Objective: To investigate whether continuity of care in family practice reduces unplanned hospital use for people with serious mental illness (SMI). Data Sources Linked administrative data on family practice and hospital utilization by people with SMI in England, 2007-2014. Study Design: This observational cohort study used discrete-time survival analysis to investigate the relationship between continuity of care in family practice and unplanned hospital use: emergency department (ED) presentations, and unplanned admissions for SMI and ambulatory care-sensitive conditions (ACSC). The analysis distinguishes between relational continuity and management/ informational continuity (as captured by care plans) and accounts for unobserved confounding by examining deviation from long-term averages. Data Collection/Extraction Methods: Individual-level family practice administrative data linked to hospital administrative data. Principal Findings: Higher relational continuity was associated with 8-11 percent lower risk of ED presentation and 23-27 percent lower risk of ACSC admissions. Care plans were associated with 29 percent lower risk of ED presentation, 39 percent lower risk of SMI admissions, and 32 percent lower risk of ACSC admissions. Conclusions: Family practice continuity of care can reduce unplanned hospital use for physical and mental health of people with SMI.

Background: The average life expectancy for people with a severe mental illness (SMI) such as schizophrenia or bipolar
disorder is 15-20 years less than for the population as a whole. Diabetes contributes significantly to this inequality, being 2-3
times more prevalent in people with SMI. Various risk factors have been implicated, including side effects of antipsychotic
medication and unhealthy lifestyles, which often occur in the context of socio-economic disadvantage and healthcare inequality.
However, little is known about how these factors interact to influence the risk of developing diabetes and poor diabetic
outcomes, or how the organisation and provision of healthcare may contribute.
Objective: The study aims to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with
SMI.
Methods: This study will employ a concurrent mixed methods design combining the interrogation of electronic primary care
health records from the Clinical Practice Research Datalink (CPRD GOLD) with qualitative interviews with adults with SMI and
diabetes, their relatives/friends, and healthcare staff. The study has been funded for two years, from September 2017 to
September 2019 and data collection has recently ended.
Results: CPRD and linked health data will be used to explore the association of socio-demographic, illness and healthcarerelated factors with both the development and outcomes of Type 2 diabetes in people with SMI. Experiences of managing the
comorbidity and accessing healthcare will be explored through qualitative interviews using topic guides informed by evidence
synthesis and expert consultation. Findings from both datasets will be merged to develop a more comprehensive understanding of diabetes risks, interventions and outcomes for people with SMI. Findings will be translated into recommendations for
interventions and services using co-design workshops.
Conclusions: Improving diabetes outcomes for people with SMI is a high priority area nationally and globally. Understanding
how risk factors combine to generate high prevalence of diabetes and poor diabetic outcomes for this population is a necessary
first step in developing healthcare interventions to improve outcomes for people with diabetes and SMI.