Under the Health and Social Care Act, the NHS Commissioning Board and Clinical Commissioning Groups (CCGs) will be accountable for improving health and treatment outcomes in the NHS.
We've produced two slide sets to help CCGs make the best use of measurement to support them to commission for improved outcomes (the pdf versions on the right include explanatory notes - to access, click on the comments icon on the top left of each page).
Pick'n'Mix: an introduction to choosing and using indicators
Our first slide set introduces general concepts about approaches to measurement in health care, the uses of structure, process and outcome indicators, and how to achieve a good mix of indicators for commissioning.
Measuring quality along care pathways
Our second slide set looks specifically at how commissioners can build up sets of measures along whole pathways of care.
As a resident in one of 3 blocks of flats for older people in Ludlow I am extemely concerned about the impact of this (and other) groups of extreme elders and the disabled who will be unable to use public transport because of mobility problems, and who will have to resort to taxis or home visits.
What sorts of outcome measures will the King's Fund or other agencies be developing to keep track of the impact of this policy on older and disabled people's access to GPs?
Thanks you for this, very useful review.
On a specific note slide 32 implies that screening has a role in reducing incidence. I am not sure how this might be. It certainly helps identify cancers at an earlier stage (and hence improving survival) but not sure how it would provent them arising in th first place (unless you count the identificaiton of pre-cancerous conditions)
Whenever services are reconfigured or reorganised, it is important to ensure that no communities and user groups are unduly disadvantaged in terms of access to services - especially in the case of GP services, as they are the first port of call for most people. The King’s Fund’s role does not extend to developing outcome indicators, but we do recommend that commissioners should use appropriate tools to measure access to local services for all groups, particularly those with special needs, and take remedial action where access is compromised.
We agree that outcome measures are useful and have an important role to play. In these slide sets our aim was to suggest ways of using measurement to answer not just the “what” but also the “how” ie to inform how outcomes can be improved, including for example for people with long-term conditions. The slide sets are aimed especially at commissioners, who will need to use measurement in various ways beyond just measuring outcomes. The principles, first established by Donabedian, are in fact quite simple, and we are arguing for a return to them.
Re slide 32 (pdf version): Cancer screening does not impact on incidence. It was included among the population-based indicators, to differentiate it from the provider-based indicators, but we have amended this.
(1) Given that the subject is care pathways, it would have been nice to show how the various measures relate to a pathway visually. Care pathways generally follow the presentation - testing - diagnosis - treatment - discharge pattern so which measures are relevant at which stage? Without this simple visual it all gets rather complicated as Tim Benson commented earlier.
(2) Most people have trouble not with what to measure but how to do it effectively. At the risk of being accused of blowing my own trumpet, I would invite readers to view this short video which attempts to address that particular challenge - institute.nhs.uk/productive_general_practice/general/knowing_how_we_are_doing.html