{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:47:40Z","timestamp":1782488860493,"version":"3.54.5"},"reference-count":32,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2020,9,8]],"date-time":"2020-09-08T00:00:00Z","timestamp":1599523200000},"content-version":"unspecified","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["PhD"],"award-info":[{"award-number":["PhD"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,6,23]]},"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We aimed to spatially describe hospital admissions for ambulatory care sensitive conditions (ACSC) in England at small-area geographical level and assess whether recorded practice performance under one of the world\u2019s largest primary care pay-for-performance schemes led to reductions in these potentially avoidable hospitalisations for chronic conditions incentivised in the scheme.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>We obtained numbers of ACSC hospital admissions from the Hospital Episode Statistics database and information on recorded practice performance from the Quality and Outcomes Framework (QOF) administrative dataset for 2015\/2016. We fitted three sets of negative binomial models to examine ecological associations between incentivised ACSC admissions, general practice performance, deprivation, urbanity and other sociodemographic characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Hospital admissions for QOF incentivised ACSCs varied within and between regions, with clusters of high numbers of hospital admissions for incentivised ACSCs identified across England. Our models indicated a very small effect of the QOF on reducing admissions for incentivised ACSCs (0.993, 95%\u2009CI 0.990 to 0.995), however, other factors, such as deprivation (1.021, 95%\u2009CI 1.020 to 1.021) and urbanicity (0.875, 95%\u2009CI 0.862 to 0.887), were far more important in explaining variations in admissions for ACSCs. People in deprived areas had a higher risk of being admitted in hospital for an incentivised ACSC condition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Spatial analysis based on routinely collected data can be used to identify areas with high rates of potentially avoidable hospital admissions, providing valuable information for targeting resources and evaluating public health interventions. Our findings suggest that the QOF had a very small effect on reducing avoidable hospitalisation for incentivised conditions. Material deprivation and urbanicity were the strongest predictors of the variation in ACSC rates for all QOF incentivised conditions across England.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-036046","type":"journal-article","created":{"date-parts":[[2020,9,9]],"date-time":"2020-09-09T13:02:06Z","timestamp":1599656526000},"page":"e036046","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Impact of a national primary care pay-for-performance scheme on ambulatory care sensitive hospital admissions: a small-area analysis in England"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1621-8648","authenticated-orcid":false,"given":"Christos","family":"Grigoroglou","sequence":"first","affiliation":[{"name":"NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK"},{"name":"Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4540-6744","authenticated-orcid":false,"given":"Luke","family":"Munford","sequence":"additional","affiliation":[{"name":"Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK"},{"name":"Health Organisation, Policy and Economics, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Webb","sequence":"additional","affiliation":[{"name":"Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK"},{"name":"Centre for Mental Health and Safety, Division of Psychology & Mental Health, The University of Manchester, Manchester, UK"},{"name":"NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navneet","family":"Kapur","sequence":"additional","affiliation":[{"name":"Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK"},{"name":"NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK"},{"name":"Centre for Suicide Prevention, Division of Psychology and Mental Health, University of Manchester, Manchester, UK"},{"name":"Greater Manchester Mental Health Trust, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Doran","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of York, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren","family":"Ashcroft","sequence":"additional","affiliation":[{"name":"NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK"},{"name":"Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK"},{"name":"NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK"},{"name":"Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6450-5815","authenticated-orcid":false,"given":"Evangelos","family":"Kontopantelis","sequence":"additional","affiliation":[{"name":"NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK"},{"name":"Faculty of Biology, Medicine & Health, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, Greater Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,9,9]]},"reference":[{"key":"2026062608011003000_10.9.e036046.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-004746"},{"key":"2026062608011003000_10.9.e036046.2","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1016\/j.healthpol.2015.08.007","article-title":"Which hospitalisations are ambulatory care-sensitive, to what degree, and how could the rates be reduced? results of a group consensus study in Germany","volume":"119","author":"Sundmacher","year":"2015","journal-title":"Health Policy"},{"key":"2026062608011003000_10.9.e036046.3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.330.7492.657"},{"key":"2026062608011003000_10.9.e036046.4","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-13-11"},{"key":"2026062608011003000_10.9.e036046.5","unstructured":"Blunt I . 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