title: Does the quality and outcomes framework reduce psychiatric admissions in people with serious mental illness? A regression analysis.
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.
authors.affiliation: Centre for Health Economics, University of York, York, UK.
authors.forename: Nils
authors.initials: N
authors.lastname: Gutacker
authors.affiliation: Centre for Health Economics, University of York, York, UK.
authors.forename: Anne R
authors.initials: AR
authors.lastname: Mason
authors.affiliation: Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, UK.
authors.forename: Tony
authors.initials: T
authors.lastname: Kendrick
authors.affiliation: Centre for Health Economics, University of York, York, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Goddard
authors.affiliation: Centre for Health Economics, University of York, York, UK.
authors.forename: Hugh
authors.initials: H
authors.lastname: Gravelle
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Gilbody
authors.affiliation: Service User, UK.
authors.forename: Lauren
authors.initials: L
authors.lastname: Aylott
authors.affiliation: Service User, UK.
authors.forename: June
authors.initials: J
authors.lastname: Wainwright
authors.affiliation: Centre for Health Economics, University of York, York, UK.
authors.forename: Rowena
authors.initials: R
authors.lastname: Jacobs
mesh_terms: D000328:Adult; D000368:Aged; D004739:England; D005260:Female; D058006:General Practice / Q000592:standards*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000592:standards*; D012044:Regression Analysis; D012052:Reimbursement, Incentive; D055815:Young Adult
keywords: HEALTH ECONOMICS; MENTAL HEALTH; PRIMARY CARE