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Do higher primary care practice performance scores predict lower rates of emergency admissions for persons with serious mental illness? An analysis of secondary panel data

Do higher primary care practice performance scores predict lower rates of emergency admissions for persons with serious mental illness? An analysis of secondary panel data
Do higher primary care practice performance scores predict lower rates of emergency admissions for persons with serious mental illness? An analysis of secondary panel data
Background

Serious mental illness (SMI) is a set of chronic enduring conditions including schizophrenia and bipolar disorder. SMIs are associated with poor outcomes, high costs and high levels of disease burden. Primary care plays a central role in the care of people with a SMI in the English NHS. Good-quality primary care has the potential to reduce emergency hospital admissions, but also to increase elective admissions if physical health problems are identified by regular health screening of people with SMIs. Better-quality primary care may reduce length of stay (LOS) by enabling quicker discharge, and it may also reduce NHS expenditure.

Objectives

We tested whether or not better-quality primary care, as assessed by the SMI quality indicators measured routinely in the Quality and Outcomes Framework (QOF) in English general practice, is associated with lower rates of emergency hospital admissions for people with SMIs, for both mental and physical conditions and with higher rates of elective admissions for physical conditions in people with a SMI. We also tested the impact of SMI QOF indicators on LOS and costs.

Data

We linked administrative data from around 8500 general practitioner (GP) practices and from Hospital Episode Statistics for the study period 2006/7 to 2010/11. We identified SMI admissions by a main International Classification of Diseases, 10th revision (ICD-10) diagnosis of F20–F31. We included information on GP practice and patient population characteristics, area deprivation and other potential confounders such as access to care. Analyses were carried out at a GP practice level for admissions, but at a patient level for LOS and cost analyses.

Methods

We ran mixed-effects count data and linear models taking account of the nested structure of the data. All models included year indicators for temporal trends.

Results

Contrary to expectation, we found a positive association between QOF achievement and admissions, for emergency admissions for both mental and physical health. An additional 10% in QOF achievement was associated with an increase in the practice emergency SMI admission rate of approximately 1.9%. There was no significant association of QOF achievement with either LOS or cost. All results were robust to sensitivity analyses.

Conclusions

Possible explanations for our findings are (1) higher quality of primary care, as measured by QOF may not effectively prevent the need for secondary care; (2) patients may receive their QOF checks post discharge, rather than prior to admission; (3) people with more severe SMIs, at a greater risk of admission, may select into practices that are better organised to provide their care and which have better QOF performance; (4) better-quality primary care may be picking up unmet need for secondary care; and (5) QOF measures may not accurately reflect quality of primary care. Patient-level data on quality of care in general practice is required to determine the reasons for the positive association of QOF quality and admissions. Future research should also aim to identify the non-QOF measures of primary care quality that may reduce unplanned admissions more effectively and could potentially be incentivised.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.
2050-4349
Jacobs, Rowena
49686cdf-0222-4e1a-9d81-1914187fcec9
Gutaker, Nils
5086548e-6da7-4f57-ad69-955c1c5459f8
Mason, Anne
f23014c5-0733-4a71-9c3f-2cad48797ca2
Goddard, Maria
06cc3cde-3794-4419-aa74-dad7030ab10a
Gravelle, Hugh
7bded0be-eaaa-4612-b246-5b0b3f132cce
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Gilbody, Simon
6d135882-a8df-444c-85aa-980dddef45a5
Aylott, Lauren
0a8328e9-c5bb-408f-9703-37982af32ffb
Wainwright, June
3cd98d0a-d8d5-4638-aad7-640050ddc0d3
Jacobs, Rowena
49686cdf-0222-4e1a-9d81-1914187fcec9
Gutaker, Nils
5086548e-6da7-4f57-ad69-955c1c5459f8
Mason, Anne
f23014c5-0733-4a71-9c3f-2cad48797ca2
Goddard, Maria
06cc3cde-3794-4419-aa74-dad7030ab10a
Gravelle, Hugh
7bded0be-eaaa-4612-b246-5b0b3f132cce
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Gilbody, Simon
6d135882-a8df-444c-85aa-980dddef45a5
Aylott, Lauren
0a8328e9-c5bb-408f-9703-37982af32ffb
Wainwright, June
3cd98d0a-d8d5-4638-aad7-640050ddc0d3

Jacobs, Rowena, Gutaker, Nils, Mason, Anne, Goddard, Maria, Gravelle, Hugh, Kendrick, Tony, Gilbody, Simon, Aylott, Lauren and Wainwright, June (2015) Do higher primary care practice performance scores predict lower rates of emergency admissions for persons with serious mental illness? An analysis of secondary panel data. Health Services and Delivery Research, 3 (16). (doi:10.3310/hsdr03160). (PMID:25927138)

Record type: Article

Abstract

Background

Serious mental illness (SMI) is a set of chronic enduring conditions including schizophrenia and bipolar disorder. SMIs are associated with poor outcomes, high costs and high levels of disease burden. Primary care plays a central role in the care of people with a SMI in the English NHS. Good-quality primary care has the potential to reduce emergency hospital admissions, but also to increase elective admissions if physical health problems are identified by regular health screening of people with SMIs. Better-quality primary care may reduce length of stay (LOS) by enabling quicker discharge, and it may also reduce NHS expenditure.

Objectives

We tested whether or not better-quality primary care, as assessed by the SMI quality indicators measured routinely in the Quality and Outcomes Framework (QOF) in English general practice, is associated with lower rates of emergency hospital admissions for people with SMIs, for both mental and physical conditions and with higher rates of elective admissions for physical conditions in people with a SMI. We also tested the impact of SMI QOF indicators on LOS and costs.

Data

We linked administrative data from around 8500 general practitioner (GP) practices and from Hospital Episode Statistics for the study period 2006/7 to 2010/11. We identified SMI admissions by a main International Classification of Diseases, 10th revision (ICD-10) diagnosis of F20–F31. We included information on GP practice and patient population characteristics, area deprivation and other potential confounders such as access to care. Analyses were carried out at a GP practice level for admissions, but at a patient level for LOS and cost analyses.

Methods

We ran mixed-effects count data and linear models taking account of the nested structure of the data. All models included year indicators for temporal trends.

Results

Contrary to expectation, we found a positive association between QOF achievement and admissions, for emergency admissions for both mental and physical health. An additional 10% in QOF achievement was associated with an increase in the practice emergency SMI admission rate of approximately 1.9%. There was no significant association of QOF achievement with either LOS or cost. All results were robust to sensitivity analyses.

Conclusions

Possible explanations for our findings are (1) higher quality of primary care, as measured by QOF may not effectively prevent the need for secondary care; (2) patients may receive their QOF checks post discharge, rather than prior to admission; (3) people with more severe SMIs, at a greater risk of admission, may select into practices that are better organised to provide their care and which have better QOF performance; (4) better-quality primary care may be picking up unmet need for secondary care; and (5) QOF measures may not accurately reflect quality of primary care. Patient-level data on quality of care in general practice is required to determine the reasons for the positive association of QOF quality and admissions. Future research should also aim to identify the non-QOF measures of primary care quality that may reduce unplanned admissions more effectively and could potentially be incentivised.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

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Published date: 28 April 2015
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 376807
URI: http://eprints.soton.ac.uk/id/eprint/376807
ISSN: 2050-4349
PURE UUID: a1b47f54-00f3-4fc3-8c76-9d121ba68d3f
ORCID for Tony Kendrick: ORCID iD orcid.org/0000-0003-1618-9381

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Date deposited: 22 May 2015 15:57
Last modified: 18 Feb 2021 16:51

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Contributors

Author: Rowena Jacobs
Author: Nils Gutaker
Author: Anne Mason
Author: Maria Goddard
Author: Hugh Gravelle
Author: Tony Kendrick ORCID iD
Author: Simon Gilbody
Author: Lauren Aylott
Author: June Wainwright

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