elizabeth fisher: tracking the quality of care

© Nuffield Trust and Health Foundation © Nuffield Trust

23 October 2013

Indicators to track changes in the quality of care Elizabeth Fisher

© Nuffield Trust and Health Foundation

Developing a set of indicators

Exploit & structure • Review existing indicators from a variety of organisations • By 6 quality domains (access, capacity, effectiveness, equity, person-

centred care & experience, safety) • By 5 care sectors (social care, primary & community, secondary, mental

health, population & commissioning)

Select • Does it describe the quality of care? • Is it able to distinguish good from bad? • Is the indicator capable of showing change over time? • Does it cover enough people/services/organisations to have sufficient

impact? • Is it reliably measured? • Is it important in national policy terms? • Avoiding duplication of indicators which measure the same underlying

aspect of quality



Initial outputs • 19 sources of potential indicators reviewed • Covered >1,800 indicators • ~1,300 initially selected = >1,500 mappings

Domain Socia

l care

Prim

ary

&

com

munity

Care

secondary

care

menta

l health

Popula

tion&

com

mis

sio

nin

g

Tota

l

Access 13 46 75 41 9 184

Capacity 30 35 47 24 1 137

Effectiveness 13 147 274 26 82 542

Equity 0 7 10 10 1 28

Person-centered care & experience 18 27 159 77 5 286

Safety 11 66 160 82 7 326

Total 85 328 725 260 105 1503



Overall findings from the process • A large number of indicators were deemed unsuitable

• Uneven distribution − some areas were very well covered (differ only slightly or difficult to

determine differences) − some areas poorly covered (difficult keeping to criteria) − areas covered by the one/few data source/s

• No clear consensus

• Lack of historical data or stability of indicators over time

• More appropriate indicators that may not have been in other lists

• Some indicators better grouped together to tell the story

• Different views (analysis) of the same thing can produce different findings

• Lack of sensitivity in some measures



What next and where can you help

• We intend to add to and refine the indicator set as the QualityWatch programme develops.

• Further refinement will include seeking feedback on:

− our choices of indicators

− the analysis applied

− How the analysis is displayed/viewed

• How we will gather feedback?

− users of the website – ‘Have your say’

− testing whether formal consensus development methods (such as Delphi or nominal group technique) can be used to select the most valuable indicators based on the views of professional groups or representatives of the general public.


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23 October 2013

www.qualitywatch.org.uk

elizabeth fisher: tracking the quality of care

Health & Medicine