Authors respond to comments made on The Mental Elf about their research

Posted on 6 January 2016

Does QOF reduce hospitalisation for people with severe mental illness?

Dr Andrés Fonseca’s post on The Mental Elf provides an excellent summary of our recent research published in the BMJ Open.  

Here, we respond to some of the key points:

  • Our study tests the effects of the national Quality and Outcomes Framework (QOF) on hospital admissions. So our definition of serious mental illness (SMI) was taken from the QOF business rules for mental health, and includes schizophrenia, bipolar disorder, schizoaffective disorder and other psychoses. These rules exclude severe depression and anxiety disorders.  
  • QOF exception reporting, a mechanism to protect patients from coercive care and respect their choice to refuse intervention, pertains to individuals rather than practices who may be excluded from achievement calculations for logistical or clinical reasons. Exception reporting of SMI patients is high compared with other clinical conditions and it matters.
  • Hospital Episodes Statistics (HES) data captures all publicly-funded inpatient activity in England. The vast majority of mental health hospital care in England is publicly funded.
  • We ran both cross-sectional and longitudinal data regression models, covering the period 2006/07 to 2010/11. Results were robust.
  • Good quality care for chronic conditions should help reduce avoidable admissions, but this does not mean that all psychiatric admissions are unnecessary. Nonetheless, other outcome measures are also very important for people with SMI. Our new study examines a wider set of quality indicators in primary care (non-QOF quality measures), and investigates how these are linked to a range of different outcomes (aside from avoiding emergency admissions).  

Contact: Rowena Jacobs