title: Service quality as measured by service fit and mortality among public mental health system service recipients.
abstract: Service fit, defined as consistency between mental health services judged needed and services received was measured for a random sample of service recipients in a public mental health system (N = 6588). A variant of small area analysis was used to measure the relationship between catchment area mortality rates from natural causes, suicide, and medicolegal causes and area fit scores for a variety of services. We tested the theory-based hypothesis that service fit would predict interarea variations in mortality better than simple measures of amount of service prescribed and received. We also tested the hypothesis that, controlling for relevant demographic and clinical factors, fit would be protective for mortality from all causes. Findings supported the first hypothesis. With respect to the second, service fit for only certain services was protective. Housing and clubhouses services were particularly protective, suggesting the importance of services providing social support.
authors.affiliation: Human Services Research Institute, 2336 Massachusetts Avenue, Cambridge, Massachusetts 02140, USA. sleff@hsri.org or chow@hsri.org
authors.forename: H Stephen
authors.initials: HS
authors.lastname: Leff
authors.forename: James C
authors.initials: JC
authors.lastname: McPartland
authors.forename: Stephen
authors.initials: S
authors.lastname: Banks
authors.forename: Bruce
authors.initials: B
authors.lastname: Dembling
authors.forename: William
authors.initials: W
authors.lastname: Fisher
authors.forename: I Elaine
authors.initials: IE
authors.lastname: Allen
mesh_terms: D000328:Adult; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000592:standards*; D008875:Middle Aged; D009026:Mortality; D017150:Public Sector; D011787:Quality of Health Care; D020379:Risk Adjustment; D014481:United States / Q000453:epidemiology