Research report
1 Nov 2016

This report describes the results of a pilot analysis of the effectiveness of using routine health care data to determine areas that have made quality improvements in the care of frail and older people over time. It focuses on a few indicators that were mainly derived from acute emergency hospital use and applies statistical analyses to them at the local authority area level. Follow-up interviews and document reviews were then conducted in an attempt to ascertain whether the identified changes could be attributed to local initiatives to improve quality of care, and therefore whether these statistical methods were relevant signals of quality improvement. It concludes that there is scope to use these methods and approaches not only to track past change, but also as part of real-time monitoring of ongoing interventions.


There is a large amount of variation in the quality of care that is currently delivered to older people across England. Numerous initiatives have been set up with the aim of improving care, but much of the evidence of their effectiveness remains anecdotal. Furthermore, when multiple improvement activities are in place in one area, it is not always clear which parts improve outcomes and which do not.

In the absence of useful data to show that an activity is working to improve care, it may be useful to approach from the other direction by starting with the data and asking whether certain patterns visible in routine data are good at identifying activity that improves quality of care. If they are, then we may have a way of identifying activity that might otherwise be overlooked.

This report describes the results of some pilot analysis to ascertain the usefulness of using this approach, using a few indicators that were mainly derived from acute emergency hospital use. The aims were to test out ways of using data to identify potential success; to understand the challenges of attributing data findings to real-world activity; to judge the feasibility of extending into wider work; and to inform what this wider work should look like.

This study shows that there is scope for using more sophisticated analytical methods for identifying improvements in care quality, and that they have advantages in improving specificity and as continuous monitoring tools. This may be particularly true at the local level, or even at a lower level, such as individual GP practices. While we applied these techniques retrospectively, there are likely to be advantages in using these methods for prospective monitoring and evaluation.

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