RT Journal Article
SR Electronic
T1 Does the quality and outcomes framework reduce psychiatric admissions in people with serious mental illness? A regression analysis
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e007342
DO 10.1136/bmjopen-2014-007342
VO 5
IS 4
A1 Nils Gutacker
A1 Anne R Mason
A1 Tony Kendrick
A1 Maria Goddard
A1 Hugh Gravelle
A1 Simon Gilbody
A1 Lauren Aylott
A1 June Wainwright
A1 Rowena Jacobs
YR 2015
UL http://bmjopen.bmj.com/content/5/4/e007342.abstract
AB 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.