A research-industry collaboration is testing a new tool that links care outcomes with the planning and review process to improve quality in home care. Natasha Egan reports.
Representatives from two universities, one peak body and four aged care organisations are developing the basis of a national system to measure care outcomes across community care services with the help of 26 case managers and 600 consumer directed care clients in New South Wales.
With demand for community care projected to increase significantly in the coming decades, a robust, reliable and effective system for collecting and measuring information on outcomes is essential, says Professor Michael Fine, adjunct professor of sociology at Macquarie University and lead on the ‘Ageing Well at Home: Measuring the Impact of Community Care for Older People’ project.
The project’s primary aim is to develop, test and validate the Australian Community Care Outcomes Measure (ACCOM) for use in the community aged care sector.
“Despite all the reform and restructuring of services in recent years, there is still no reliable measure of what the results of care provided at home are for consumers, their families, or for the services that support them in their home. Nor is there any way of comparing the outcomes achieved by different services or innovative models of provision,” Fine says.
The project also aims to improve the outcomes of individuals and organisations and across services through industry benchmarking.
The partnership is between Macquarie University, University of Wollongong, service provider organisations BaptistCare, The Whiddon Group, KinCare, and Community Options Australia, and peak body Aged and Community Services NSW/ACT. It has a two-year funding grant from the Australian Research Council and builds on a previous Macquarie-industry collaboration.
Fine is leading the project with Professor Kathy Eagar, the director of the Australian Health Services Research Institute (AHSRI) at the University of Wollongong, which already has national outcome measurement centres for palliative care, pain and rehabilitation services.
The industry partners have been actively involved in the development of the tool during the first 12 months of the project and began testing the ACCOM in December with a range of home care clients across metropolitan and regional NSW.
Central to the design of the tool – and a learning from AHSRI’s outcome measurement centres – is that the ACCOM needs to be part of a case manager’s everyday work, says Cathy Duncan, a research fellow at AHSRI and one of the key researchers on the project.
“The information we are using to measure outcomes is a by-product of the information they are collecting to do their care planning and review process,” Duncan tells Community Care Review.
The ACCOM has been designed for the Australian community care environment and links outcomes with ongoing care planning. It incorporates the UK’s validated Adult Social Care Outcomes Toolkit (ASCOT), which is a questionnaire for consumers to rate care outcomes. One of its developers, Professor Ann Netten from the University of Kent, is also collaborating on the Australian project.
The definitions of terms in the guidelines have been adapted for an Australian context, but ACCOM uses the same questions as the ASCOT, which will also allow international comparisons, says Duncan.
Community aged care clients complete a paper-based ACCOM questionnaire that is designed to monitor their progress against the goals they set with the case manager during care planning.
It measures care outcomes over a number of key domains, such as control over daily life, personal cleanliness, comfort and safety, food and drink, social participation, occupation, accommodation cleanliness and comfort, and dignity.
Case managers complete an online version of the ACCOM with the same care outcome questions but from their perspective, plus a functional assessment.
The functional aspects are based on the HACC Functional Screen and include mobility, housework, shopping, medication management, financial management, personal care, and, if applicable, cognition and behavioural problems.
“There is a question after each domain in the functional screen where the case manager identifies whether a client needs assistance in that area and then they identify whether or not that domain is included into the care plan. This is where we are measuring outcomes and relating it back to care planning,” says Duncan.
If, for example, the client needs assistance with housework but they have enlisted a family member to help, it is not part of the care plan. But if the client rates the situation poorly in the ACCOM, the case manager would see it isn’t part of the care plan and could suggest to include it, she says.
The live trial runs until June 2016 and by late January this year, most participants had completed their first ACCOM, says Duncan.
Wendy Mason, senior home services consultant and BaptistCare’s key representative on the project, says four sites across metropolitan Sydney and regional and rural areas, 14 case managers and around 250 of BaptistCare’s clients are participating in the trial.
“We wanted to get that scope of clients. We have picked sites that have a good breadth of CALD clients as well,” says Mason.
She says one of the reasons BaptistCare is participating in the project is because the outcome measurement process dovetails well into their consumer directed care model – You Choose – which follows a goal-based care planning approach and aims to recognise that everyone’s services are individual.
“We were already talking to our clients and our staff about thinking about outcomes and to now potentially have a measurement tool that is going to assist us to actually measure changes in outcomes for our clients is just great.”
On a larger scale, she says BaptistCare would like the ACCOM to be recognised as a validated tool that could be used by all service providers and across all programs.
“At the moment we are trialling it on home care package clients around CDC, but we are making sure that it is a tool that can be used across the Commonwealth Home Support Program as well.”
Mason says providing information to all care workers has helped with the smooth implementation of the ACCOM test because when a survey is delivered to clients, care workers are often the ones asked about it. The project has been thorough and the advantage of the researchers partnering with service providers is that they have been able to inform on the best ways for the tool to work and be rolled out, she says.
“The idea of measuring outcomes is you are ultimately hoping to improve quality of care. If staff understand that then they are happy to be involved in it.”
Measuring both perspectives
Ensuring willingness among case managers to use the ACCOM has been a key factor in its development, says Dr Beatriz Cardona, a senior research fellow at Macquarie University and key researcher on the project.
“The questionnaire is simple; it doesn’t take long. Preliminary findings show it takes them between 5 and 10 minutes to answer the questions and they can do them online, which makes it easy for them to use,” says Cardona.
While Mason says they have experienced no difficulties with the project, Cardona says training case managers spread across the state has been a challenge for the study. To address this, the project has also involved developing training tools to ensure all case managers are at the same stage. “We have many regional areas so we have to be creative when developing training including doing online sessions and face to face,” she says.
Measuring client outcomes is a quality improvement process but it also gives clients a voice, says Cardona. “This tool allows clients to give their feedback and opinion about the quality of the service they are receiving and therefore this would lead to improvement in client outcomes.”
After collating the first ACCOM responses, the researchers are next working on how to compare the client and case manager perspectives in a meaningful way. Comparing perspectives aims to further improve the care planning and review process, says Duncan.
Measuring both perspectives aims to help organisations identify differences in case manager-client outcomes, unmet client needs and care plan priorities as well as develop and deliver more evidence-based services, says Duncan. For the purpose of the trial, however, the comparative analysis is for the researchers only and case managers will not see client responses, she says.
The ACCOM allows service providers to be transparent about their case management processes and offers added value to their clients by measuring outcomes, says Duncan.
“In a competitive market, the providers that are part of our pilot project are seeing this as a positive step towards having some sort of evidence around that they are good providers; that they are working towards consumer directed care; that they are working towards having some measurement of transparency.”
She says the long-term vision of the project is to establish a national outcomes centre for community care similar to those AHSRI has established for pain, rehabilitation and palliative care. For the ACCOM to work, service providers need the support of the universities to do the data analysis, she says.
“At the national outcomes centres [at AHSRI], there is a team of statisticians that process all of the outcome measurement results, produce reports, then individual services can be benchmarked against national outcomes. Service providers could do their own internal data collection but in terms of getting the best out of it, it needs to be an ongoing partnership between the universities and service provider organisations.”
However, participation in outcome measurement should always be voluntary, she says. “An important aspect is that it is a carrot approach and not a stick approach.”
In the meantime, and funding permitting, the researchers want to undertake a national trial and also look at cultural sensitivity in the ASCOT, particularly for Aboriginal and Torres Strait Islander and CALD groups, says Duncan. They also want to further develop work being done by an ASCOT team in the UK with a carer outcome measurement tool.
“We would love to get funding to work on applying that in an Australian context as well. That is on our wish list. Taking it nationally would incorporate some of those special needs considerations.”
For more information on the project, go to: www.agedcareoutcomes.net
This feature article was first published in the February edition of Community Care Review magazine.
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