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Does the quality and outcomes framework reduce psychiatric admissions in people with serious mental illness? A regression analysis

Does the quality and outcomes framework reduce psychiatric admissions in people with serious mental illness? A regression analysis
Does the quality and outcomes framework reduce psychiatric admissions in people with serious mental illness? A regression analysis
Background

The Quality and Outcomes Framework (QOF) incentivises general practices in England to provide proactive care for people with serious mental illness (SMI) including schizophrenia, bipolar disorder and other psychoses. Better proactive primary care may reduce the risk of psychiatric admissions to hospital, but this has never been tested empirically.

Methods

The QOF data set included 8234 general practices in England from 2006/2007 to 2010/2011. Rates of hospital admissions with primary diagnoses of SMI or bipolar disorder were estimated from national routine hospital data and aggregated to practice level. Poisson regression was used to analyse associations.

Results

Practices with higher achievement on the annual review for SMI patients (MH9), or that performed better on either of the two lithium indicators for bipolar patients (MH4 or MH5), had more psychiatric admissions. An additional 1% in achievement rates for MH9 was associated with an average increase in the annual practice admission rate of 0.19% (95% CI 0.10% to 0.28%) or 0.007 patients (95% CI 0.003 to 0.01).

Conclusions

The positive association was contrary to expectation, but there are several possible explanations: better quality primary care may identify unmet need for secondary care; higher QOF achievement may not prevent the need for secondary care; individuals may receive their QOF checks postdischarge rather than prior to admission; individuals with more severe SMI may be more likely to be registered with practices with better QOF performance; and QOF may be a poor measure of the quality of care for people with SMI.
1-11
Gutacker, N.
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Mason, A.
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Kendrick, T.
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Goddard, M.
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Gravelle, H.
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Gilbody, S.
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Aylott, L.
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Wainwright, J.
b1469599-d09e-483d-af82-805e680c83a5
Jacobs, R.
6011817b-2d0a-4dbf-94f3-ac523a51b8e9
Gutacker, N.
483d818b-e6cf-4c46-8d54-b7ed795903fe
Mason, A.
0cfc2ff4-70c2-4d1e-ad12-6b90ffe60b3f
Kendrick, T.
c697a72c-c698-469d-8ac2-f00df40583e5
Goddard, M.
bd52d741-1b9a-4b68-969b-a0c84526063a
Gravelle, H.
4ec9e07d-24f5-43ad-818e-db1df8c6fe2c
Gilbody, S.
9de3029e-dc51-46c8-9938-868a501aa3d9
Aylott, L.
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Wainwright, J.
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Jacobs, R.
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Gutacker, N., Mason, A., Kendrick, T., Goddard, M., Gravelle, H., Gilbody, S., Aylott, L., Wainwright, J. and Jacobs, R. (2015) Does the quality and outcomes framework reduce psychiatric admissions in people with serious mental illness? A regression analysis. BMJ Open, 5 (e007342), 1-11. (doi:10.1136/bmjopen-2014-007342). (PMID:25897027)

Record type: Article

Abstract

Background

The Quality and Outcomes Framework (QOF) incentivises general practices in England to provide proactive care for people with serious mental illness (SMI) including schizophrenia, bipolar disorder and other psychoses. Better proactive primary care may reduce the risk of psychiatric admissions to hospital, but this has never been tested empirically.

Methods

The QOF data set included 8234 general practices in England from 2006/2007 to 2010/2011. Rates of hospital admissions with primary diagnoses of SMI or bipolar disorder were estimated from national routine hospital data and aggregated to practice level. Poisson regression was used to analyse associations.

Results

Practices with higher achievement on the annual review for SMI patients (MH9), or that performed better on either of the two lithium indicators for bipolar patients (MH4 or MH5), had more psychiatric admissions. An additional 1% in achievement rates for MH9 was associated with an average increase in the annual practice admission rate of 0.19% (95% CI 0.10% to 0.28%) or 0.007 patients (95% CI 0.003 to 0.01).

Conclusions

The positive association was contrary to expectation, but there are several possible explanations: better quality primary care may identify unmet need for secondary care; higher QOF achievement may not prevent the need for secondary care; individuals may receive their QOF checks postdischarge rather than prior to admission; individuals with more severe SMI may be more likely to be registered with practices with better QOF performance; and QOF may be a poor measure of the quality of care for people with SMI.

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More information

Accepted/In Press date: 16 January 2015
Published date: 20 April 2015
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 375407
URI: http://eprints.soton.ac.uk/id/eprint/375407
PURE UUID: 9b419277-d72c-45a2-8e41-e10165f9c634
ORCID for T. Kendrick: ORCID iD orcid.org/0000-0003-1618-9381

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Date deposited: 23 Mar 2015 12:04
Last modified: 15 Mar 2024 02:59

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Contributors

Author: N. Gutacker
Author: A. Mason
Author: T. Kendrick ORCID iD
Author: M. Goddard
Author: H. Gravelle
Author: S. Gilbody
Author: L. Aylott
Author: J. Wainwright
Author: R. Jacobs

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