Tools and resources to understand and measure impact

National frameworks

There are three outcomes frameworks, one each for public health, adult social care and the NHS. They set out high-level areas for improvement, alongside supporting measures, to help track progress without overshadowing local priorities. They are intended to provide a focus for improvement and action across the system and will be a helpful reference for you in shaping your local outcomes framework.

• NHS National Outcomes Framework
• Public Health Outcomes Framework
• Adult Social Care Outcomes Framework (ASCOF)

Cross-government resources

• The HM Treasury Green Book: Central Government Guidance on Appraisal and Evaluation - This provides a substantial overview of approaches to appraisal and evaluation.
• The HM Treasury Magenta: Guidance for Evaluation The recommended central government guidance on evaluation that sets out best practice for departments to follow.
• Rapid Evidence Assessment Toolkit (Government Social Research Unit) - Information about REA and other secondary research methodologies.

International examples

In many countries, the introduction of policy reforms to support approaches to integrated health and social care delivery have also seen attention placed on how to develop a set of quality measures through which to monitor system performance.

• How will outcomes be tracked and measured? - In the USA, the Magellan dashboard for Serious and Enduring Mental Illness measures key performance indicators, such as the number of nonelective admissions, performance of primary care and performance of prevention measures. It is publicly accessible, providing information to patients, families, staff and providers on areas that are working well and those that need improvement. Each dashboard includes indicators grouped into balanced scorecard categories.
• Value-based purchasing analytics - In the USA, in wake of the Affordable Care Act, the Arkansas state adopted the Medicaid programme to improve quality of care and reduce costs. To aid the state’s efforts, General Dynamics Health Solutions crafted an advanced analytics solution, ‘Quality Care Insight’, to collect clinical and quality data, and share the results and related best practices with providers.
• Development of a survey instrument to measure patient experience of integrated care - In the USA San Francisco Origin, BMC Health Services Research developed a survey instrument to measure patient experience of integrated care.
• The measurement of New Zealand health care (2015) - In New Zealand (NZ) the use of quality and safety indicators (QSIs) measures progress toward the NZ triple aim – page 51, figure 1 page 52.
• Population health systems: going beyond integrated care - The King’s Fund uses examples from organisations and systems in other countries that are making a shift to integrated care. A key aspect to consider is that improving population health is not just the responsibility of staff or providers. It requires co-ordinated efforts across population health systems.

Toolkits

• The Policy Innovation Research Unit (PIRU) provides advice on measures of integrated care for individual and collective progress monitoring, using routine data.
• The Nuffield Trust undertook a series of evaluations looking at case studies of integrated and community based care. The Evaluating integrated and community-based care report summarises a series of ‘key points’ that can help systems when developing their integrated care models. A key aspect to consider is to develop robust methods to provide interim reporting of service changes and feedback on observations about process in a way that informs decision-making, enables learning, informs the next stage of service change and can itself be tracked within the evaluation.
• King’s Fund: Integrated care map: examples of new models of care in practice
• Picker Institute Europe: Developing measures of people’s self-reported experiences of integrated care
• The Health Foundation: Measuring patient experience
• North West London Toolkit. How do we define outcomes and metrics?
• BMC Health Services Research: Selecting process quality indicators for the integrated care of vulnerable older adults affected by cognitive impairment or dementia
• Public sector Transformation Network: introductory guide to evaluation
• National Collaborating Centre for Methods and Tools: Guidelines for selecting and using indicators
• NICE Standards and Indicators