Service quality and clinical outcomes: an example from mental health rehabilitation services in England.
BACKGROUND
Current health policy assumes better quality services lead to better outcomes.


OBJECTIVE
To investigate the relationship between quality of mental health rehabilitation services in England, local deprivation, service user characteristics and clinical outcomes.


METHODS
Standardised tools were used to assess the quality of mental health rehabilitation units and service users' autonomy, quality of life, experiences of care and ratings of the therapeutic milieu. Multiple level modelling investigated relationships between service quality, service user characteristics and outcomes.


RESULTS
A total of 52/60 (87%) National Health Service trusts participated, comprising 133 units and 739 service users. All aspects of service quality were positively associated with service users' autonomy, experiences of care and therapeutic milieu, but there was no association with quality of life.


CONCLUSIONS
Quality of care is linked to better clinical outcomes in people with complex and longer-term mental health problems. Thus, investing in quality is likely to show real clinical gains.
Mental Health Sciences Unit, University College London, London, UK. h.killaspy@ucl.ac.uk
Helen
H
Killaspy
Louise
L
Marston
Rumana Z
RZ
Omar
Nicholas
N
Green
Isobel
I
Harrison
Melanie
M
Lean
Frank
F
Holloway
Tom
T
Craig
Gerard
G
Leavey
Michael
M
King
D000328:Adult; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005260:Female; D006291:Health Policy; D006301:Health Services Needs and Demand; D006801:Humans; D008134:Long-Term Care / Q000592:standards*; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D008605:Mental Health Services / Q000592:standards*; D055361:Multilevel Analysis; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D026684:Personal Autonomy; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards*; D011788:Quality of Life; D012047:Rehabilitation Centers / Q000592:standards*; D058992:Social Participation; D013222:State Medicine / Q000592:standards; D000078329:Workforce