The quest for evidence-based healthcare

Kim Sutherland, from the University of Cambridge, is one of the lead researchers on the QQUIP initiative. “We’re aiming to answer three fundamental questions about healthcare in England,” she says. “What is the current state of quality and performance? What works to improve quality and performance? And are we getting value for money from what is spent on the NHS?”

The project contains three strands of work, each of which tackle one of these questions. “Firstly, we’re concerned to track quality indicators and performance, so that we can see how the system is performing over time and how it performs relative to other countries,” Kim explains. “We’re also trying to build an evidence base about how to improve performance. In order to do that, we’re undertaking a series of literature reviews, asking what works to improve quality across a range of interventions, such as regulation, incentives, IT and patient engagement.

“The third area we work in is cost effectiveness, because there’s always a trade off between cost and quality,” she continues. “In order for policy makers and managers to make sensible decisions, they need to be aware of what that trade off is.”

Although it won't always be possible to pinpoint the exact impact of QQUIP on healthcare decision making, Kim believes that the project is an important part of a broader movement and often chimes with other think tanks, academics and commentators, to bring about change in healthcare policy and management.

The first QQUIP report, on patient-focused interventions (1), was massively popular, with over 12,000 downloads from The Health Foundation website in the month it was published. The report was considered by the Department of Health as part of its consultation on the reform of primary care, leading to the white paper 'Our health, our care, our say', which placed a particular emphasis on patient engagement.

The evidence in the report was also used as the starting point for a Health Foundation demonstration project, Co-creating Health, which is supporting eight teams from across the UK to create new models of healthcare that embed self-management within mainstream health services. At the centre of the initiative is a radical shift in the relationship between patients and clinicians, towards the creation of a more equal partnership.

“I think the patient-focused interventions report has been hugely influential,” Kim comments. “There’s obviously great interest in increasing patient engagement in the NHS.”

Another QQUIP report on the link between health spending and outcomes (2) led to its lead researcher, Peter Smith, giving evidence to a House of Commons select committee meeting about the National Institute for Health and Clinical Excellence (NICE) thresholds for approving new treatments for use in the NHS. NICE itself is now reconsidering the level at which these thresholds are set.

“Peter’s work on the NICE thresholds was absolutely groundbreaking,” Kim says. “He found that the existing care we provide for circulatory disease and cancer appears to be better value for money in terms of quality adjusted life years than the NICE threshold for new interventions. This suggests that if by funding new NICE interventions you’re crowding out what we’re already doing, then that is actually a backwards step.”

Most recently, a new report on patient and public experience in the NHS (3) has found that there is an often substantial gap between government rhetoric on patient choice and what patients actually want. “What is clear from our study is that a truly patient-centred NHS would place a higher priority on communicating and giving information, shared decision-making and treating patients as individuals,” Kim says.

In addition to the investment of £2.5 million in QQUIP, Kim believes that the support from The Health Foundation has helped bring the messages from the initiative to a wider audience, increasing their impact. “QQUIP takes a very broad approach to quality,” she explains. “We draw on health economics, health services research, systematic reviewing and performance reporting. It’s a really quite unique approach, and one that needed significant funding. The Health Foundation was able to provide that.

“The other thing The Health Foundation brings is communications and publication support, which helps disseminate the information,” Kim continues. “The researchers can do the academic work, but it’s making that next step of getting it out to the decision makers where The Health Foundation has made a really significant contribution.”

Looking forward, the QQUIP team has plans to broaden the geographic scope of the project by comparing data from the devolved healthcare systems of Wales, Scotland and England. They are also looking to work more closely with local commissioning organisations and within particular disease areas. “When we get into particular disease areas such as stroke, you can inform expectations and almost arm influencers with the information about best practice and relative performance,” Kim comments.

It’s still early days, but QQUIP is already informing debates on how to improve the quality of healthcare in England and, perhaps more importantly, is helping ensure that whatever decisions are made, they are based on the best available evidence.

References

1. Angela Coulter and Jo Ellins, Patient-focused interventions: A review of the evidence, The Health Foundation, August 2006
2. Stephen Martin, Nigel Rice and Peter C Smith, The link between healthcare spending and health outcomes: Evidence from English programme budgeting data, The Health Foundation, June 2007
3. Sheila Leatherman and Kim Sutherland, Patient and public experience in the NHS: A quality chartbook, The Health Foundation, September 2007