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Does the quality and outcomes framework reduce psychiatric admissions in people with serious mental illness? A regression analysis
  1. Nils Gutacker1,
  2. Anne R Mason1,
  3. Tony Kendrick2,
  4. Maria Goddard1,
  5. Hugh Gravelle1,
  6. Simon Gilbody3,
  7. Lauren Aylott4,
  8. June Wainwright4,
  9. Rowena Jacobs1
  1. 1Centre for Health Economics, University of York, York, UK
  2. 2Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, UK
  3. 3Department of Health Sciences, University of York, York, UK
  4. 4Service User, UK
  1. Correspondence to Dr Rowena Jacobs; rowena.jacobs{at}york.ac.uk

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.

  • MENTAL HEALTH
  • PRIMARY CARE
  • HEALTH ECONOMICS

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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