Variations in Performance of Mental Health Providers in the English NHS: An Analysis of the Relationship Between Readmission Rates and Length-of-Stay

Moran, Valérie; Jacobs, Rowena; Mason, Anne

doi:10.1007/s10488-015-0711-4

Cited by 10 publications

(9 citation statements)

References 32 publications

(39 reference statements)

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“…Our research (Moran 2015, 2017) shows that the type of quality or outcome metric may matter in the design of the payment system and its selection should be based on sound evidence. The collection and use of these performance indicators within a payment framework may also have unintended consequences`.…”

Section: Two Payment Approaches For Mental Health Servicesmentioning

confidence: 99%

Funding approaches for mental health services: is there still a role for clustering?

et al. 2018

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Funding for mental health services in England faces many challenges including operating under financial constraints where it is not easy to demonstrate the link between activity and funding. Mental health services need to operate alongside and collaborate with acute hospital services where there is a well-established system for paying for activity. The funding landscape is shifting at a rapid pace and we outline the distinctions between the three main options – block contracts, episodic payment and capitation. Classification of treatment episodes via clustering presents an opportunity to demonstrate activity and reward it within these payment approaches. We have been engaged in research to assess how well the clustering system is performing against a number of fundamental criteria. Clusters need to be reliably recorded, to correspond to health needs, and to treatments that require roughly similar resources. We find that according to these criteria, clusters are falling short of providing a sound basis for measuring and financing services. Yet, we argue, it is the best available option and is essential for a more transparent funding approach for mental health to demonstrate its claim on resources, and that, as such, clusters should be a starting point for evolving a better funding system.

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Section: Two Payment Approaches For Mental Health Servicesmentioning

confidence: 99%

Funding approaches for mental health services: is there still a role for clustering?

et al. 2018

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“…Patient factors have not fully explained variations in length of stay, suggesting that other factors exert an in uence. We hypothesise that factors associated with how mental health services are delivered have an impact on length of stay, potentially explaining the variation in length of stay between UK trusts [8] . There is a lack of studies addressing service factors such as the type of ward, use of locum Consultant, change in Consultant and ward transfers.…”

Section: Introductionmentioning

confidence: 99%

Patient and Service-Level Factors Affecting Length of Inpatient Stay in an Acute Mental Health Service: A Retrospective Case Cohort Study

Crossley

Sweeney

2020

Preprint

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Background: The NHS Mental Health Implementation Plan aims to reduce length of inpatient psychiatric stays to a maximum of 32 days, yet provides little guidance on how to achieve this. Previous studies have attempted to analyse factors influencing length of stay in mental health units, focussing mostly on patient factors. These models fail to sufficiently explain the variation in duration of inpatient stay. We assess how the type of service delivered by a trust, in addition to patient factors, influences length of stay.Methods: We conducted a retrospective case cohort study in a large inner-city NHS mental health trust for all admissions in a one month period. Data was gathered from electronic notes of 105 patients. Descriptive univariate and bivariate analyses were conducted on the data, with multiple regression analysis conducted on statistically significant data. Results: Short-stay assessment ward admission significantly reduced length of stay. Patients under outpatients or under care co-ordination, admitted through Mental Health Act assessment and formally detained all had longer length of stay. Out of area admissions, locum Consultant care, changing Responsible Clinician and ward transfers all led to longer length of stay. Factors indicating more severe illness such as increased observation level and polypharmacy, as well as diagnoses of psychosis or bipolar disorder were associated with longer duration of stay. Discharges requiring referral to accommodation or rehabilitation led to longer stays. The most significant factors that influenced length of stay were higher observation levels, diagnosis of psychotic illness or bipolar, and discharge to rehabilitation placement. The final model, taking into account all these factors, was able to account for 59.6% of the variability in length of stay.Conclusions: The study backs up existing literature which shows patient-factors have an influence on length of stay. The study also demonstrates that service-level factors have an impact on the duration of stay. This data may be used to inform further studies which may aid provision of inpatient and community services in the future.

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“…Several factors were identified as contributing to prolongation of AHLS . Although the reduction of AHLS may reduce the very high occupancy rates of psychiatric bed, it could also impact on quality and outcomes and, thus, increase readmission rates . Older people with dementia may need longer AHLS than those without dementia .…”

Section: Discussionmentioning

confidence: 99%

“…63 Although the reduction of AHLS may reduce the very high occupancy rates of psychiatric bed, it could also impact on quality and outcomes and, thus, increase readmission rates. 48,[64][65][66][67] Older people with dementia may need longer AHLS than those without dementia. 68 However, in a study that evaluated the effects of reductions in AHLS on dementia patients, no differences were found between prereduction and postreduction groups on measures of agitation or overall functioning at the time of discharge.…”

Section: Comparison With the Literaturementioning

confidence: 99%

Hospital length of stay among older people treated with flexible and integrative psychiatric service models in Germany

Ignatyev

Mundt

Peter

et al. 2019

Int J Geriat Psychiatry

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Objective Since 2012, a new law (§64b, Book V of the Social Security Code [SGB V]) regulates the implementation of flexible and integrative psychiatric treatment projects (FIT64b) in Germany. FIT64b allows rapid discharge of patients from inpatient to outpatient settings and cost reductions of hospital stays. Several psychiatric centres exclusively provide FIT64b; others provide FIT64b alongside with standard health care. The aim of the study was to assess the average hospital length of stay (AHLS) of older patients with mental illness included in FIT64b projects. Methods A secondary data analysis was conducted using administrative data from eight German mental health centres providing FIT64b. The effects of gender, age, type of centre, and main diagnosis on AHLS were calculated for all older patients with age 65 years or older (n = 3495) treated in FIT64b in the year 2016. Data were analysed with descriptive statistics and robust multiway procedures. Results The AHLS of older people with mental illness was 4.8 (SD = 11.5) days. The AHLS was shorter in centres exclusively providing FIT64b than in centres providing FIT64b alongside with standard health care: 3.2 (SD = 6.4) vs 8.4 (SD = 17.8) days, P = .001. This difference was particularly marked among patients with schizophrenia spectrum disorders, mood disorders, and neurotic, stress‐related, and somatoform disorders. Conclusions FIT64b relates to very short AHLS even among older people. Centres using FIT64b alongside with standard health care usually provide standard care to most patients, which could lead to lower fidelity in the implementation of FIT64b.

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Variations in Performance of Mental Health Providers in the English NHS: An Analysis of the Relationship Between Readmission Rates and Length-of-Stay

Cited by 10 publications

References 32 publications

Funding approaches for mental health services: is there still a role for clustering?

Funding approaches for mental health services: is there still a role for clustering?

Patient and Service-Level Factors Affecting Length of Inpatient Stay in an Acute Mental Health Service: A Retrospective Case Cohort Study

Hospital length of stay among older people treated with flexible and integrative psychiatric service models in Germany

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