HoNOS - their utility for payment by results in mental health.
OBJECTIVE
The purpose of this paper is to present findings from two studies exploring the Health of the Nation Outcome Scale's (HoNOS) utility within a new payment by results (PbR) system for mental health services in England.


METHODS
In the first study principal axis factoring extraction was used to explore a sample of 23,641 HoNOS ratings. In a second study confirmatory factor analysis was used to evaluate four subscale structures on a new sample of 34,716 HoNOS ratings.


RESULTS
No HoNOS factor structure evaluated in this study demonstrated adequate fit statistics across several clinical presentations. A new four-factor model was the only structure to achieve fit statistics across all clinical populations, but can only be championed on a "best fit" basis as opposed to "good fit" at the present time.


CONCLUSIONS
Data used in the current studies relate to six NHS mental health service providers. Replication using a national sample is recommended. Exploration of different HoNOS factor structures for different mental health clusters within the PbR system in England is also recommended. However, it is also possible that removing redundant or adding new items may result in a more stable HoNOS generic factor structure.


CONCLUSIONS
This is the first HoNOS evaluation as a generic outcome measure for use within a PbR system and provides important insights into its mental health utility and limitations. The findings have significant implications for those developing the national PbR quality and outcomes framework for England's mental health services. However, there are also implications for all nations in which HoNOS is used to report mental health outcomes.
Department of Psychology Management, Tees, Esk and Wear Valleys NHS Foundation Trust, Middlesbrough, UK.
Barry L
BL
Speak
Paula
P
Hay
Steven J
SJ
Muncer
D001519:Behavior; D003863:Depression / Q000523:psychology; D004739:England; D006212:Hallucinations / Q000523:psychology; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D007398:Interpersonal Relations; D001523:Mental Disorders / Q000628:therapy*; D008603:Mental Health; D008605:Mental Health Services / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011594:Psychometrics; D012052:Reimbursement, Incentive / Q000458:organization & administration*; D012720:Severity of Illness Index; D012959:Socioeconomic Factors
Health measures; HoNOS; Mental health; Outcome scales and measures; Payment by results