Does Better Disease Management in Primary Care Reduce Hospital Costs?

We apply cross-sectional and panel data methods to a database of 5 million patients in 8,000 English general practices to examine whether better primary care management of 10 chronic diseases is associated with reduced hospital costs. We find that only primary care performance in stroke care is associated with lower hospital costs. Our results suggest that the 10% improvement in the general practice quality of stroke care between 2004/5 and 2007/8 reduced 2007/8 hospital expenditure by about £130 million in England. The cost savings are due mainly to reductions in emergency admissions and outpatient visits, rather than to lower costs for patients treated in hospital or to reductions in elective admissions.Quality; disease management; primary care; hospital costs; ambulatory care sensitive conditions; preventative care.

Patterns of emergency admissions for ambulatory care sensitive conditions: : a spatial cross-sectional analysis of observational data

Objectives: To examine the spatial and temporal patterns of English general practices’ emergency admissions for Ambulatory Care Sensitive Conditions (ACSC). Design: Observational study of annual hospital admission data for ACSC emergency admissions at general practice level for all practices in England 2004 to 2017. Participants: All patients with an emergency admission to a National Health Service (NHS) hospital in England who were registered with an English GP practice. Main outcome measure: Practice level age and gender indirectly standardised ratios (ISARs) for emergency admissions for ACSC. Results: In 2017 41.8% of the total variation in ISARs across practices was between the 207 Clinical Commissioning Groups (the administrative unit for general practices) and 58.2% was across practices within CCGs. ACSC ISARs increased by 4.7% between 2004 and 2017 while those for conditions incentivised by the Quality and Outcomes Framework fell by 20.02%. Practice ISARs are persistent: practices with high rates in 2004 also had high rates in 2017. Standardising by deprivation as well as age and gender reduced the coefficient of variation of practice ISARs in 2017 by 22% Conclusions: There is persistent spatial pattern of emergency admissions for ACSC across England both within and across CCGs. We illustrate the reduction in ACSC emergency admissions across the study period for conditions incentivised by the QOF but find that this was not accompanied by a reduction in variation in these admissions across practices. The observed spatial pattern persists when admission rates are standardised by deprivation. The persistence of spatial clusters of high emergency admissions for ACSC within and across CCG boundaries suggests that policies to reduce potentially unwarranted variation should be targeted at practice level

Reshaping suburbs

A report produced as part of the EPSRC solutions project - the sustainability of land use and transport in outer neighberhoods

Lingual epilepsy due to cortical demyelination involving the frontal operculum

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Does better disease management in primary care reduce hospital costs? Evidence from English primary care

We apply cross-sectional and panel data methods to a database of 5 million patients in 8,000 English general practices to examine whether better primary care management of 10 chronic diseases is associated with reduced hospital costs. We find that only primary care performance in stroke care is associated with lower hospital costs. Our results suggest that the 10% improvement in the general practice quality of stroke care between 2004/5 and 2007/8 reduced 2007/8 hospital expenditure by about £130 million in England. The cost savings are due mainly to reductions in emergency admissions and outpatient visits, rather than to lower costs for patients treated in hospital or to reductions in elective admissions.Quality. Disease management. Primary care. Hospital costs. Ambulatory care sensitive conditions. Preventative care.

Restoration of the external Scandinavian Caledonides

Three models are evaluated for restoring basement rocks coring tectonic windows (Window-Basement) in the Scandinavian Caledonides; parautochthonous (Model I) and allochthonous (models II/III), with initial imbrication of the Window-Basement post-dating or pre-dating, respectively, that in the external imbricate zone (Lower Allochthon). In Model I, the Window-Basement comes from the eastern margin of the basin now imbricated into the Lower Allochthon, while in models II/III it comes from the western margin. In Model II, the Window-Basement formed a basement-high between Tonian and Cryogenian sediments imbricated into the Middle and Lower allochthons; in Model III deposition of the Lower Allochthon sediments commenced in Ediacaran times. Balanced cross-sections and branch-line restorations of four transects (Finnmark–Troms, Västerbotten–Nordland, Jämtland–Trøndelag, Telemark–Møre og Romsdal) show similar restored lengths for the models in two transects and longer restorations for models II/III in the other transects. Model I can result in c. 280 km wide gaps in the restored Lower Allochthon, evidence for which is not seen in the sedimentology. The presence of <3 km thick alluvial-fan deposits at the base of the Middle Allochthon indicates proximal, rapidly uplifting basement during Tonian–Cryogenian periods, taken as the origin of the Window-Basement during thrusting in models II/III. Model I requires multiple changes in thrusting-direction and predicts major thrusts or back-thrusts, currently unrecognized, separating parts of the Lower Allochthon; neither are required in models II/III. Metamorphic data are consistent with models II/III. Despite considerable along-strike structural variability in the external Scandinavian Caledonides, models II/III are preferred for the restoration of the Window-Basement