Impact of secondary care financial incentives on the quality of physical healthcare for people with psychosis: a longitudinal controlled study

Abstract

BackgroundConcerns have repeatedly been expressed about the quality of physical healthcare that people with psychosis receive.AimsTo examine whether the introduction of a financial incentive for secondary care services led to improvements in the quality of physical healthcare for people with psychosis.MethodLongitudinal data were collected over an 8-year period on the quality of physical healthcare that people with psychosis received from 56 trusts in England before and after the introduction of the financial incentive. Control data were also collected from six health boards in Wales where a financial incentive was not introduced. We calculated the proportion of patients whose clinical records indicated that they had been screened for seven key aspects of physical health and whether they were offered interventions for problems identified during screening.ResultsData from 17 947 people collected prior to (2011 and 2013) and following (2017) the introduction of the financial incentive in 2014 showed that the proportion of patients who received high-quality physical healthcare in England rose from 12.85% to 31.65% (difference 18.80, 95% CI 17.37–20.21). The proportion of patients who received high-quality physical healthcare in Wales during this period rose from 8.40% to 13.96% (difference 5.56, 95% CI 1.33–10.10).ConclusionsThe results of this study suggest that financial incentives for secondary care mental health services are associated with marked improvements in the quality of care that patients receive. Further research is needed to examine their impact on aspects of care that are not incentivised.

Examining the effects of national initiatives to improve the physical health of people with psychosis in England: secondary analysis of data from the National Clinical Audit of Psychosis

“…For both the EIP and CMHT audits, we were able to examine physical health measures before and after the introduction of the Commissioning for Quality and Innovation programme. 22 Although the introduction of the programme was associated with a marked increase in the proportion of patients who were offered interventions for their physical health, 24 we found only limited evidence that this resulted in changes to the health of people under the care of CMHTs.…”

“…This study corroborates previous findings that the physical health of people with psychosis remains poor, despite an improvement in physical health screening and intervention following national initiatives implemented in England since 2014. 24 Both CMHT and EIP audits showed improvements in health according to some of these measures, and deteriorations in others. The proportion of patients in overall good health according to a composite measure was low across all rounds of both audits, but did improve significantly post-2014 for those patients receiving care from EIP services.…”

“…This study corroborates previous findings that the physical health of people with psychosis remains poor, despite an improvement in physical health screening and intervention following national initiatives implemented in England since 2014. 24 …”

“…However, the proportion of missing data did generally improve over subsequent rounds of each audit, possibly reflecting the previously noted incentivised improvements in screening rates and recording. 24 …”

“…23 Since these initiatives were implemented, there is some evidence that the quality of physical healthcare delivered to patients with psychosis has improved. 24 However, there are ongoing concerns that this has not translated to an improvement in patients' health. A recent study found that cardiometabolic risk factors were already pronounced in those presenting to services with a first episode of psychotic illness, and that physical health deteriorated during the first year of treatment.…”