Quality measurement and productivity and efficiency analysis - Projects


1. Quality of care, staff job satisfaction and workforce stability


Project lead: Julien Forder, Raphael Wittenberg


Context and problem statement


Social care is a highly labour-intensive industry but little is known about the relationship between workforce characteristics and quality of care. There are a range of policies that could potentially affect the functioning of the social care labour market and in turn quality (and cost) of care. Minimum wage, qualification and training, regulations regarding workload are examples of relevant policies.

 
Project aims


The overall aim of this study is to investigate the effects of labour market dynamics in social care in terms of the impact on the quality and sustainability of care services. In particular, we propose to assess:

  1. whether there are direct links between social care labour market characteristics (including wage rates/conditions of care staff, turnover rates etc.) and (a) quality of care (of both care homes and home care), and (b) care home closures;
  2. the effect of increases in the National Minimum Wage (in particular on the share of staff employed on zero-hour contracts);
  3. the use of zero hours contracts and other employment conditions and how this affects staff turnover in the care sector (with implications for quality); and
  4. the determinants of job satisfaction in a comparative analysis of three sectors characterised by low pay levels and/or high stress levels: social care, retail trade and primary/secondary school education.

2. Evaluating the intended and unintended consequences of best practice tariffs on patient health outcomes and provider behaviour


Project lead: Nils Gutacker


Context and problem statement


Policy makers increasingly rely on pay-for-performance (P4P) schemes to incentivise healthcare providers to improve quality and contain costs. This research will contribute to the evidence base on the effectiveness and cost-effectiveness of P4P schemes, and thus inform the design of future P4P schemes in the English NHS.


Project aims


The objective of this research is to assess the intended and unintended effects of BPTs on patient outcomes and provider behaviour and contrast those to the additional costs of the schemes. It will analyse a large set of BPTs introduced since 2009 that are implemented nationally and rely on administrative data. This broad view will help us shed light on

  1. whether BPTs are effective in what they are set out to do (i.e. improve processes or outcomes) and whether there are spill-overs to non-incentivised outcomes,
  2. whether their effectiveness differs by provider characteristics and past performance,
  3. whether changes in BPT design, e.g. increases in bonus payments, had measurable effects,
  4. whether the BPTs are a cost-effective use of resources,
  5. and whether there are particular design elements that are associated with cost-effectiveness, e.g. the choice between specifying improved processes or outcomes

3. Incentive schemes to increase the number of people diagnosed with dementia: an evaluation of the effects, costs and unintended consequences


Project lead: Anne Mason


Context and problem statement


The need for effective community care that supports patients and carers to live independently is a high policy concern. Dementia is devastating long-term condition, managed predominantly in the community and requiring integrated health and social care. GPs are uniquely placed to co-ordinate care for people with dementia and their carers. The Quality and Outcomes Framework (QOF) dementia review is an annual health check for patients and their carers, in which GPs identify and help to address their needs for support. The project will identify the costs and consequences of these schemes and, thereby, help inform the design of policies aimed at boosting the diagnostic rate, as results will be generalizable to other financial schemes.


Project aims


The project aims to assess the individual and collective impacts of financial incentive schemes designed to increase the number of people diagnosed with dementia. 


We will assess the effects on prevalence and on the number of people subsequently treated under the dementia QOF. We will also estimate the cost of the schemes and seek to identify unintended consequences, such as poorer access to services or misdiagnosis.

 

4. Higher quality primary care for dementia: the effects on risk of care home placement


Project lead: Anne Mason


Context and problem statement


Care home placement is a defining event in the lives of dementia patients and their carers, and placement following an acute hospital admission is an indication that the care process has failed. Investigation of how such placements may be avoided has important implications for patients, commissioners and policymakers.


The research will provide a clearer picture of the quality of care provided by GPs for their dementia patients (and carers). Information on the aspects of care associated with a lower risk of care home placement, and the most effective ways to support carers of people with dementia, could be used to refine the QOF or other incentive schemes.


Project aims


Our objectives are to address the following research questions

  1. What care do people with dementia and their carers receive during the QOF dementia review and how is this care integrated across settings?
  2. How does the care provided by GPs align with expectations articulated in the QOF?
  3. Which components of integrated care are effective in reducing the risk of care home placement following acute hospital admission?

5. Variations in costs and outcomes under the National Tariff Payment System for mental health services in England 


Project lead: Rowena Jacobs


Context and problem statement


A new prospective method of funding mental health services, the National Tariff Payment System (formerly known as Payment by Results (PbR)), is being rolled out in England. This research will analyse the impact of the National Tariff Payment System on mental health providers in terms of variations in a) costs and b) outcomes.


Project aims


In order for a payment system such as the National Tariff to work effectively, it needs to group patients into a manageable number of clusters which are intended to be both (a) clinically meaningful and (b) economically homogenous within each grouping, i.e. patients utilise approximately the same amount of resources (costs). Validating the clusters with regard to their homogeneity is important both with a view to the costs as well as to the combination of idiosyncratic needs.


We will examine:

  1. Are the average costs per cluster a reasonable estimate for the patients assigned to them?
  2. What are the distributions of cluster costs for providers over time?
  3. Are patients within one cluster similar enough to be described by their cluster label and treated in the same care pathway?
  4. What is the variation in outcomes for providers across clusters?