by 9.1%, from 27.5 to 25.0 per 10,000 people with diabetes, during thestudy period (P 0.2 for both). The incidence of minor and major amputations did notsignificantly change (15.7–14.9 and 11.8–10.2 per 10,000 people with diabetes; P 0.66 andP 0.29, respectively). Poisson regression analysis showed no statistically significant change indiabetes-related amputation incidence over time (0.98 decrease per year [95% CI 0.93–1.02];P 0.12). Nondiabetes-related amputation incidence decreased from 13.6 to 11.9 per 100,000people without diabetes (0.97 decrease by year [0.93–1.00]; P 0.059). The relative risk of anindividual with diabetes undergoing a lower extremity amputation was 20.3 in 2004 and 21.2 in2008, compared with that of individuals without diabetes.CONCLUSIONS — This national study suggests that the overall population burden of amputationsincreased in people with diabetes at a time when the number and incidence of amputationsdecreased in the aging nondiabetic population.
Millett C, Chattopadhyay A, Bindman AB, 2010, Unhealthy Competition: Consequences of Health Plan Choice in California Medicaid, AMERICAN JOURNAL OF PUBLIC HEALTH, Vol: 100, Pages: 2235-2240, ISSN: 0090-0036
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- Citations: 10
Vamos EP, Bottle A, Majeed A, et al., 2010, Changes in the incidence of lower extremity amputations in people with and without diabetes in England between 2004 and 2008, 46th EASD Annual Meeting
Millett C, Everett CJ, Matheson EM, et al., 2010, Impact of Medicare Part D on Seniors' Out-of-pocket Expenditures on Medications, ARCHIVES OF INTERNAL MEDICINE, Vol: 170, Pages: 1325-1330, ISSN: 0003-9926
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- Citations: 22
Curcin V, Bottle A, Molokhia M, et al., 2010, Towards a scientific workflow methodology for primary care database studies, STATISTICAL METHODS IN MEDICAL RESEARCH, Vol: 19, Pages: 378-393, ISSN: 0962-2802
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- Citations: 5
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