BMJ 2003;326:371-372 ( 15 February )

Primary care

Association between practice size and quality of care of patients with ischaemic heart disease: cross sectional study

Azeem Majeed, professor of primary care ^a, Jeremy Gray, director ^b, Gareth Ambler, statistician ^c, Kevin Carroll, specialist registrar in public health medicine ^b, Andrew B Bindman, professor of medicine, epidemiology, and biostatistics ^d. 

^a Primary Care Research Unit, School of Public Policy, University College London, London WC1H 9QU, ^b Battersea Research Group, Bolingbroke Hospital, London SW11 6HN, ^c Medical Statistics Unit, Research and Development Directorate, University College London Hospitals NHS Trust, London NW1 2LT, ^d Departments of Medicine, Epidemiology, and Biostatistics, University of California San Francisco, San Francisco, CA 94118, USA

Correspondence to: A Majeed
a.majeed@ucl.ac.uk

The first 150 words of the full text of this article appear below.

Proportionally fewer inpatients die in hospitals that do more operations than in hospitals that do fewer.¹ Similar associations between outcome and the size of hospitals have been found in other studies. An association between size and outcome may also be important in primary care settings, where most patients with chronic illnesses are managed. If large practices or those that treat more people provide better care, this could have important implications for the organisation of primary care services. We looked for an association in patients with ischaemic heart disease because the management of this disease is an international priority.²

	Participants, methods, and results

From September 2000 to May 2001, we identified patients diagnosed as having ischaemic heart disease using paper and computerised medical records in four primary care groups in southwest London (69 general practices; population 382 188). Seven general practices did not take part.³

We recorded patients as hypertensive if their blood pressure was more than 140/85 mm . . . [Full text of this article]

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Rapid Responses:

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Where is the quality of care?

Michael Mason, et al.
bmj.com, 18 Feb 2003 [Full text]

Results sensitive to practice variation in case identification rate?

Andrew T Prevost
bmj.com, 21 Feb 2003 [Full text]

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