Relationship between research activity and the performance of English general practices: cross-sectional and longitudinal analyses.
Gibson J., Kontopantelis E., Sutton M., Boaz A., Little P., Mallen C., McManus R., Park S., Usher-Smith J., Bower P.
BACKGROUND: Research activity usually improves outcomes by being translated into practice; however, there is developing evidence that research activity itself may improve the overall performance of healthcare organisations. Evidence that these relationships represent a causal impact of research activity is, however, less clear. Additionally, the bulk of the existing evidence relates to hospital settings, and it is not known if those relationships would also be found in general practice, where most patient contacts occur. AIM: To test 1) whether there are significant relationships between research activity in general practice and organisational performance; and 2) whether those relationships are plausibly causal. DESIGN AND SETTING: National data were analysed between 2008 and 2019, using cross-sectional and longitudinal analyses on general practices in England. METHOD: Cross-sectional, panel, and instrumental variable analyses were employed to explore relationships between research activity (including measures from the National Institute for Health and Care Research Clinical Research Network and the Royal College of General Practitioners) and practice performance (including clinical quality of care, patient-reported experience of care, prescribing quality, and hospital admissions). RESULTS: In cross-sectional analyses, different measures of research activity were positively associated with several measures of practice performance, but most consistently with clinical quality of care and accident and emergency attendances. The associations were generally modest in magnitude; however, longitudinal analyses did not support a reliable causal relationship. CONCLUSION: Similar to findings from hospital settings, research activity in general practice is associated with practice performance. There is less evidence that research is causing those improvements, although this may reflect the limited level of research activity in most practices. No negative impacts were identified, suggesting that research activity is a potential marker of quality and something that high-quality practices can deliver alongside their core responsibilities.