Utility of the Health of the Nation Outcome Scales (HoNOS) in Predicting Mental Health Service Costs for Patients with Common Mental Health Problems: Historical Cohort Study

Abstract

BackgroundFew countries have made much progress in implementing transparent and efficient systems for the allocation of mental health care resources. In England there are ongoing efforts by the National Health Service (NHS) to develop mental health ‘payment by results’ (PbR). The system depends on the ability of patient ‘clusters’ derived from the Health of the Nation Outcome Scales (HoNOS) to predict costs. We therefore investigated the associations of individual HoNOS items and the Total HoNOS score at baseline with mental health service costs at one year follow-up.MethodsAn historical cohort study using secondary care patient records from the UK financial year 2012–2013. Included were 1,343 patients with ‘common mental health problems’, represented by ICD-10 disorders between F32-48. Costs were based on patient contacts with community-based and hospital-based mental health services. The costs outcome was transformed into ‘high costs’ vs ‘regular costs’ in main analyses.ResultsAfter adjustment for covariates, 11 HoNOS items were not associated with costs. The exception was ‘self-injury’ with an odds ratio of 1.41 (95% CI 1.10–2.99). Population attributable fractions (PAFs) for the contribution of HoNOS items to high costs ranged from 0.6% (physical illness) to 22.4% (self-injury). After adjustment, the Total HoNOS score was not associated with costs (OR 1.03, 95% CI 0.99–1.07). However, the PAF (33.3%) demonstrated that it might account for a modest proportion of the incidence of high costs.ConclusionsOur findings provide limited support for the utility of the self-injury item and Total HoNOS score in predicting costs. However, the absence of associations for the remaining HoNOS items indicates that current PbR clusters have minimal ability to predict costs, so potentially contributing to a misallocation of NHS resources across England. The findings may inform the development of mental health payment systems internationally, especially since the vast majority of countries have not progressed past the early stages of this development. Discrepancies between our findings with those from Australia and New Zealand point to the need for further international investigations.

Treatment results for severe psychiatric illness: which method is best suited to denote the outcome of mental health care?

“…Large datasets have thus become available to evaluate the psychometric quality of the instrument, and some negative findings have emerged. For instance, the HoNOS appears not to be associated with need-for-care as operationalized by costs of treatment in a large British cohort of 1343 patients with common mental health problems [ 35 ]. For this patient group, the sensitivity to change in severity of psychopathology of the HoNOS appears to be limited as only three items (7, 8, and 9) seem relevant and appropriate [ 21 ].…”

A percepção dos profissionais de saúde sobre o cuidado ao idoso com transtorno mental

“…O grupo constrói, por meio de suas falas (linguagem), explicações inconscientes que justificam alguns obstáculos relacionados ao cuidado do idoso com transtorno mental (11) . intersetorial (20)(21) . Sendo assim, mais uma estratégia seria a partir das representações da equipe sobre a ausência de rede e protocolos, a construção de indicadores para avaliação dessas representações (1,10,20) .…”

“…intersetorial (20)(21) . Sendo assim, mais uma estratégia seria a partir das representações da equipe sobre a ausência de rede e protocolos, a construção de indicadores para avaliação dessas representações (1,10,20) .…”

“…Com os resultados poderiam conceber estratégias mais acuradas em pontos específicos da rede para aumentar a eficiência e um exemplo seriam a estratégia de referência, capacitação para aplicação de escalas e construção de protocolos de acolhimento e atendimento (20)(21) . Profissionais qualificados em gestão e suporte se saúde são vitais para supervisionar a implementação de estratégias para alcançar melhores níveis de atenção em saúde mental (6,10) .…”

Latent class analysis of the health of the nation outcome scales: A comparison of Swiss and English profiles and exploration of their predictive utility

“…More recently, however, HoNOS total score was found not to be a useful predictor of mental health service costs in a sample of patients with common mental health problems, and indeed only the 'self injury' item showed any relationship [18]. Golay and colleagues [19] also found that overall the HoNOS items had weak predictive validity for duration of stay in hospital, re-hospitalization and also time before re-hospitalization.…”