Abstract
Aims and method To provide information regarding the extent to which the process of clustering using the mental health clustering tool captures the complexity of patient need across different geographical areas. Investigation was undertaken via a ‘deep dive’ into patient notes, with data collected on patients allocated to cluster 5, 8 or 13 in three different London boroughs.Results There is evidence for within-cluster differences between patients in different London boroughs in terms of various complexity factors. Further findings in relation to accuracy of clustering suggest some area-specific patterns in terms of clustering practice, raising the possibility that clinicians have different scoring thresholds in different areas.Clinical implications Complexity factors can affect resource use and therefore cost of service provision. In the case of a national tariff, providers of care to more complex patients may be placed at greater financial risk. It is therefore likely that some form of tariff adjustments will need to be introduced so as not to disadvantage patients and clinicians practising in areas of greater complexity.
Highlights
In London, concerns about the potential role of complexity factors have been expressed at forums supporting the implementation of payment by results (PbR) locally
Notes were selected for investigation from three different clusters within three different London boroughs
Two factors did not show any difference between the different areas: primary diagnosis within cluster and involvement with safeguarding procedures, either safeguarding adult or child protection. This project was undertaken as part of a leadership fellowship post working with London Health Programmes and Central and North West London NHS Foundation Trust
Summary
A total of 546 patient notes were initially reviewed. Of these, nearly 50% were found to have been allocated an inappropriate cluster, only 283 were included in the ‘deep dive’ analysis. Substance misuse It can be seen that for the non-psychotic group, both boroughs A and B patients scored significantly higher on item 3 than borough C patients. There were no significant differences seen between the areas on item 3 scores for the psychotic group, which may reflect the fact that there is a specific cluster available for patients with comorbid substance misuse in this supercluster (cluster 16). Activity and occupation For activities of daily living (item 10), borough B patients with psychosis had greater difficulty in this area than patients in the other two boroughs, with no differences being seen for the non-psychotic group. Other factors Information was collected on psychiatric comorbidity recording in the notes and statistically significant differences were seen between the areas for the psychotic group patients (borough C having greater comorbidity recorded), but not for the non-psychotic group patients. Two factors did not show any difference between the different areas: primary diagnosis within cluster and involvement with safeguarding procedures, either safeguarding adult or child protection
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