Dalton-Locke, Christian;
(2022)
Using the Clinical Records Interactive Search (CRIS) to investigate the effectiveness of mental health rehabilitation services.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Background: The Clinical Records Interactive Search (CRIS) de-identifies electronic health records. The aim of this PhD was to investigate the effectiveness of mental health rehabilitation services using the Camden and Islington NHS Foundation Trust (CIFT) CRIS database. / Methods: The feasibility of using CIFT CRIS to identify a sample of individuals who had used mental health supported accommodation services was explored. A systematic review of the effectiveness of mental health rehabilitation services was undertaken. A further study using CIFT CRIS to compare inpatient service use before and after an admission to an inpatient mental health rehabilitation unit was conducted, and the feasibility of using propensity score matching to identify a comparison group was investigated. / Results: A total of 2,477 individuals were identified as a current or previous resident at a local supported accommodation service, but around a third were estimated to be false positives as the use of this type of service was not recorded systematically. The review identified 33 studies, of which, four reported reductions in inpatient service use after an admission to an inpatient rehabilitation unit. However, there were substantial limitations to these studies. The CRIS study investigating inpatient rehabilitation, identified a sample of 172 patients with a mean exposure period of 4.4 years (SD 2.2) before, and 5.2 years (SD 2.4) after, their rehabilitation admission. With adjustment for potential confounders, inpatient service use reduced by half after the rehabilitation admission compared to before (IRR 0.520, 95% CI 0.367 to 0.737). Propensity score matching methods proved unfeasible in identifying a valid comparison group. / Conclusions: CRIS can be used to investigate the effectiveness of inpatient mental health rehabilitation. Inpatient rehabilitation is associated with a reduction in subsequent inpatient service use, but the existing research lacks valid comparison groups and therefore the degree to which causality can be inferred is limited.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Using the Clinical Records Interactive Search (CRIS) to investigate the effectiveness of mental health rehabilitation services |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2023. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry > Epidemiology and Applied Clinical Research |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10162689 |
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