James Coles, Director of CASPE (Clinical Accountability, Service Planning and Evaluation) Research

CASPE Research was established in 1979 to develop better managerial and information systems for use by clinicians and managers.

CASPE's main focus has been the development and evaluation of systems that bring clinicians and managers closer together and result in the delivery of more effective and efficient patient care.

It is a 'not-for-profit' independent research unit, largely funded by research grants from various divisions of the Department of Health, European Union, World Health Organization, King's Fund and a number of other charitable bodies, and from health authorities and trusts themselves.

Early work concentrated on better describing and controlling the 'inputs' to care, e.g. clinical budgeting, the Doctors in Management programme, and case-mix. In the late 1980s, however, the unit's focus moved to include projects in the field of output and outcome measurement.

Also, at this time, the unit expanded into the primary care field. CASPE has undertaken a range of projects in the clinical audit area, evaluated major programmes (including the National Confidential Enquiry into Perioperative Deaths, NCEPOD) and has been instrumental in promoting the patient's perspective within its outcomes research programme.

An important aspect of CASPE's approach has been its closeness to the service and the very good working relationships that its research teams have been able to foster with senior clinicians.

These are of major importance in maintaining credibility and support in undertaking research and evaluation work, particularly with respect to clinical issues. We have worked closely with senior members of many of the medical and nursing Royal Colleges a/d with other health service national bodies.

Current interests of the Research Unit include:

  • The development and use of clinical indicators of all aspects of quality, including assessment of the impact of risk factors
  • The development of health outcome indicators, and facilitating their use in practice
  • Assuring the quality of routine data sources and collection systems
  • Evaluation of audit and other initiatives aimed at promoting evidence-based best practice.

Additionally, in support of improving the overall quality of care, CASPE runs two accreditation and organisational development programmes:

  • The Hospital Accreditation Programme (HAP) for NHS community and small independent hospitals and associated community services, e.g. district nursing
  • The Accreditation and Development of Health Records Programme (ADR).

CASPE undertakes primary research, e.g. in supporting multiprofessional working groups in the development and piloting of outcome indicators across 10 clinical conditions. This work, which spanned primary and secondary care, involved reviews of the effectiveness of interventions and different models of provision as well as assessment of measuring tools and underlying data availability.

Reports to the DoH on outcomes have now been published (e.g. Birkhead et al1 and many of the groups' recommendations have been taken up and included in various National Service Framework documents.

Another example of CASPE's primary research work can be seen in a qualitative study of asthma patients' feelings, concerns and reactions as they made the transition to CFC-free metered dose inhalers. Patients were interviewed on a number of occasions, often in their own home, as they switched inhalers. CASPE's findings have contributed to a broader study in this area which is being undertaken in Newcastle.

As well as direct research, CASPE has undertaken a number of large-scale evaluations. The purpose of these has been not merely to identify 'success' or 'failure', but also to examine the way that initiatives have developed, to identify stimuli and barriers to progress and to modify the approach (if needed) as lessons are learnt.

Examples of this approach include evaluation of NCEPOD, which CASPE completed just over 12 months ago. The study2 assessed the project in terms of its ability to obtain complete, reliable and accurate data, the value of the information provided back to participating clinicians and the impact of the Enquiry's findings on clinical practice.

At present, CASPE is evaluating the AIM 2000 (Asthma Into the Millenium) initiative in North West England. AIM 2000 is a 3-year initiative to improve the overall quality of asthma care across a large geographic area, by reducing inequalities in access to best practice. More than 90 practices are involved. Experiences, difficulties and best practice are discussed and disseminated through a network of learning sets and educational activities.

CASPE has undertaken a range of baseline measurements (including an extensive patient survey) across experimental and control practices with repeat assessments at 1 and 2 years. Qualitative interviews with participating practices are also planned.

As mentioned above, CASPE also works directly with health service organisations to support improvements in the quality of care.

CASPE's two accreditation and organisational development programmes focus on improving systems, which are often the prime cause of suboptimal care.

Hospital Accreditation Programme

The HAP,3 started in 1990, offers to healthcare organisations a voluntary programme designed to ensure that robust systems are in place to deliver quality services and support clinical and corporate governance.

The Programme's standards are reviewed regularly and are subject to a widely based consultation process to ensure that they remain appropriate and up to date.

Organisational development support is provided, if required, before a peer review survey. Accreditation is awarded by an independent professional board with Royal College representation.

Accreditation and Development of Health Records Programme

The ADR Programme is very similar to HAP but focuses solely on the health records function.

This programme has focused primarily on the hospital sector, but following recent discussions the programme is now developing explicit, agreed quality standards to address health records management within primary care groups and trusts. This programme is also overseen by an independent, professional board with patient representation.

For further information, please visit our website at www.caspe.co.uk or contact CASPE directly (see Box below for contact details).

CASPE Research

Set up

Objectives To develop and evaluate systems that bring clinicians and managers closer together and result in the delivery of more effective and efficient patient care
Status/funding Independent health services research unit funded mainly by research grants from various divisions of the Department of Health, European Union, World Health Organization, King's Fund and a number of other charitable bodies, and from health authorities and trusts themselves
Key personnel Director, Research Unit: James Coles
Director, Audit and Quality:
Dr Charles Shaw
  Director, Outcomes Development Programme: Dr Robert Cleary
Senior Researcher:
Ms Moyra Amess
ADR Programme Manager:
Ms Anne Clarke
HAP Programme Manager:
Ms Jackie Hayes
Contact details
11–13 Cavendish Square, London W1M 0AN
020 7307 2879
020 7307 2422

  1. Birkhead J, Goldacre M, Mason A et al (Eds). Health Outcome Indicators: Myocardial Infarction. Report of a Working Group to the Department of Health. Oxford: National Centre for Health Outcomes Development, 1999.
  2. Coles J, Pryce D. The National Confidential Enquiry into Perioperative Deaths (NCEPOD). An external evaluation by CASPE Research. CASPE Research, 1998.
  3. Lee-Jones M, Hayes J. Standards for the Accreditation of Community Services and Small Hospitals. 4th edn. CASPE Research, 1999.

Guidelines in Practice, October 2000, Volume 3
© 2000 MGP Ltd
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