Quality measurement and productivity and efficiency analysis - Projects
1. Measuring variations in costs following hip fracture
Measuring the productivity of interventions that cut across traditional health and social care boundaries remains challenging. This project promises to provide greater insight into the drivers of productivity by focussing on the patient care pathway for specific conditions. Thus far, we have concentrated on evaluating the management of care for patients who suffer hip fracture. This condition was chosen for analysis because (i) there is robust data, (ii) a significant interplay between H&SC sectors, (iii) it accounts for around £2 billion in H&SC costs which is around 2% of the total NHS healthcare budget, and (iv) it affects a frail elderly population which is set to increase as demographics change.
Our objective is to analyse the variation in costs and length of stay for hospitals across the patient care pathway for hip fracture, from emergency admission, to hospital stay and follow-up outpatient appointments. We map costs to each step and explain variation in costs due to: i) socio-demographic characteristics and clinical conditions of the patient, and ii) characteristics of the providers of care. By looking in detail at the complete care pathway, we are able to identify which factors are most associated with best practice, and inform policy about what configurations are more likely to yield efficiency gains.
Lead: Andrew Street
2. Social care productivity
There are apparent differences in how productivity is defined and measured in the health and social care sectors. Moreover the construction of accurate and comprehensive productivity measures requires accurate and comprehensive data. Our work to date has provided the conceptual framework and foundation for further empirical work on productivity to be undertaken.
The value of information about productivity lies in motivating improvements in productivity by commissioners, providers, and regulators. National trends can tell us about how productivity changes year-on-year but productivity information is particularly useful where it is disaggregated into service type, service-user group and locality. To be valuable, productivity assessment needs to reflect strategic goals for social care and also account for all relevant factors.
Currently ONS statistics appear to indicate that the national productivity trend in adult social care (ASC) is downwards. The national trend is calculated as the change in the total (cost-weighted) volume of ASC service divided by the change in the volume of inputs (deflated expenditure). Volume measures (e.g. resident-weeks or hours of home care) do not fully reflect the value of ‘outputs’ of ASC. They do not account for changes in the nature of the population served or the outcomes achieved for that population.
The aim of this project is to:
- Incorporate both outcome and case-mix/severity-of-need adjustments in productivity measurement
- Estimate productivity rates over time and by service type, group and locality
The project will use these estimates to compare trends and comment on potential improvements in SC productivity.
Lead: Julien Forder
3. Higher quality primary care for people with dementia: the effects on hospital admissions
In 2000, the Audit Commission published evidence of poor assessments and treatment for dementia, with little joint health and social care planning and working (Audit Commission 2000). Only half of GPs believed it important to look actively for signs of dementia and to make an early diagnosis. A range of policy measures were introduced in response, and since 2006/7 GP practices have been paid to identify and review patients with dementia as part of the Quality and Outcomes Framework (QOF). The reviews are a type of health check, and are designed to address the support needs of carer and patient.
Compared with their peers, people with dementia are at a higher risk of depression, and are less likely to report physical conditions. Therefore, the QOF health check for people with dementia should increase the level of care received in primary care settings, and increase outpatient and planned inpatient care. Insofar as it has a preventative effect, the health check may also reduce the rate of unplanned hospital admissions. If carer burden is appropriately managed, the probability that people with dementia enter a care home may also change, but the direction of change is difficult to predict. Practice performance on this QOF indicator is sufficiently variable to allow these hypothesised effects to be tested empirically (see Figure).
To test whether the quality of care provided by the GP practice is associated with:
Q1: Higher levels of planned hospital admissions
Q2: Lower levels of unplanned hospital admissions
Q3: Shorter stays for patients who are hospitalised
Q4: Probability of discharge to a care home
We will test whether the quality of care provided by GP practices influences the level of hospital admissions, and whether it has an impact on length of stay and discharge destination for those who are admitted. The work will add to knowledge of the link between primary and secondary care and between health and social care. It will help to highlight where resources should be invested in order to address the growing demand for care by those suffering from dementia and it can also help inform future developments of the QOF.
Lead: Anne Mason