Improvements in quality of clinical care in English general practice 1998-2003: longitudinal observational study
BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.38632.611123.AE (Published 10 November 2005) Cite this as: BMJ 2005;331:1121Data supplement
Posted as supplied by the author
Quality scores in 1998 and 2003 (items in italics represent conditional indicators, i.e. ones which did not necessarily apply to all patients)
Coronary heart disease (1998 sample =737 patients, 2003 sample =487 patients)
Indicator; recording of…
Score in 1998
(%)
Score in 2003
(%)
Change in scores 1998 to 2003
(95% CI)
Significance of change in scores
(p-value)
Improvement in scores as a percentage of maximum possible improvement
Number of patients (1998)
Number of patients
(2003)
Frequency or pattern of angina attacks (last 15 months) **
43.3
60.8
17.5
(9.4 – 25.6)
<0.001
30.9
726
487
Blood pressure (last 15 months) **
87.0
91.0
4.0
(-5.1 – 8.5)
0.082
30.8
736
487
Exercise capacity(last 15 months) **
36.8
66.9
30.2
(21.2 – 39.1)
<0.001
47.7
734
487
Prescribed or advised to take aspirin unless record of contraindication or intolerance
76.1
75.2
-1.0
(-5.6 – 3.6)
0.687
-4.1
733
487
Prescribed beta-blocker as maintenance therapy if sole therapy
52.02
59.1
7.1
(-4.3 – 18.5)
0.224
14.8
173
154
Action taken on blood pressure if systolic blood pressure >160, or >140 if cholesterol level >5.5 mmol/l (last 15 months) **
37.0
57.7
20.7
(6.0-35.4)
0.006
32.8
100
52
Cholesterol (last 5 years)
63.0
89.3
26.3
(19.7 – 32.9)
<0.001
71.1
735
487
Dietary advice (last 5 years)
59.4
76.6
17.2
(7.3 – 27.1)
0.001
42.4
721
487
Smoking status (last 5 years)
85.6
87.1
1.5
(-5.1 – 8.0)
0.662
10.1
736
487
Smoking advice to smokers (last 5 years)
61.8
77.3
15.5
(0.6 – 30.6)
0.042
40.6
157
75
Weight advice if overweight (last 5 years)
61.9
78.4
16.5
(5.3 – 27 6)
0.004
43.3
289
227
Action if cholesterol >5.5 mmol/l {age <70) (most recent recording in last 5 years)
56.7
71.7
15.0
(0.1 – 30.0)
0.048
34.6
120
46
Ever referred to specialist or for exercise ECG
75.3
87.9
12.6
(7.4 – 17.8)
<0.001
51.1
736
487
BP level <150/90 (average of last 3 recordings over last 15 months)
47.3
72.2
24.9
(18.9 – 31.0)
<0.001
47.3
734
464
Cholesterol level (NSF <5) (most recent recording in last 5 years)
17.6
61.4
43.8
(37.0 – 50.7)
<0.001
53.2
735
435
Asthma (1998 sample = 786 patients; 2003 sample = 504 patients)
Indicator; recording of…
Score in 1998
(%)
Score in 2003
(%)
Change 1998 to 2003 (95% CI)
Significance of change in scores
Improvement in scores as a percentage of maximum possible improvement
Number of patients (1998)
Number of patients
(2003)
Record of daily, nocturnal or activity limiting symptoms (last 15 months) **
43.6
57.7
14.2
(5.0-23.3)
0.002
25.1
780
504
Normal/ predicted peak flow or record of difficulty using meter (last 5 years)
77.3
85.7
8.4
(2.7 – 14.2)
0.004
37.1
783
504
Smoking status (last 5 years)
82.3
84.3
2.1
(-4.7 – 8.9)
0.550
11.7
783
504
Inhaler technique (last 5 years)
53.6
58.7
5.1
(-4.4 – 14.7)
0.292
11.1
763
504
Smoking advice to smokers (last 5 years)
59.8
86.9
27.1
16.5 – 37.7)
<0.001
67.4
174
122
Self-management plan for those on high dose steroids or who have had in-patient treatment for asthma (last 5 years)
34.4
50.8
16.4
(-1.5 – 34.2)
0.072
24.9
151
63
For patients with recorded exercise induced bronchospasm, short-acting bronchodilators prescribed for use before exercise (last 5 years)
35.5
84.9
49.4
(30.3 – 68.5)
<0.001
76.5
141
66
Speech rate/pulse/respiratory rate during consultation for exacerbation of asthma if immediate bronchodilator therapy was used (most recent in last 5 years) *
100.0
45.7
-54.3
10
35
Peak flow during a consultation for an exacerbation (most recent in last 5 years)
71.7
69.7
-2.0
(-15.3 – 11.3)
0.769
-7.0
254
89
Oral steroids prescribed if peak flow <60% of normal (most recent in last 5 years) *
88.5
90.9
2.5
52
11
Action taken if patient experiencing nocturnal symptoms (most recent in last 5 years)
63.0
71.6
8.6
(-5.9 – 23.0)
0.246
23.1
200
116
Action taken if patient experiencing activity limiting symptoms (most recent in last 5 years)
52.6
70.8
18.1
(-2.7 – 39.0)
0.088
38.3
114
65
Referral to a respiratory physician where oral steroids are used in maintenance treatment (last 5 years) *
47.8
57.1
9.3
23
7
Type 2 diabetes (1998 sample = 777 patients; 2003 sample = 504 patients)
Indicator; recording of…
Score in 1998
(%)
Score in 2003
(%)
Change 1998 to 2003 (95% CI)
Significance of change in scores
Improvement in scores as a percentage of maximum possible improvement
Number of patients (1998)
Number of patients
(2003)
HbA1c(last 15 months)**
87.6
92.7
5.1
(1.0 – 9.1)
0.014
40.8
775
504
Visual examination of the feet (last 15 months)**
61.5
69.6
8.1
(-0.06 – 16.8)
0.066
21.1
774
504
Peripheral pulses or record of vibration sense (last 15 months)**
58.8
62.7
3.9
(-7.0 – 14.8)
0.482
9.5
774
504
Serum creatinine (last 15 months)**
79.8
89.5
9.7
(4.5 – 14.9)
<0.001
48.0
776
504
Urine proteinuria (last 15 months)**
67.7
74.6
6.9
(-0.4 – 14.2)
0.064
21.4
771
504
Examination of fundi or visual acuity (last 15 months)**
70.8
71.8
1.1
(-5.6 – 7.7)
0.754
3.7
773
504
Weight (last 15 months)**
80.5
86.5
6.0
(0.3 – 11.7)
0.039
30.7
775
504
Blood pressure (last 15 months)**
92.8
94.6
1.9
(-1.6 – 5.3)
0.285
25.8
776
504
Hhypoglycaemia symptoms if on sulphonylurea (last 15 months)**
18.4
8.0
-10.4
(-16.9 - -3.8)
0.002
-12.7
571
311
Smoking status (last 5 years)
87.0
88.5
1.5
(-4.2 – 7.2)
0.615
11.3
771
504
Serum cholesterol(last 5 years)
74.9
97.6
22.8
(16.5 – 29.0)
<0.001
90.5
776
504
Documentation of education if diagnosed <5 years (last 5 years)
82.3
86.4
4.1
(-6.9 – 15.0)
0.467
23.2
254
249
Advice given to smokers (last 5 years)
66.9
77.2
10.3
(-6.4 – 27.0)
0.226
31.1
133
79
Under 80 years: Offered treatment if average of last 3 readings shows diastolic >100 or systolic >150 and diastolic >90 (last 15 months) *
63.6
81.8
18.2
66
33
Referral to a specialist where creatinine is >200 mmol/l (last 15 months) *
76.9
100.0
23.1
13
3
If patient is being treated for hypertension and has proteinuria (macro- but not micro-albuminuria), the patient is on an ACE inhibitor*
53.1
57.1
4.0
367
7
If patient was started on ACE inhibitor, creatinine and potassium were measured within 1 month of starting treatment (anytime in last 5 years)
37.4
32.1
-5.3
(-18.4 – 7.8)
0.427
-8.5
198
184
For patients under 70, where the last HbA1c was >9,patient offered a therapeutic intervention to improve glycaemic control (last 15 months)
73.0
71.6
-1.4
(-13.7 – 10.9)
0.823
-5.2
100
81
For patients over 70, where the last HbA1c was >10, patient offered a therapeutic intervention to improve glycaemic control (last 15 months) *
77.3
60.0
22
5
BP level < 140/85 (average of last 3 recordings over last 15 months)
21.8
35.8
14.0
(8.3 – 19.8)
<0.001
17.9
776
483
Cholesterol level <5 (last 15 months)
21.5
52.0
30.5
(25.4 – 35.7)
<0.001
38.9
777
492
HBA1c level <7.4 (last 15 months)
37.9
39.7
1.8
(-5.1 – 8.6)
0.622
2.9
775
469
* Statistical tests were not carried out on variables if there was a mean of less than one case per practice where the indicator was triggered.
** Data adjusted for the fact that ‘in the past year’ was interpreted as a record of the clinical feature in the previous 14 months in 1998 (in line with the review criteria proposed by expert panels18), and a record in the previous 15 months in 2003 in line with the 2004 GMS contract.
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