Abstract
BackgroundThe performance of Primary Care Trusts in England is assessed and published using a number of different performance indicators. Our study has two broad purposes. Firstly, to find out whether pairs of indicators that purport to measure similar aspects of quality are correlated (as would be expected if they are both valid measures of the same construct). Secondly, we wanted to find out whether broad (global) indicators correlated with any particular features of Primary Care Trusts, such as expenditure per capita.MethodsCross sectional quantitative analysis using data from six 2004/05 PCT performance indicators for 303 English Primary Care Trusts from four sources in the public domain: Star Rating, aggregated Quality and Outcomes Framework scores, Dr Foster mortality index, Dr Foster equity index (heart by-pass and hip replacements), NHS Litigation Authority Risk Management standards and Patient Satisfaction scores from the Star Ratings. Forward stepwise multiple regression analysis to determine the effect of Primary Care Trust characteristics on performance.ResultsStar Rating and Quality and Outcomes Framework total, both summary measures of global quality, were not correlated with each other (F = 0.66, p = 0.57). There were however positive correlations between Quality and Outcomes Framework total and patient satisfaction (r = 0.61, p < 0.001) and between screening/'additional services' indicators on the Star Ratings and Quality and Outcomes Framework (F = 24, p < 0.001). There was no correlation between different measures of access to services. Likewise we found no relationship between either Star Rating or Litigation Authority Standards and hospital mortality (F = 0.61, p = 0.61; F = 0.31, p = 0.73).ConclusionPerformance assessment in healthcare remains on the Government's agenda, with new core and developmental standards set to replace the Star Ratings in 2006. Yet the results of this analysis provide little evidence that the current indicators have sufficient construct validity to measure the underlying concept of quality, except when the specific area of screening is considered.
Highlights
The performance of Primary Care Trusts in England is assessed and published using a number of different performance indicators
This paper focuses on six Performance Indicators available in the public domain for the 303 English Primary Care Trusts (PCTs)
Meeting the standard seen as better quality Relevance of measure can be explained Indicator measures what it purports to measure Data are complete, accurate, consistent and reproducible Data are independent of subjective judgement Data are available quickly/routinely with minimal cost or effort Indicator is context free Performance on an indicator can be attributed to the relevant individual or team Indicator should reflect health needs, capacity, structures or performance Indicator should be comparable to a gold standard Poor performance on an indicator can be remedied Indicator should be sensitive to improvement
Summary
The performance of Primary Care Trusts in England is assessed and published using a number of different performance indicators. A recent action research report has highlighted that the UK public do not like performance league tables and consider sources of information on quality as inadequate [3]. One essential 'acid test' considered in this paper is the construct validity of the indicator (a combination of the attributes "effective" and "comparable" used by Pringle and colleagues [7]). Construct validity is essential if Performance Indicators are to be used fruitfully by the public in their newly-acquired choice of providers or by regulators as a means of imposing sanctions or rewards
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