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Service quality and clinical outcomes: an example from mental health rehabilitation services in England

  • Helen Killaspy (a1), Louise Marston (a2), Rumana Z. Omar (a3), Nicholas Green (a4), Isobel Harrison (a5), Melanie Lean (a6), Frank Holloway (a7), Tom Craig (a8), Gerard Leavey (a8) and Michael King (a8)...

Abstract

Background

Current health policy assumes better quality services lead to better outcomes.

Aims

To investigate the relationship between quality of mental health rehabilitation services in England, local deprivation, service user characteristics and clinical outcomes.

Method

Standardised tools were used to assess the quality of mental health rehabilitation units and service users' autonomy, quality of life, experiences of care and ratings of the therapeutic milieu. Multiple level modelling investigated relationships between service quality, service user characteristics and outcomes.

Results

A total of 52/60 (87%) National Health Service trusts participated, comprising 133 units and 739 service users. All aspects of service quality were positively associated with service users' autonomy, experiences of care and therapeutic milieu, but there was no association with quality of life.

Conclusions

Quality of care is linked to better clinical outcomes in people with complex and longer-term mental health problems. Thus, investing in quality is likely to show real clinical gains.

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Copyright

Corresponding author

Dr Helen Killaspy, Mental Health Sciences Unit, University College London, Charles Bell House, 67-73 Riding House Street, London W1W7EJ, UK. Email: h.killaspy@ucl.ac.uk

Footnotes

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Declaration of interest

None.

Footnotes

References

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Service quality and clinical outcomes: an example from mental health rehabilitation services in England

  • Helen Killaspy (a1), Louise Marston (a2), Rumana Z. Omar (a3), Nicholas Green (a4), Isobel Harrison (a5), Melanie Lean (a6), Frank Holloway (a7), Tom Craig (a8), Gerard Leavey (a8) and Michael King (a8)...
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Authors' response

Helen Killaspy, Reader in Rehabilitation Psychiatry
01 February 2013

On the basis of their definition of "outcome", Prince Vincent and David Curtis challenge the conclusions of our national study of mental health inpatient rehabilitation services where we found that the quality of services was positively associated with better clinical outcomes. In doing so, they seem to adopt a medical model and ignore important insightsarising from patient centred concepts of recovery. They regard 'symptoms,functioning and relapse' as key, whereas a recovery orientated approach would also value the quality of therapeutic relationships, the promotion of autonomy and better quality of life. Our aim was to try and bridge this ideological divide by placing patient reported outcomes on an equal footing with so-called clinical measures. At the risk of excessive pedantry, it would be fair to say that measures of patient experiences of care, such as those we used in our study, could be considered assessments of process rather than outcome, though they are nevertheless, an importantaspect in the measurement of service quality. In any case, such measures are usually referred to as "Patient Reported Outcome Measures". We found a positive association between our service managers' assessments of the quality of their own services (using our standardized measure, the QualityIndicator for Rehabilitative Care, QuIRC) and patients' experiences of care. This corroborates the service managers' ratings and strongly suggests that improving service quality will result in a better service user experience - surely an "outcome" everyone can relate to as worthwhile. We also found that greater quality of mental health rehabilitation services was associated with greater service user autonomy.We gave a number of possible reasons why we did not find a positive association between service quality and service user quality of life, the main one being that the measure we used focuses on experiences outside of an inpatient setting (relationships with family/partner, work, income etc.). Our findings reflect the reality for people in inpatient mental health rehabilitation units who tend to have lengthy admissions (in our study, their current admission was 18 months on average with eight of these in the rehabilitation unit) due to the severity and complexity of their symptoms and severe impairment of social functioning, all of which impact negatively on their social inclusion and quality of life. Nevertheless, it is absolutely correct that rehabilitation service should (and do) aim to facilitate service users in achieving a successful community life which, ultimately should be reflected in their quality of life. Our findings reflect the focus of our study - inpatient mental health rehabilitation services deal with individuals at the beginning of their rehabilitation, when they are most severely unwell and least able toengage in the community. Later phases of our research will provide further data on the longitudinal outcomes, including social functioning and successful community living.

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Conflict of interest: None declared

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