Improvement Measures

A suite of Core Measures has been developed to support Partnerships to track their progress in Reshaping Care for Older People. These Core Measures will help Partnerships to understand their local systems and the steps required to improve processes, experience, efficiency, effectiveness and outcomes of care and support.

Measurement is an essential component of quality improvement. The Reshaping Care improvement measures have been designed to focus attention at key points along the health and social care pathway for older people. They should be fully integrated into local service improvement work and will contribute to the wider performance management and reporting.

Background to Measures

The development of the Core Measures has been informed by:

  • Thematic analysis of the wide range of measures which the 32 Partnerships proposed to use to track progress of their Change Plans;
  • Aligning these measures to the Reshaping Care pathway;
  • Feedback on the JIT/Scottish Community Care Benchmarking Network consultation paper from 24 partnerships and other individuals and organisations;
  • Discussions via two WebEx sessions with local partnerships and stakeholders;
  • Feedback from COSLA and from the NHS Chief executives group;
  • Stakeholder groups who volunteered to draft definitions for local measures; and
  • Discussion of draft definitions at the Joint Information Network on 22nd of August 2011.

Measures and Definitions

The agreed suite of Core Measures was distributed on 30th June 2011 to NHS Boards, Local Authorities, and operational and strategic leads for Reshaping Care. These Measures contribute to the Quality Measurement Framework, link to the Community Care Outcomes Framework and align with the National Performance Framework.

Using these measures should prompt local actions to test changes in order to improve experience and outcomes. Timely feedback of data from local improvement measures connects practitioners and teams with the changes they are making and helps them reflect on how to continually improve aspects of care and support. The information which is collected locally to monitor each improvement measure will build a picture of trends over time, allowing teams to incrementally determine the impact of the changes they have been testing and implementing.

The Core Measures fall into three categories:

  • Nationally available outcome measures and indicators which use data already collected at local level and compiled nationally;
  • A set of improvement measures to inform and support local change; and
  • Measures of shift in Partnership resource and in Change Fund use over time.

A: Nationally available outcome measures and indicators

A1. Emergency inpatient bed day rates for people aged 75+ (NHS HEAT 2011/12).

A2. a. Patients whose discharge from hospital is delayed; and
b. Accumulated bed-days for people delayed (NB further detailed guidance on b. will be issued soon, once the Delayed Discharge Expert Group has reported).

A3. Prevalence rates for diagnosis of Dementia (NHS QOF).

A4. Percentage of people aged 65+ who live in housing, rather than a care home or a hospital setting (ISD).

A5. Percentage of time in the last 6 months of life spent at home or in a community setting (further detailed guidance on this will be issued soon as part of the Quality Measurement Framework and the Re-shaping Care Network will be consulted on the measure’s methodology).

We also recommend that partnerships continue to develop their use of:

A6. Experience measures and support for carers from the Community Care Outcomes Framework (Community Care Benchmarking Network).

B: Local Improvement Measures

Anticipatory and preventative care

B1. Proportion of people aged 75 and over living at home who have an Anticipatory Care Plan shared with Out-of-Hours staff.

B2. Waiting times between request for a housing adaptation, assessment of need, and delivery of any required adaptation.

B3. Proportion of people aged 75+ with a telecare package.

Responsive / flexible home care and carers

B4. Measure of dependency: before and after re-ablement.

B5. Respite care for older people per 1000 population.

Demand for acute care

B6. Rates of 65+ conveyed to Accident & Emergency with principal diagnosis of a fall (Data from Scottish Ambulance Service).

Effective flow in acute care

B7. Proportion of frail emergency admissions who access specialty unit within 24 hours.

Use of long term residential care

B8. Use of long term care homes and continuing care.

C: Partnership resource use

C1. Per capita weighted cost of accumulated bed days lost to delayed discharge.

C2. Cost of emergency inpatient bed days for people over 75 per 1000 population over 75.

C3. A measure of the balance of care (e.g. split between spend on institutional and community-based care)

IRF data will support use of these C measures in particular.