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Does a cluster always equal a cluster? Geographical variation of cluster populations

  • Josephine Morgan (a1)
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.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Josephine Morgan (josephine.morgan@nhs.net)
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Department of Health. Mental Health Payment by Results Guidance for 2013–14. Department of Health, 2013.
2 Monitor, NHS England. Consultation on the 2014/154 National Tariff Payment System. Monitor, 2013.
3 Self, R, Painter, J. Study: To Improve and Demonstrate the Structural Properties of the Care Clusters that Form the Basis of the PbR Currently Development Programme (Care Pathways and Packages Project). Care Pathways and Packages Project, 2009.
4 Department of Health. A Simple Guide to Payment by Results. Department of Health, 2012.
5 London Health Programmes. Mental Health PbR and Outcomes Project e-Bulletin. London Health Programmes, 2012 (http://www.londonhp.nhs.uk/wp-content/uploads/2012/03/Mental-Health-PbR-and-Outcomes-Project-ebulletin-February-2012.pdf).
6 Department of Health. Mental Health Clustering Booklet Version 2.0, 2011/12. Department of Health, 2012 (http://www.cppconsortium.nhs.uk/admin/files/1299679285Highlighted%20Mental%20Health%20Clustering%20Tool%202%200.pdf).
7 Public Health England. Analytical Tools for Public Health Commonly used Public Health Statistics and Their Confidence Intervals. Association of Public Health Observatories, 2008 (http://www.apho.org.uk/resource/item.aspx?RID=48617).
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BJPsych Bulletin
  • ISSN: 2053-4868
  • EISSN: 2053-4876
  • URL: /core/journals/bjpsych-bulletin
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Does a cluster always equal a cluster? Geographical variation of cluster populations

  • Josephine Morgan (a1)
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