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The association between quality of primary care, deprivation and cardiovascular outcomes: a cross-sectional study using data from the UK Quality and Outcomes Framework
  1. T Kiran1,2,
  2. A Hutchings3,
  3. I A Dhalla1,4,
  4. C Furlong5,
  5. B Jacobson6
  1. 1Kennan Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
  2. 2Regent Park Community Health Centre, Toronto, Ontario, Canada
  3. 3Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK
  4. 4Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  5. 5Harrow Primary Care Trust, Harrow, UK
  6. 6London Health Observatory, London, UK
  1. Correspondence to Dr Tara Kiran, 30 Bond Street, Toronto, ON M5B 1W8, Canada; tara.kiran{at}


Background The Quality and Outcomes Framework, a financial incentive scheme for general practitioners in the UK, seems to have improved the quality of primary care and reduced inequalities in primary care delivery. It remains unclear, however, whether higher-quality primary care improves health outcomes or reduces health inequalities.

Methods We conducted a cross-sectional study examining the association between quality of cardiovascular care and coronary heart disease (CHD) outcomes in 1531 general practices in London. We calculated CHD quality achievement scores (ranging from 0 to 100) for each practice using the 2006–2007 data from the Quality and Outcomes Framework. We used weighted linear regression models to assess the practice-level association between the CHD quality score and CHD admissions and deaths.

Findings Overall, practices with higher CHD quality achievement scores had better CHD outcomes. Each one point increase in the CHD quality achievement score was associated with 4.28 (95% CI 1.19 to 7.38; p=0.007) fewer admissions per 100 000 for practices serving highly deprived populations and 2.11 (95% CI 0.68 to 3.55; p=0.004) fewer admissions per 100 000 for practices serving populations of average deprivation. There was no association between the CHD quality achievement score and the CHD admissions for practices serving affluent populations (p=0.906). We observed a similar deprivation-dependent gradient between quality achievement and CHD deaths.

Interpretation High-quality primary care is associated with improved health outcomes. This association is strongest in deprived areas, suggesting that high-quality primary care may play an important role in reducing health inequalities.

  • Primary healthcare
  • health services research
  • quality of healthcare
  • socioeconomic factors

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  • Funding This study was funded through the usual operating funds of the London Health Observatory. IAD is supported by a Felllowship Award from the Canadian Institutes of Health Research. The London Health Observatory provided administrative and logistic support including providing access to the data and use of statistical software and office facilities.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the London School of Hygiene and Tropical Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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