title: Variations in Performance of Mental Health Providers in the English NHS: An Analysis of the Relationship Between Readmission Rates and Length-of-Stay.
abstract: Length-of-stay (LOS) for inpatient mental health care is a major driver of variation in resource use internationally. We explore determinants of LOS in England, focusing on the impact of emergency readmission rates which can serve as a measure of the quality of care. Data for 2009/2010 and 2010/2011 are analysed using hierarchical and non-hierarchical models. Unexplained residual variation among providers is quantified using Empirical Bayes techniques. Diagnostic, treatment and patient-level demographic variables are key drivers of LOS. Higher emergency readmission rates are associated with shorter LOS. Ranking providers by residual variation reveals significant differences, suggesting some providers can improve performance.
authors.affiliation: Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. Valerie.Moran@lshtm.ac.uk.
authors.forename: Valerie
authors.initials: V
authors.lastname: Moran
authors.affiliation: Centre for Health Economics and Department of Economics and Related Studies, University of York, Alcuin A Block, Heslington, York, YO10 5DD, UK.
authors.forename: Rowena
authors.initials: R
authors.lastname: Jacobs
authors.affiliation: Centre for Health Economics and Department of Economics and Related Studies, University of York, Alcuin A Block, Heslington, York, YO10 5DD, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Mason
mesh_terms: D001499:Bayes Theorem; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D013222:State Medicine / Q000706:statistics & numerical data*
keywords: Length-of-stay; Mental health providers; Multilevel modelling; Performance; Readmission rates