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.
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Authors
Twomey, Conal
Prina, A Matthew
Baldwin, David S
Das-Munshi, Jayati
Kingdon, David
Koeser, Leonardo
Prince, Martin J
Stewart, Robert
Tulloch, Alex D
Cieza, Alarcos
Issue Date
2016-11-30
Type
Journal Article
Language
en
Keywords
Alternative Title
Abstract
Few 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.
An 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.
After 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.
Our 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.
An 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.
After 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.
Our 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.
Description
Citation
Twomey, C., Prina, A. M., Baldwin, D. S., Das-Munshi, J., Kingdon, D., Koeser, L., Prince, M. J., Stewart, R., Tulloch, A. D., & Cieza, A. (2016). 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. PloS one, 11(11), e0167103. https://doi.org/10.1371/journal.pone.0167103
Publisher
License
Journal
PloS one
Volume
11
Issue
11
PubMed ID
DOI
10.1371/journal.pone.0167103
10.3109/09638237.2011.562261
10.1192/bjp.bp.110.090993
10.1176/ajp.143.2.131
10.1056/NEJM198611203152106
10.1016/j.jsat.2010.03.011
10.1186/1471-244X-12-121
10.1016/j.jad.2010.02.135
10.3109/10398562.2011.561845
10.1186/1471-244X-9-51
10.1007/s11136-011-0071-9
10.1186/1477-7525-3-76
10.1177/1039856214563851
10.1186/1752-4458-5-20
10.1176/ajp.145.1.19
10.1016/j.genhosppsych.2013.08.009
10.1136/bmjopen-2015-007575
10.1136/bmjopen-2014-006690
10.1111/resp.12226
10.1002/sim.4067
10.1002/sim.4067
10.2340/16501977-0845
10.1007/s00127-010-0183-5
10.1093/eurpub/ckl248
10.1186/1471-2296-14-198
10.1016/j.jpsychores.2014.11.002
10.1192/bjp.200.2.162
10.1016/j.jhin.2011.06.016
10.3109/09638237.2011.562261
10.1192/bjp.bp.110.090993
10.1176/ajp.143.2.131
10.1056/NEJM198611203152106
10.1016/j.jsat.2010.03.011
10.1186/1471-244X-12-121
10.1016/j.jad.2010.02.135
10.3109/10398562.2011.561845
10.1186/1471-244X-9-51
10.1007/s11136-011-0071-9
10.1186/1477-7525-3-76
10.1177/1039856214563851
10.1186/1752-4458-5-20
10.1176/ajp.145.1.19
10.1016/j.genhosppsych.2013.08.009
10.1136/bmjopen-2015-007575
10.1136/bmjopen-2014-006690
10.1111/resp.12226
10.1002/sim.4067
10.1002/sim.4067
10.2340/16501977-0845
10.1007/s00127-010-0183-5
10.1093/eurpub/ckl248
10.1186/1471-2296-14-198
10.1016/j.jpsychores.2014.11.002
10.1192/bjp.200.2.162
10.1016/j.jhin.2011.06.016
ISSN
1932-6203