Developing quality indicators for community services: the case of district nursing

Area of Science:

• Healthcare Quality Improvement
• Community Health Services Research

Background:

• Existing quality indicators primarily cover acute and primary care within the National Health Service (NHS).
• Measuring the quality of community health services has historically received less attention.
• This project aimed to address the gap in quality measurement for community services.

Purpose of the Study:

• To establish a framework for developing quality indicators specific to Bristol Community Health services.
• To create an initial set of quality indicators for these services using the developed framework.

Main Methods:

• A framework for indicator development was designed, informed by NHS policy, stakeholder input, and literature review.
• The framework was tested using district nursing services, focusing on wound, diabetes, and end-of-life care.
• Indicator refinement involved surveys, workshops with nurses, interviews with service users, and consultations with managers and commissioners.

Main Results:

• A final set of 23 organizational, clinical process, and outcome indicators was developed for district nurses.
• Eight patient experience indicators were also created.
• These indicators are currently undergoing piloting, alongside tools for capturing patient-reported outcomes.

Conclusions:

• Developing quality indicators for community services is a time-consuming and resource-intensive process.
• A multidisciplinary approach requiring clinical, project management, and evidence-based medicine expertise is necessary.
• The active commitment and involvement of frontline professionals are essential for successful indicator development and implementation.