Re: Investigating the relationship between quality of primary care and premature mortality in England: a spatial whole-population study
It should come as no surprise that the authors were unable to find any relationship in this study. The limitations which they accept are dwarfed by other factors. While medical progress is probably one of the contributors to increasing survival, it has always been difficult to attribute it to any specific medical intervention, the improvement in disease specific mortality often preceding medical advances for example tuberculosis in the middle of the last century and it could be argued coronary heart disease in the second half.
The best example is from Mid Staffordshire in the first decade of this one. I looked at the relationship between hospital and population mortality and there was none. Over the decade the hospital mortality in Mid-Staffordshire showed a consistent pattern, a marked deterioration followed by an equally smooth improvement, over a 50% range in all. During the same period there was no change in the smooth trend of the independently calculated improvement in survival in the town mirroring exactly the national trend. Furthermore the local government district served by the worst average hospital performer over the decade (not Mid-Staffordshire) was near the top of the list for increase in life expectancy for males and for females, and well ahead of the district of “best” hospital.
Despite my best efforts I was unable to get anything published in the lay or medical press at the time, probably because it be counterintuitive or even because, as one medical editor claimed, it would be seen as the profession making excuses for itself. The profession should accept that individual therapeutic successes have less impact on population survival than they might hope, and recognise that these effects are likely to be lost in the noise of other factors and chance when the relationship between the two is studied.
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Re: Investigating the relationship between quality of primary care and premature mortality in England: a spatial whole-population study
It should come as no surprise that the authors were unable to find any relationship in this study. The limitations which they accept are dwarfed by other factors. While medical progress is probably one of the contributors to increasing survival, it has always been difficult to attribute it to any specific medical intervention, the improvement in disease specific mortality often preceding medical advances for example tuberculosis in the middle of the last century and it could be argued coronary heart disease in the second half.
The best example is from Mid Staffordshire in the first decade of this one. I looked at the relationship between hospital and population mortality and there was none. Over the decade the hospital mortality in Mid-Staffordshire showed a consistent pattern, a marked deterioration followed by an equally smooth improvement, over a 50% range in all. During the same period there was no change in the smooth trend of the independently calculated improvement in survival in the town mirroring exactly the national trend. Furthermore the local government district served by the worst average hospital performer over the decade (not Mid-Staffordshire) was near the top of the list for increase in life expectancy for males and for females, and well ahead of the district of “best” hospital.
Despite my best efforts I was unable to get anything published in the lay or medical press at the time, probably because it be counterintuitive or even because, as one medical editor claimed, it would be seen as the profession making excuses for itself. The profession should accept that individual therapeutic successes have less impact on population survival than they might hope, and recognise that these effects are likely to be lost in the noise of other factors and chance when the relationship between the two is studied.
Competing interests: No competing interests