National Evaluation of POPP: The Evidence Base

Report authors and core team: Karen Windle, Richard Wagland, Julien Forder, Francesco D’Amico, Dirk Janssen, Gerald WistowWider national evaluation team: Roger Beech, Ann Bowling, Angela Dickinson, Kate Ellis, Catherine Henderson, Emily Knapp, Martin Knapp, Kathryn Lord, Brenda Roe

POPP Programme

£60 million ring-fenced funding for council-based partnerships to lead locally innovative pilot projects for older people.

Overall aim was to improve the health, well-being and independence of older people through: Provide person centred and integrated responses for

older people Encourage investment in approaches that promote

health, well-being and independence for older people and

Prevent or delay the need for high intensity or institutionalised care.

19 pilot sites funded May 2006 – 2008 10 further pilot sites May 2007 – 2009

The National EvaluationResearch QuestionsProcess Did the POPP programme

change partnership working and practice across the sites?

What was the level of older people’s involvement across the programme?

Outcome Did the interventions

improve users quality of life? Did the POPP programme

reduce use of high intensity-services?

Measurement Interviews and focus groups

(operational staff, users and users outside of the POPP programme)

Structured questionnaire to key informants

Standardised user questionnaire completed at two time points (before and after intervention); EQ-5D, service change, demographic data

‘Difference in Difference’ Analysis (Emergency Bed Days)

Financial/ Activity data

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POPP InterventionsGardening/

handyperson/befriending/

learning/leisure

Holistic assessments/ Hospital aftercare/Falls

Prevention/ Peer Monitoring and

support/Falls follow-ups

Rapid Response Teams/ Hospital at Home/ Intensive

support teams/ Case Management/

Proactive Case Finding

146 core projects, 530 upstream projects

Users within the interventions Total of 264,637 users either contacted or were referred

to the POPP interventions 77% of the population aged 70 and over, with a third

(32%) aged 85 and over One-third was married (33%), the remainder widowed,

divorced, separated or single. 81% lived in their own homes, but almost a fifth lived in

sheltered housing, residential and nursing care Fewer men were using services that address lower-level

needs (1:3) than those focused toward secondary or tertiary support (1:1)

The age at which respondents use services differs with levels of deprivation

Weekly income (where reported) was £100 less per week than the median income for general population (Age Concern 2008)19/04/23 5

Outcomes & Impact: Measuring changes in health-related quality of life

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Standardised user questionnaire -before the POPP intervention and up to six months after the project (62 projects; n=1,529)

EQ-5D, Health-related quality of life Measured on mobility, self-care, usual activities,

pain/discomfort, Anxiety/Depression Used quasi-comparison group (British Household

Panel Survey) to benchmark the outcomes

Age range of participant Overall population POPP sampleAged 55 - 64 0.80 0.54Aged 65 - 74 0.78 0.58Aged 75+ 0.73 0.54

Outcomes & Impact:Health Related QoL: POPP & Quasi-Comparison group

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Outcomes & Impact: HRQoL: Categories of Projects

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Outcomes and Impact: Overall Emergency Bed-Days

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Effect of… Management Overhead

Effect size

Effect on… Lower CI

Upper CI

+£1 spend on POPP project per month in POPP PCT (at POPP time)

30% -£1.00 Cost per month per PCT of bed-days

-£1.30 -£0.7020% -£1.10 -£1.50 -£0.8010% -£1.20 -£1.60 -£0.800% -£1.30 -£1.70 -£0.90

Outcomes & Impact: EBDs;Secondary/Tertiary and Primary Prevention

Secondary and Tertiary prevention PCTs: headline saving of -£1.40 on EBDs for £1 extra POPP spend, with a range of -£1.00 to -£1.90.

Primary prevention PCTs: headline saving of -£0.70 for £1 extra POPP spend, with a range of £0.10 to -£1.40

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Outcomes and impact: Overall programme cost-effectiveness

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Outcomes and Impact:Overall change in service use & costs

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Service use Pre-intervention (t1) mean cost

Post-intervention (t2) mean cost

Mean cost change per person

Physiotherapy £14.23 £9.67 £4.56A & E £80.59 £79.43 £1.16Hospital overnight

£188.46 £115.87 £72.59

Outpatient £182.48 £137.71 £44.77Totals £465.76 £342.68 -£328.05

Outcomes and Impact:Categories; change in service use & costs

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Project Category Total Saving per personWell-Being – Emotional/ Social Isolation -£30.16Well-Being – Physical Health -£126.33Specialist Falls -£25.45Proactive Case Coordination -£243.41Hospital Discharge -1741.29

Total -£2166.35

HRQoL and/ or efficiencies?

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Project Category % Increase in HRQoL

(standardised)

Efficiency Savings from individual use (per

person)Well-Being Practical 13% £0

Well-Being Emotional Social -3% -£30.16

Well-Being - Physical Health 12% -£126.33

Well-Being -Community 4% £0

Information, Signposting and Access 0.20% £0

Specialist Falls 4% -£25.45

Proactive Case Coordination 4% -£243.41

Long-Term Conditions - Hospital Discharge

-2% -1741.29

HE = 0.70p per

extra £

HE = £1.40 per

extra £

Summary

Good data enables analysis of effectivenessGood data respects the participants voiceGood data enables analysis of qualityGood data ensures the work that the

enormously hard work and effort that you have carried out is not compromised

Good data ensures we can build on the evidence base, changing policy and practice

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