Practice variations in French public psychiatry and associated factors – PRAVA-PSY

A set of variables was used to describe practice both at the individual level (hospital stay) and aggregated by hospital or PPOU (length of stay, time until readmission, etc.). Potentially associated factors were identified through a systematic literature review.
A descriptive analysis was first carried out to describe practice variations and assess their magnitude across French public psychiatric hospitals and organizational units (PPOUs) using data from the Summary of medical information for psychiatry (RIM-P) for the year 2012. Factors associated with practice variations will now be investigated using multivariate modeling.
Finally, on the basis of our results, conclusions will be drawn through a workshop bringing together decision makers, mental health care professionals and patient representatives to issue recommendations to address unwarranted practice variations and thus improve equity and efficiency in the system.

Variations were observed for all practice variables described at the individual level, which presented high standard deviations and ranges. When practice variables were described at the aggregated level (hospital or PPOU), coefficients of variation were considerable. The study of the ratios of the 90th and 10th percentiles of the distribution of each practice variable and graphical approaches showed that those variations were not the result of a limited number of outlier values. Practice variations among PPOUs appeared to be higher than among hospitals.
In the bivariate analysis, practice variables were not only associated with patient characteristics but also with hospital and PPOU characteristics and with a large number of environment characteristics.

This project will lead to a better understanding of the factors associated with practice variations in French public psychiatric care and to recommendations on how to reduce unwarranted variations. These findings will have implications for policy-makers as they will provide evidence to improve the organization of public psychiatric care in France. Finally, further work will be developed based on the results of the project.

• Publications
C. Gandré, M. Michel, K. Chevreul. Factors associated with practice variations in psychiatry: a systematic review (Upcoming submission).
• Oral communications
C. Gandré, J. Thillard, JM. Macé, K. Chevreul. Practice variations in French public psychiatry. Twelfth workshop on costs and assessment in psychiatry. Mental health policy and economics research : improving access, quality and outcomes, Venice, Italy, 29th March 2015.
C. Gandré, J. Thillard, JM. Macé, K. Chevreul. Practice variations in French public psychiatry. The 15th Congress of the International Federation for Psychiatric Epidemiology. Bergen, Norway, 10th October 2015.

Practice variations in French public psychiatry and associated factors (PRAVA-PSY)

Background

As in other countries, mental disorders in France represent a significant epidemiologic and economic burden that is expected to increase dramatically. Practice variations across public psychiatric services are a source of inequity and inefficiency and thus challenge the quality of care. While the need for evidence-based policy has been emphasized, research on practice variations in French public psychiatry, which represents two-thirds of mental health care delivered to patients in terms of expenditure, does not exist.

Objectives

The objectives of our study are threefold:
1/ To produce evidence on practice variations in French adult public psychiatry;
2/ To have a better understanding of the factors associated with mental health care practice variations;
a. To identify characteristics of the providers of public psychiatric care that are associated with practice variations
b. To identify patient characteristics that are associated with practice variations
c. To identify the characteristics of the environments of the providers that are associated with practice variations;
3/ To develop recommendations on how to develop and implement policies to reduce unwarranted practice variations and to direct future research.

Methods

First, we will use descriptive analysis to describe practice variations and assess their ranges across French adult public psychiatric organizational units (PPOUs) using data from the Summary of medical information for psychiatry (RIM-Psy). A set of variables will be used to describe practice (e.g. average length of stay, annual re-hospitalization rate, etc.).
Second, we will investigate factors associated with practice variations for mental disorders by using multivariate modeling. Three steps will be successively undertaken:
1) Hypotheses on predictors of practice variations, including characteristics of providers (PPOUs), their patients and their environments, will be developed to construct an explanatory model for each variable describing practice.
2) Database on predictors will be prepared.
3) Models will be run.
Third, on the basis of the results, conclusions will be drawn with experts through a workshop bringing together decision makers, mental health care professionals and patient representatives to issue recommendations to address unwarranted practice variations and thus improve equity and efficiency in the system.
Skills in health research services, statistical analysis, workfield psychiatry and health geography are needed for the completion of this project, and a multidisciplinary team has therefore been built.

Prospects

This project will enable a better understanding of the factors associated with practice variations in French public psychiatric care. These findings will be published in peer-reviewed journals and will have implications for policy-makers as they will provide evidence to improve the organization of public psychiatric care in France. Recommendations will be issued and further work will be developed based on the results of the project.