Using outcome and quality data

Background

At the heart of the 2010 DH White Paper, Equity and Excellence: Liberating the NHS is the ambition to re‐focus the NHS to achieve world‐class healthcare outcomes. To this end, the White Paper proposed that the NHS will be held to account against “clinically credible and evidence‐based outcome measures”; inspection of services will be against essential quality standards; and payment systems will be developed to reflect outcomes and quality, not just activity, to provide incentives for better quality. The frameworks for assessing outcomes and quality in health and social care are outlined in the documents Transparency in outcomes: a framework for the NHS and Transparency in outcomes: a framework for quality in adult social care.

Designing and deploying outcomes indicators is one component of an outcomes‐focused strategy. Also needed is evidence about the extent to which activities – services, intervention, policies etc. – of the health and social care system contribute to improving outcomes for patients, service users and other stakeholders. Similarly, little is known about the relationship between the characteristics of providers, of their workforce and service quality, and outcomes for service users and patients. In other words, we need to determine what works and what does not in producing outcomes. As signalled by the greater role of the National Institute for Health and Clinical Excellence (NICE), these judgements will also need to reflect the cost of health and care activities. NICE will develop quality standards including, as a new development – and subject to the Health and Social Care Bill – those for social care. NICE defines quality standards as “a set of specific, concise statements that act as markers of high‐quality, cost‐effective patient care, covering the treatment and prevention of different diseases and conditions.” This information is also crucial for accountability, service development and for improving service commissioning by public authorities and service users themselves. It may also be useful for regulatory activities.

Other important components of an outcomes‐focused strategy are systems of incentives, performance and governance arrangements that will guide and motivate NHS and social care organisations to produce the desired improvements in outcomes. Organisations will need to know what is cost‐effective and they also need to be motivated to provide the cost‐effective mix of services, interventions and policies.

Aims

The main aim of this set of projects is to provide evidence about the impact and cost‐effectiveness of services, support and interventions. Its particular focus will be on how routinely‐collected outcomes information can be used to provide evidence about impact. Central to the theme of this project is the ideal of attribution of effect.

The projects will use data on outcomes from survey and administrative datasets, such as the PROMS datasets, satisfaction surveys, GP survey and the Adult Social Care survey. The intention is to develop methods and undertake analyses that will identify and estimate the impact of services and interventions on measured outcomes.

Given the relative paucity of cost‐effectiveness and impact evidence in (adult) social care, and also reflecting NICE’s new role in social care, the initial projects will focus on the impact of adult social care services and support, investigating using data to guide commissioning (Forder et al 2012), changes through time in the quality of home care services in England, and provider and workforce characteristics influences on user‐reported indicators of quality and outcomes.

We will be extending these analyses to health service outcomes data, including PROMs data and also results from the GP survey. We also intend assessing the implications of these analyses for implementation, incentive frameworks and performance measures for health and social care organisations.

Methods

The projects all draw on existing national datasets and data collections of patient and service users experiences, focusing in particular on those where information about outcomes, service use, case mix, need and service user characteristics has been collected. Statistical analysis is used to investigate the relationships between the variables

Timing and Outputs

We will produce a series of academic papers during the course of the programme so that the methods and results can be peer‐reviewed. We will also publish summary reports for social care stakeholders that outline the methods but concentrate on the results and the policy implications. This information is potentially invaluable to commissioners and other decision‐makers charged with allocating scarce social care resources. It will be useful to NICE in developing quality standards, and help inform the implementation of the forthcoming White Paper policies. It may also be useful for regulatory activities.

Research Team

Julien Forder, José‐Luis Fernández, Juliette Malley, Francesco D’Amico, Valentina Zigante