BackgroundThe International Consortium for Health Outcomes Measurement (ICHOM) was founded in 2012 to propose consensus-based measurement tools and documentation for different conditions and populations.This article describes how the ICHOM Older Person Working Group followed a consensus-driven modified Delphi technique to develop multiple global outcome measures in older persons.The standard set of outcome measures developed by this group will support the ability of healthcare systems to improve their care pathways and quality of care. An additional benefit will be the opportunity to compare variations in outcomes which encourages and supports learning between different health care systems that drives quality improvement. These outcome measures were not developed for use in research. They are aimed at non researchers in healthcare provision and those who pay for these services.MethodsA modified Delphi technique utilising a value based healthcare framework was applied by an international panel to arrive at consensus decisions.To inform the panel meetings, information was sought from literature reviews, longitudinal ageing surveys and a focus group.ResultsThe outcome measures developed and recommended were participation in decision making, autonomy and control, mood and emotional health, loneliness and isolation, pain, activities of daily living, frailty, time spent in hospital, overall survival, carer burden, polypharmacy, falls and place of death mapped to a three tier value based healthcare framework.ConclusionsThe first global health standard set of outcome measures in older persons has been developed to enable health care systems improve the quality of care provided to older persons.Electronic supplementary materialThe online version of this article (10.1186/s12877-017-0701-3) contains supplementary material, which is available to authorized users.
Background: The daily management of long-term conditions falls primarily on individuals and informal carers, but the impact of household context on health and social care activity among people with multimorbidity is understudied. Aim: To test whether co-residence with a multimorbid person (compared with a non-multimorbid co-resident) is associated with utilisation and cost of primary, community and secondary health care and formal social care. Design and Setting: Linked data from health providers and local government in Barking and Dagenham for a retrospective cohort of people aged 50+ in two-person households in 2016-2018. Methods: Two-part regression models were applied to estimate annualised use and cost of hospital, primary, community, mental health and social care by multimorbidity status of individuals and co-residents, adjusted for age, gender and deprivation. Applicability at the national level was tested using the Clinical Practice Research Datalink. Results: Over 45% of multimorbid people in two-person households were co-resident with another multimorbid person. They were 1.14 (95% CI 1.00, 1.30) times as likely to have community care activity and 1.24 (95% CI 0.99,1.54) times as likely to have mental health care activity compared to those co-resident with a healthy person. They had more primary care visits (8.5 (95% CI 8.2,8.8) vs 7.9 (95% CI 7.7,8.2)) and higher primary care costs. Outpatient care and elective admissions did not differ. Findings in national data were similar. Conclusions: Care utilisation for people with multimorbidity varies by household context. There may be potential for connecting health and community service input across household members.
Objective: A growing proportion of older people live in care homes and are at high risk of preventable harm. This study describes a participatory qualitative evaluation of a complex safety improvement intervention, comprising training, performance measurement and culture-change elements, on the safety of care provided for residents. Design: A participatory qualitative study. Setting: Ninety care homes in one geographical locality in southern England. Participants: A purposeful sample of care home managers, front-line staff, residents, quality improvement facilitators and trainers, local government and health service commissioners, and an embedded researcher. Main outcome measures: Changes in care home culture and work processes, assessed using documentary analysis, interviews, observations and surveys and analysed using a framework-based thematic approach. Results: Participation in the programme appears to have led to changes in the value that staff place on resident safety and to changes in their working practices, in particular in relation to their desire to proactively manage resident risk and their willingness to use data to examine established practice. The results suggest that there is a high level of commitment among care home staff to address the problem of preventable harm. Mobilisation of this commitment appears to benefit from external facilitation and the introduction of new methods and tools. Conclusions: An evidence-based approach to reducing preventable harm in care homes, comprising an intervention with both technical and social components, can lead to changes in staff priorities and practices which have the potential to improve outcomes for people who live in care homes.
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