Title: An Evaluation of the Effectiveness of Annual Health Checks and Quality of Health Care for Adults With Learning Disability
Funder: Department of Health (England)

Abstract: Background People with learning disability are a vulnerable group who experience high levels of physical morbidity and mortality. There is evidence that people with learning disability receive sub-optimal care and this inequity contributes to poor health outcomes including avoidable mortality. In 2008 an Independent Inquiry into Access to Health Care for People with Learning Disability concluded that people with learning disability receive less effective care leading to avoidable suffering and death. In addition the report highlighted the paucity of information on NHS health care for people with learning disability. A key focus of National policy is improving the quality of primary care. In 2007 the Disability Rights Commission recommended the introduction of annual health checks which was supported by the Independent Inquiry. In 2009 a national Directed Enhanced Service (DES) was introduced in England. This DES funds practices to provide annual health checks to adults with learning disability and requires that staff receive training. The health check is intended to identify undetected health problems improve prescribing and coordination with secondary care. A systematic review by the Learning Disability Observatory confirms that health checks are effective in identifying health problems but found a paucity of evidence on their impact on health outcomes. This study is a large sample evaluation of the effectiveness of annual health checks and a comprehensive study of health and healthcare in a national sample of adults with learning disability Aims 1. To evaluate the process and outcome effectiveness of Annual Health Checks for adults with learning disability in primary care.2. To describe the health healthcare quality and equity and NHS costs for adults with learning disability in a National sample Objectives Aim 1 •Determine whether individuals receiving Annual Health Checks experience improvement in healthcare process measures and health problem identification. •Determine whether individuals receiving Annual Health Checks experience improvement in health outcomes •Determine whether practice participation in the Annual Health Check directed enhanced service improves outcomes for people with learning disability• Determine the change in health service costs in the year before and after an Annual Health CheckAim 2 •Quantify primary and secondary care utilisation•Describe and quantify specific health risks for adults with learning disability •Describe the quality of primary care received by adults with learning disability •Determine annual health service costs for people with learning disability compared to the general populationMethods Data Source An established anonymised primary care database which includes full individual records of primary care consultation diagnoses and prescribing with linked hospital admission data.Sample 12000 adults (18 and over) with learning disability registered with general practices in England between April 2007 and March 2013 and agesex and practice matched controls without learning disability. Design Evaluation of Annual Health Checks will be undertaken at individual and practice level. The individual level analysis will evaluate the effectiveness of health checks as a personal intervention. We will undertake a self-controlled before and after analysis with practice matched general population controls. This will compare the difference in outcomes between the two years before first annual health check and the two years following with the matched controls. Our practice level analysis will compare changes in outcomes for all people with learning disability in practices which offer health checks with changes in outcomes in non-participating practices since introduction of the directed enhanced service. This analysis will complement the individual patient analysis and identify the population benefit of health checks while also controlling for any temporal improvements in health outcomes for people with learning disability. The description of health healthcare quality and equity will identify prevalence and annual rates for key health outcomes in all adults with learning disability and quality of primary care in comparison to a practice matched general population controls. We will also estimate the annual NHS costs for people with learning disability compared to people without learning disability. Outcomes For evaluation of Annual Health Checks the main outcome will be emergency hospital admissions. This outcome has been selected as it is hypothesised that improvements in care across a range of health conditions as a result of Annual Health Checks will lead to a reduction in this outcome for people with learning disability. Secondary outcomes will include generic and disease specific process and outcome measures of quality of care and total NHS costs. Our description of health will include additional outcomes including disease incidence and prevalence. Benefit for NHS There are barriers to implementation of this Annual Health Checks in primary care including concern over their effectiveness and resources required. Less than 50% of eligible adults received a Health Check by March 2011. Our study will strengthen the evidence base for this intervention. Evidence of clear benefit from health checks would encourage further implementation while limited evidence of benefit would stimulate modifications to achieve greater benefit for people with learning disability including improvements in the NHS response to health problems identified during Annual Health Checks. This study will also address the paucity of information on the health and quality of NHS care for adults with learning disability to enable the NHS to target interventions to maximise health gain.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH