Ann Netten Completed 2010
In social care, as in other fields, there is increasing emphasis on ‘outcomes’, but what is meant by outcome inevitably varies depending on the context and scope of what is under consideration. Information about outcomes is needed for a number of purposes including policy evaluation, performance management and quality assurance.
Measuring outcomes quantitatively is challenging in any field, but particularly so in social care. Fundamentally, outcomes are about impact – the effect of social care support. Even when restricted to considering the impact on individual service users and their carers clarity is needed on exactly what it is that is being measured.
Some of the key issues that arise can be addressed through research design and careful analysis, but it is critical that the measures of outcome used are valid, reliable and, crucially, sensitive to the impact of social care. Although the ultimate aim might be better well-being or quality of life than would have occurred in the absence of an intervention there are usually a number of intervening objectives that researchers would want to measure to reflect the outcome of an intervention. These will include events or ‘intermediate outcomes’, such as whether people move into a care home, improvements in quality of care, and specific aspects of quality of life that are the focus of the intervention.
It is important to understand the relationship between these different ‘types’ of outcome for the purposes of the research design, analysis and the interpretation of results.
This review aims to discuss the measurement of outcome for individuals and their carers for research purposes, particularly the type of research which evaluates the effectiveness and cost effectiveness of social care for adults and which has implications for social care practice.
The review discusses what is meant by outcome in social care, presenting a model that describes different ‘types’ of outcome and how these are related to one another. Ultimately the objective is improving people’s quality of life, and the review defines ‘social care-related quality of life’ as key to reflecting the impact of services.
Some of the important challenges in measuring outcome in social care are identified: attribution, adaptation, reflecting the relative importance of the diverse aspects of quality of life and mental capacity and communication difficulties.
The review then briefly describes practical approaches to measurement and concludes by making a number of recommendations for measuring outcomes in practice and the need for further methodological development.