Effect of Named, Accountable GPs on Continuity of Care: Protocol for a Regression Discontinuity Study of a National Policy Change

摘要

Introduction: Increasing continuity of care has been identified as a strategy to improve patient outcomes, but previous studies of integrated care have tended to focus on pilot areas, which limit their generalisability and the ability to determine in which contexts integrated care was most successful. Objective: This study protocol describes a quantitative evaluation of a reform in England that introduced named, accountable general practitioners for all National Health Service (NHS) patients aged 75 years or over. The national contract for general practice services required that named general practitioners offer longitudinal continuity of care within the general practice and be accountable for coordinating care to meet the patient’s healthcare needs. Methods: This study will apply a regression discontinuity design to pseudonymised electronic medical records from a sample of general practices in England. We will compare outcomes for patients aged just below and above the age of 75 to estimate the effect of named general practitioners and relate these estimated treatment effects to the characteristics of general practices. Outcomes will include a metric relating to continuity of care, namely the Usual Provider of Care Index, and numbers of general practitioner contacts, referrals to specialist care and diagnostic tests. Discussion: The study illustrates an approach to evaluate national changes aimed at more integrated care using electronic records, which will complement in-depth examination in pilot sites.