Care Quality Evaluation

Care Quality Evalution (CQE) is a concept envisaged as a digital platform technology, developed by Dr Michela Tinelli, a qualified pharmacist and health economist at LSE. The idea is to support an Integrated Care Ecosystem using pre-built compliant capability and re-usable tools, to deliver a service that can develop new insight at population level through the collection, monitoring and evaluation of data created from patient level interventions, and the context in which those interventions were delivered. The underpinning business intelligence capability is intended to be easy to use and likely delivered through a Software as a Service model, to reduce the time and cost of developing new services and provide health and care professionals, and patients, with a consistent user experience, irrespective of circumstance.  

Connecting individual patient outcomes to the economic productivity and social impact of care management on the population will realise a multiplication effect at population level, from delivering small incremental differences for individual patients.

This image depicts the integrated care lifecycle and the CQE focus within it (click image to expand):

As defined by the NHS Long Term Plan, the NHS in England is in the midst of its most ambitious reform programme for a generation. The ambition is to move from a national network of small-scale commissioning and provider organisations operating without aligned strategic coherence to 42 regionally based health and care Integrated Care Systems (ICSs). This will create new partnerships between the organisations that meet health and care needs across an area, to coordinate services and to plan in a way that improves population health and reduces inequalities between different groups. This represents a fundamental shift in how care is planned, delivered, funded and managed.

Subject to the Health and Care Bill’s passage through Parliament, ICSs, which have been operating as voluntary partnerships, will be placed on a statutory footing in April 2022.

ICSs have been established to bring together providers and commissioners of NHS services, local authorities and other local partners to plan health and care services to meet the needs of their population. The stated target outcomes are:

• Improve outcomes in population health & healthcare
• Tackle inequalities in outcomes, experience & access
• Enhance productivity and value for money
• Support social & economic development.

ICS developments are relevant not only for England (and the UK) but also worldwide as outlined by WHO with the global strategy on people-centred and integrated health services. The core principles articulated in this strategy for people-centred and integrated health services seek to build upon and enhance the ongoing commitment of WHO to universal health coverage and primary health care.

There is currently no joined-up mechanism that can evaluate the data generated from patient centred interventions and data from the context in which those interventions were delivered, and simultaneously provide stakeholders responsible for the commissioning, management and delivery of health and social care services with the insights to cost-effectively improve quality of care and improve societal productivity at population level. 

Following a decade of research and the evaluation of more than 40 heath and social care initiatives, Dr Tinelli identified the mechanism to develop a scaleable and re-usable solution to the challenges faced by those delivering care interventions.

In addition, engagement with multiple key stakeholders, both nationally and internationally has validated the need for this underpinning technology. This has included NHSX (a joint unit bringing together teams from the Department of Health and Social Care, and NHS England and NHS Improvement, to drive the digital transformation of care), and the Universities, ICSs and NHS trusts charged with delivering the first pathfinder projects for the OneLondon Initiative (part of the Local Health and Care Record Exemplar (LHCRE) programme to increase understanding of how citizens weigh-up the benefits and potential concerns of data use, to reach an informed set of public expectations that will now shape the development of policy across the capital).

This image depicts the development timeline (click image to expand):

The feedback has been used to create the specification for a Minimal Viable Product (MVP) - a version of CQE with basic features. The MVP will be trialled and tested with user groups and stakeholders who have already committed to field studies to gain user feedback that will inform further product development in advance of getting the product ready for roll out.

 • Supplement the project team with specialist resources, including:

o Data harmonisation 
o Digitisation of manual processes
o Machine learning
o Artificial intelligence
o Natural language processing
o Trend, cluster, and predicative analytics
o Methodologies.

• Access to additional stakeholder networks that could contribute to product development, piloting in the field, and the identification and creation of new dashboards of indicators with application to multiple interventions and other chronic diseases, would have a significant impact on growth potential. If you are interested in helping, please contact Michela Tinelli at m.tinelli@lse.ac.uk. 

• Create the MVP and conduct initial trials and testing with the identified user groups and stakeholders including, for example, the OneLondon pathfinder project funded by the Healthy London Strategy and aimed at demonstrating how the use of data at scale across London can improve health outcomes.

The follow on from successful testing of the MVP will be to explore the opportunity to adapt CQE to other environments e.g., social care (for example, we are connected with the Government-funded evaluation programme of homeless out of hospital care models in England currently underway).