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Variation and statistical reliability of publicly reported primary care diagnostic activity indicators for cancer: a cross-sectional ecological study of routine data

Overview of attention for article published in BMJ Quality & Safety, August 2017
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  • In the top 25% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (87th percentile)

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1 blog
14 tweeters


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29 Mendeley
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Variation and statistical reliability of publicly reported primary care diagnostic activity indicators for cancer: a cross-sectional ecological study of routine data
Published in
BMJ Quality & Safety, August 2017
DOI 10.1136/bmjqs-2017-006607
Pubmed ID

Gary Abel, Catherine L Saunders, Silvia C Mendonca, Carolynn Gildea, Sean McPhail, Georgios Lyratzopoulos


Recent public reporting initiatives in England highlight general practice variation in indicators of diagnostic activity related to cancer. We aimed to quantify the size and sources of variation and the reliability of practice-level estimates of such indicators, to better inform how this information is interpreted and used for quality improvement purposes. Ecological cross-sectional study. English primary care. All general practices in England with at least 1000 patients. Sixteen diagnostic activity indicators from the Cancer Services Public Health Profiles. Mixed-effects logistic and Poisson regression showed that substantial proportions of the observed variance in practice scores reflected chance, variably so for different indicators (between 7% and 85%). However, after accounting for the role of chance, there remained substantial variation between practices (typically up to twofold variation between the 75th and 25th centiles of practice scores, and up to fourfold variation between the 90th and 10th centiles). The age and sex profile of practice populations explained some of this variation, by different amounts across indicators. Generally, the reliability of diagnostic process indicators relating to broader populations of patients most of whom do not have cancer (eg, rate of endoscopic investigations, or urgent referrals for suspected cancer (also known as 'two week wait referrals')) was high (≥0.80) or very high (≥0.90). In contrast, the reliability of diagnostic outcome indicators relating to incident cancer cases (eg, per cent of all cancer cases detected after an emergency presentation) ranged from 0.24 to 0.54, which is well below recommended thresholds (≥0.70). Use of indicators of diagnostic activity in individual general practices should principally focus on process indicators which have adequate or high reliability and not outcome indicators which are unreliable at practice level.

Twitter Demographics

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Mendeley readers

The data shown below were compiled from readership statistics for 29 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 29 100%

Demographic breakdown

Readers by professional status Count As %
Unspecified 9 31%
Researcher 7 24%
Other 3 10%
Student > Ph. D. Student 3 10%
Professor 2 7%
Other 5 17%
Readers by discipline Count As %
Unspecified 11 38%
Medicine and Dentistry 9 31%
Mathematics 2 7%
Economics, Econometrics and Finance 1 3%
Biochemistry, Genetics and Molecular Biology 1 3%
Other 5 17%

Attention Score in Context

This research output has an Altmetric Attention Score of 16. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 26 November 2017.
All research outputs
of 13,305,387 outputs
Outputs from BMJ Quality & Safety
of 1,346 outputs
Outputs of similar age
of 267,226 outputs
Outputs of similar age from BMJ Quality & Safety
of 43 outputs
Altmetric has tracked 13,305,387 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 92nd percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 1,346 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 35.0. This one has gotten more attention than average, scoring higher than 55% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 267,226 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 87% of its contemporaries.
We're also able to compare this research output to 43 others from the same source and published within six weeks on either side of this one. This one is in the 27th percentile – i.e., 27% of its contemporaries scored the same or lower than it.