Serious mental illness (SMI) describes a group of illnesses, predominantly schizophrenia and bipolar disorder, which often require lifelong management. Schizophrenia is characterised by psychotic symptoms (disturbed thoughts, hallucinations, delusions) whereas bipolar disorder is associated with extremes of mood, from periods of extreme highs (mania) to periods of extreme low mood. People with SMI tend to experience poorer physical health and shorter life expectancy than the general population, and die 15-20 years earlier, usually from preventable physical conditions such as heart and lung disease. Research is needed to examine the impact of policies aimed at reducing the inequality. This study will use information from patients' health records to find out how we can better meet the physical health needs of people with SMI, so they can live longer, healthier lives. It will use anonymised patient data routinely recorded by general practitioners and hospitals, to investigate whether changes to national guidelines/ programmes that give clinicians financial incentives to monitor the physical health of patients e.g. the Quality and Outcomes Framework (QOF)) affect care quality and health outcomes for people with SMI. Findings will shared with a variety of audiences, including people with lived experience, academics and health professionals.
People with serious mental illness (SMI) have reduced life expectancy and are at increased risk of comorbidities compared to the general population. Unmet physical health need is increasingly recognised as one of the factors underpinning the morbidity-mortality gap. Since its inception in 2004, the Quality and Outcomes Framework (QOF) offered general practices in England incentives to conduct physical health checks on patients with SMI to address this inequality. In 2014, however, all indicators rewarding physical health checks were retired - with the exception of blood pressure. This project aims to examine the impact of incentives for physical checks on quality of care and health outcomes for SMI patients.
Data routinely collected from CPRD, linked to HES and ONS, and a technique called an Interrupted Time Series Analysis will be used to assess the impact of national guidelines and incentives on clinical activity in primary care, unplanned hospital admissions and deaths of SMI patients. Using this approach any change/trend in clinical activity, admissions and deaths due to the introduction and/or retirement of incentives will be identified.
Findings will be disseminated to a wide range of audiences and used to inform policy recommendations on how to reduce the morbidity-mortality gap associated with SMI.
Admitted Patient Care
Cholesterol levels
Blood pressure
Accident & Emergency attendance
Diabetes status
Glucose levels
HbA1c levels
BMI
Mortality
Kate Bosanquet - Chief Investigator - University of York
Kate Bosanquet - Corresponding Applicant - University of York
Ceri Owen - Collaborator - Service User of MHLDDS
David Shiers - Collaborator - University of York
Ian Watt - Collaborator - University of York
Kenan Direk - Collaborator - University College London ( UCL )
Lu Han - Collaborator - University of York
Peter Coventry - Collaborator - University of York
Rowena Jacobs - Collaborator - University of York
Shehzad Ali - Collaborator - University of York
Simon Gilbody - Collaborator - University of York
Tim Doran - Collaborator - University of York
HES Accident and Emergency;HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation