Quality of care and outcomes for people with Serious Mental Illness in England: What can we learn from financial incentives and policy initiatives?

Primary care is central to the provision of mental healthcare in England. The Quality and Outcomes Framework (QOF) is the largest pay-for-performance (P4P) scheme in primary care in the world. The QOF offers payments to GP practices to provide proactive care for people with serious mental illness (SMI). We examine whether better quality primary care for people with SMI is associated with lower hospital admissions, shorter length of stay, and lower mortality. The hypothesis is that proactive primary care should reduce preventable hospital admissions and death.

I describe two studies where we attempt to assess the impact of practice quality on hospital admissions. Our first study finds that practices with higher QOF achievement have more psychiatric admissions, contrary to expectation. It also finds no effect of QOF on length of stay. However this study relies on aggregate practice-level data and could not ascertain which patients received QOF care, and the timing of events, which prohibits analysis of the causal effect of financial incentives.

The second study explores the effectiveness of QOF by linking primary care, secondary care, and mortality data. By obtaining a complete linkage we have at our disposal crucial information about the timing of events: date of SMI diagnosis, dates of care receipt, dates of hospital admissions, and death.  To exploit this information about the sequence of events we estimate a survival analysis model. Our preliminary results confirm those from the first study, showing that receipt of QOF care decreases the time to admission but delays death. QOF care may increase patients’ and doctors’ awareness of risk indicators and encourage earlier admission for patients that may otherwise receive no care at all.

Biography:

Rowena Jacobs is Professor of Health Economics in the Health Policy Team in the Centre for Health Economics at the University of York. She has a PhD in Economics from the University of York and an MCom Degree in Economics from the University of Cape Town, South Africa. Rowena’s research interests include health policy reforms, incentives and performance measurement with a particular interest in mental health services. Recent research projects include topics such as organizational culture and performance, the use of composite performance indicators, quality of life indicators and the performance of Foundation Trust hospitals.