CCHE Seminar: Rowena Jacobs

Quality of care and outcomes for people with Serious Mental Illness in England

Rowena Jacobs is Professor of Health Economics in the Health Policy Team in the Centre for Health Economics. She has a PhD in Economics (2002) from the University of York and an MCom Degree in Economics (cum laude) (1997) from the University of Cape Town, South Africa. Rowena’s research interests include health policy reforms, incentives and performance measurement with a particular interest in mental health services. Recent research projects include topics such as organisational culture and performance, the use of composite performance indicators, quality of life indicators and the performance of Foundation Trust hospitals. Rowena recently completed a post-doctoral fellowship from the Department of Health on performance measurement in mental health services. The research examined variations in performance in outcomes, efficiency, well-being, costs, and length of stay.

Rowena has led two projects on the ESRC Public Services Programme on public sector performance. She is currently involved in a project on the Economics of Social and Health Care Research Unit (ESHCRU) on examining the performance of providers in the hip fracture care pathway. She is leading an NIHR SDO project examining the relationship between primary care practice performance and emergency admissions for persons with serious mental illness. She is an editorial board member of The Open Health Services and Policy Journal. She has acted as consultant to various UK governments and other agencies, as well as the World Bank and WHO and is currently an expert adviser to the OECD on performance measurement in mental health services. She is also a governor for York Hospitals NHS Foundation Trust.

Abstract

Primary care is central to the provision of mental healthcare in England. The Quality and Outcomes Framework (QOF) is the largest pay-for-performance (P4P) scheme in primary care in the world. The QOF offers payments to GP practices to provide proactive care for people with serious mental illness (SMI). We examine whether better quality primary care for people with SMI is associated with lower hospital admissions, shorter length of stay, and lower mortality. The hypothesis is that proactive primary care should reduce preventable hospital admissions and death.

I describe two studies where we attempt to assess the impact of practice quality on hospital admissions. Our first study finds that practices with higher QOF achievement have more psychiatric admissions, contrary to expectation. It also finds no effect of QOF on length of stay. However, this study relies on aggregate practice-level data and could not ascertain which patients received QOF care, and the timing of events, which prohibits analysis of the causal effect of financial incentives.

The second study explores the effectiveness of QOF by linking primary care, secondary care, and mortality data. By obtaining a complete linkage we have at our disposal crucial information about the timing of events: date of SMI diagnosis, dates of care receipt, dates of hospital admissions, and death.  To exploit this information about the sequence of events we estimate a survival analysis model. Our preliminary results confirm those from the first study, showing that receipt of QOF care decreases the time to admission but delays death. QOF care may increase patients’ and doctors’ awareness of risk indicators and encourage earlier admission for patients that may otherwise receive no care at all.

CCHE Seminar Series 2016/17 – full schedule

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