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Pioneering new outcome measures could improve standards of incontinence care

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For the first time, health and social care experts say they have developed a “definitive” set of outcome measures and key performance indicators (KPIs) for toileting and containment strategies.

Those behind the project said care providers and policy makers could use the tools to guide the delivery of daily continence management and evaluate the improvement in standards over time.

“This study has identified the type of outcomes upon which we should focus2

Adrian Wagg

The measures and KPIs are based on findings from a study carried out by an expert panel set up by hygiene and health company Essity with support from KPMG. The KPIs were launched earlier this week in Rome at the 7th Global Forum on Incontinence.

The group initially carried out a comprehensive literature review to develop an initial “long list” of possible KPIs. It then distilled this list via stakeholder engagement with over 60 people representing patients, carers, health professionals, policy makers and payers.

This work has resulted in a definitive list of 14 KPIs (see below), which are deemed relevant and practical for use in the full range of care settings and for health and social care systems to measure.

The outcome measures cover clinical, quality of life and economic measures, ranging from skills based KPIs to the cost of admission and re-admission related to the delivery of poor continence care.

“We hope the output from this study will make a tangible contribution to the improvement of care”

Mattias Abrahamsson

They include the proportion of staff with the skills to perform a continence assessment and prescribe a toileting and containment strategy, and the proportion of patients with incontinence in receipt of pads with a documented assessment and a toileting and containment strategy.

Others cover the proportion of people with incontinence and incontinence associated dermatitis who receive a toileting and containment strategy, and the proportion with an indwelling catheter.

The researchers said the KPIs were relevant for all people who depended on toileting and containment strategies, including those who were independent or care dependent.

The study’s backers noted that there had previously been no international consensus on what good continence care looked like, making it challenging for providers and health systems to improve care delivery.

Expert research panel chair Professor Adrian Wagg, from the University of Alberta in Canada, said: “There are many types of incontinence, and while outcome measures for over active bladder have been produced, nothing currently exists for the daily management of incontinence.

He said: “This study has identified the type of outcomes upon which we should focus and has produced tangible KPIs which, if embedded in quality frameworks, will help to advance standards of care.

“Furthermore, because of the methods used in their creation, we know that the KPIs are fully endorsed by both those affected by incontinence and those involved in tackling it,” he added.

“AGE Platform Europe welcomes the output of this study as a useful source of inspiration on what can be done”

Anne-Sophie Parent

Mattias Abrahamsson, vice president for incontinence care and global hygiene at Essity, said: “We hope the output from this study will make a tangible contribution to the improvement of care provision for people living with incontinence and be adopted by national health and social care systems.

It will give care providers and policy makers for the first time, clear outcomes to aim for, and a way to assess continuous improvement for people living with incontinence.

In addition, it will facilitate the creation of a powerful bank of benchmarking data to provide the basis for value-based health care procurement of toileting and containment strategies.”

The charity umbrella group AGE Platform Europe, whose 150 members include Age UK, welcomed the publication of the study and its findings.

Its secretary general, Anne-Sophie Parent, said: “Given the growing burden that incontinence represents for an ageing population, AGE Platform Europe welcomes the output of this study as a useful source of inspiration on what can be done to improve the quality of care that people receive, many of whom are dependent on toileting and containment strategies to live independent, dignified lives.”

  • Proportion of staff with the skills to perform a continence assessment and prescribe a toileting and containment strategy
  • Proportion of persons with incontinence in receipt of pads with a documented assessment and formulation of a toileting and containment strategy
  • Mean number of days from referral to assessment for persons with incontinence who require a toileting and containment strategy
  • Proportion of persons whose toileting and containment strategy is reviewed
  • Proportion of persons with incontinence who receive education on toileting and containment strategies
  • Proportion of persons with incontinence deemed eligible for a toileting and containment strategy who are offered a choice of product type following assessment of incontinence
  • Proportion of persons with incontinence and incontinence associated dermatitis who receive a toileting and containment strategy
  • Proportion of persons with incontinence with an indwelling catheter to manage incontinence
  • Proportion of persons with incontinence managed with a toileting and containment strategy who report “good” or “acceptable” levels of access and support to toilet facilities in their daily life
  • Persons with incontinence managed with a toileting and containment strategy who report sustained or improved emotional wellbeing
  • Proportion of persons managing incontinence with a toileting and containment strategy who are either able to remain in work or take up work
  • Cost of hospital admissions and re-admissions related to poor management with toileting and containment strategies for incontinence
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