PDF(Pubmed)
Abstract：
BACKGROUND: The Quality Outcomes Framework (QOF) is a pay incentive scheme in England designed to improve and standardise general practice. QOF attainment has been used as a proxy for primary care quality in previous research.
OBJECTIVE: To investigate whether there is a relationship between socioeconomic deprivation and QOF attainment in primary care in England.
METHODS: Retrospective longitudinal study of primary care providers in England.
METHODS: QOF scores were obtained for individual general practices in England from between 2007-2019 and linked to practice-level Indices of Multiple Deprivation (IMD) scores derived from census data. Beta regression analyses were used to analyse the relationship with either percentage of total QOF attainment or of domain-specific attainment with multivariate analyses, adjusting for additional practice-level demographics. QOF attainment in the most affluent quintile was used as the reference group.
RESULTS: General practices in less deprived areas have consistently outperformed those in more deprived areas in terms of QOF achievement. Initially, the gap between least and most deprived practices decreased, however since 2015 there has been relatively little change in comparative performance. The magnitude of inequality was reduced after adjusting for demographic factors. Of the independent variables analysed, the proportion of patients aged >65 years (\'over 65s\') had the strongest relationship with QOF attainment.
CONCLUSIONS: There remains an inequality in primary care quality by socioeconomic deprivation in England, even after accounting for demographic differences.
OBJECTIVE: To investigate whether there is a relationship between socioeconomic deprivation and QOF attainment in primary care in England.
METHODS: Retrospective longitudinal study of primary care providers in England.
METHODS: QOF scores were obtained for individual general practices in England from between 2007-2019 and linked to practice-level Indices of Multiple Deprivation (IMD) scores derived from census data. Beta regression analyses were used to analyse the relationship with either percentage of total QOF attainment or of domain-specific attainment with multivariate analyses, adjusting for additional practice-level demographics. QOF attainment in the most affluent quintile was used as the reference group.
RESULTS: General practices in less deprived areas have consistently outperformed those in more deprived areas in terms of QOF achievement. Initially, the gap between least and most deprived practices decreased, however since 2015 there has been relatively little change in comparative performance. The magnitude of inequality was reduced after adjusting for demographic factors. Of the independent variables analysed, the proportion of patients aged >65 years (\'over 65s\') had the strongest relationship with QOF attainment.
CONCLUSIONS: There remains an inequality in primary care quality by socioeconomic deprivation in England, even after accounting for demographic differences.
摘要：
背景：质量成果框架（QOF）是英格兰的一种薪酬激励计划，旨在改善和标准化一般做法。在先前的研究中，QOF达标已被用作初级保健质量的替代指标。
目的：调查英格兰初级保健中社会经济剥夺与QOF成就之间是否存在关系。
方法：对英格兰初级保健提供者的回顾性纵向研究。
方法：从2007年至2019年期间获得了英格兰个人一般实践的QOF分数，并与从人口普查数据得出的实践水平多重剥夺指数（IMD）分数相关联。贝塔回归分析用于分析与总QOF达到百分比的关系，或特定领域的成就，多变量分析根据额外的实践水平的人口统计数据进行调整。在最富裕的五分之一中达到的QOF被用作参考组。
结果：在QOF成就方面，较贫穷地区的一般做法一直优于较贫穷地区的一般做法。最初，最不贫穷的做法和最贫穷的做法之间的差距缩小了，然而，自2015年以来，比较业绩的变化相对较小。在调整了人口因素后，不平等的程度有所减少。在分析的独立变量中，超过65秒的比例与达到QOF的关系最强.
结论：在英格兰，由于社会经济剥夺，初级保健质量仍然存在不平等，即使在考虑了人口差异之后。
目的：调查英格兰初级保健中社会经济剥夺与QOF成就之间是否存在关系。
方法：对英格兰初级保健提供者的回顾性纵向研究。
方法：从2007年至2019年期间获得了英格兰个人一般实践的QOF分数，并与从人口普查数据得出的实践水平多重剥夺指数（IMD）分数相关联。贝塔回归分析用于分析与总QOF达到百分比的关系，或特定领域的成就，多变量分析根据额外的实践水平的人口统计数据进行调整。在最富裕的五分之一中达到的QOF被用作参考组。
结果：在QOF成就方面，较贫穷地区的一般做法一直优于较贫穷地区的一般做法。最初，最不贫穷的做法和最贫穷的做法之间的差距缩小了，然而，自2015年以来，比较业绩的变化相对较小。在调整了人口因素后，不平等的程度有所减少。在分析的独立变量中，超过65秒的比例与达到QOF的关系最强.
结论：在英格兰，由于社会经济剥夺，初级保健质量仍然存在不平等，即使在考虑了人口差异之后。
