Three Domains of Care Outcomes: Process, Change, and Maintenance.

Quereshi's Work on Outcome Domains provides a useful framework to understand some of our ToC outcomes. This framework categorizes outcomes into three distinct domains: process outcomes, change outcomes, and maintenance outcomes. Each domain addresses different aspects of care delivery and user experience, ensuring a holistic assessment of service quality and impact.

Process Outcomes - capture how care is experienced—focusing on the quality of relationships, interactions, and cultural fit—rather than solely on measurable outputs. They ensure that everyone involved feels valued, respected, and empowered, which in turn drives overall satisfaction and service effectiveness.

Key dimensions include:

• Relationship Quality: Are connections between care workers, service users, and community members built on trust and equity?

• User Experience: Do people feel heard, understood, and in control of their own care?

• Cultural Compatibility: Are interactions and offerings tailored to individual values, traditions, and preferences?

Change Outcomes - capture the concrete, measurable improvements in a service user’s health and well-being resulting from care interventions. They track gains in physical, mental, and emotional functioning to demonstrate the direct impact of our services.

Key dimensions include:

• Physical Functioning: Improvements in mobility, strength, endurance, and ability to perform daily activities.

• Mental and Emotional Health: Enhanced mental clarity, emotional stability, reduced anxiety or depression, and strengthened coping skills.

• Safety and Independence: Feeling safer in one’s environment, increased confidence to live independently, and reduced reliance on external support.

• Social Connection: Greater participation in community life, deeper engagement with family and peers, and reduced isolation.

Maintenance Outcomes focus on sustaining users’ existing health, independence, and quality of life, delaying any decline over time. They emphasize support for daily routines, a safe living environment, and ongoing social engagement—especially vital for older adults who wish to remain in their homes and communities.

Key dimensions include:

• Daily Living Support: Assistance with personal care and household tasks to preserve routines and autonomy.

• Meaningful Activity: Regular opportunities for purposeful engagement—hobbies, light exercise, or hobbies—that keep users active and mentally alert.

• Social Connection: Frequent, ongoing contact with peers, family, or community volunteers to prevent isolation and foster well-being.

Each of these outcome domains plays a critical role in evaluating and improving the effectiveness of care services, ensuring that they meet the diverse needs of users and enhance their overall well-being. Among these three, Change Outcomes are by far the most commonly measured. Health and social care evaluations tend to prioritize quantifiable improvements—such as gains in mobility, reductions in pain or anxiety, and extended independent living—because they can be tracked with validated scales (e.g. ADL measures, mobility tests, wellbeing questionnaires) and tied directly to service impact.

While Process and Maintenance outcomes are critically important for understanding experience and sustaining independence, they are inherently more qualitative or long-term and thus less frequently captured in routine reporting. Change outcomes, in contrast, lend themselves to standardized assessment tools and clear before-and-after comparisons, making them the domain most often measured.

References

Qureshi, H., & Nicholas, E. (2001). A New Conception of Social Care Outcomes and Its Practical Use in Assessment with Older People. Research, Policy and Planning, 19(2), 11-26.

Qureshi, H., Patmore, C., Nicholas, E., & Bamford, C. (1998). Outcomes in Social Care Practice: Developing an Outcome Focus in Care Management and User Surveys. York: Social Policy Research Unit, University of York.