Traditional measurement and evaluation has commonly focused on activity and clinical outcomes, with little focus on what people with long-term health conditions consider as important.
Designing and measuring person-centred outcomes – such as maintaining independence by staying active or in work – can be complex and there is still only limited understanding of how best to define and measure person-centred outcomes and both NHS England and NHS IQ. Working together with people with long-term health conditions to co-design the measurement and evaluation process will help to ensure that the focus is on the impact for individuals and local people.
Some examples of measures, tools and approaches that can be used to measure and evaluate impact at different levels are:
At an individual level, measures normally focus on people’s sense of well-being, quality of life, disability, emotion, sense of social support and their confidence to self-management. Clinical outcomes, such as biomedical disease markers, medication usage, and use of services, are also important in understanding the impact of self-management support for an individual.
Tools and approaches that explore the outcomes that are being achieved for individuals include:
- Patient Activation Measure (PAM)
- Health Education Impact Questionnaire (HEIQ)
- Patient Reported Outcome Measures (PROMs)
- Person Centred Outcome Measures (PCOM) or
personally determined outcome measures (PDOMs)
- Patient reported experience measures (PREMS)
- Qualitative approaches such as surveys and interviews with service users can also be effective, alongside emotional touch points and narratives.
Service and organisational level
Measures used at the individual level can be aggregated to provide a broader picture of how well services and organisations are supporting people to self-manage, and where and how improvements can be made. There are also a range of tools and approaches that are specifically designed to assess performance at a team, service and organisational level.
Tools and approaches include:
- Consultation and Relational Empathy (CARE) Measure
- Person-Centred Care Assessment tool
- Health Literacy Questionnaire
- Observing clinical encounters, and service user led mystery shopping can also provide insight into these areas.
- Outcomes for workforces such as job satisfaction (potentially measured through the staff survey) and sick rates
- Changes in service usage – for example, the use of telephone consultations may have reduced the number of face-to-face appointments
- Process measures, such as the number of people completing a self-management training course.
Because outcomes for people and populations are some of the most complex to measure – for example, measuring the number of people attending a self-management course is easier to measure than the knowledge, confidence, skills and behaviour changes of those individuals – process measures are sometimes used as a proxy.
Those responsible for planning and commissioning services at population level are increasingly moving towards developing and ensuring services deliver ‘person-centred outcomes’. However, there is still only limited understanding of how best to define and measure person-centred outcomes and both NHS England and NHS IQ have programmes of work focusing on this area.
In addition to the more common measures used by commissioners, such as clinical outcomes, service utilisation, and cost effectiveness, commissioners need to work with local people to define the outcomes that are important to them and develop measures and a measurement and evaluation process that generates data on how effectively local services are delivering those outcomes for local people.