Harkness Project Title: 

The Development of Population Survey Measures of Technical and Patient-Centered Quality of Health Care for Major Disabling Conditions

Mentors: Elizabeth McGlynn, Ph.D., and Paul Shekelle, M.D., Ph.D.

Placement: RAND Corporation

Biography at time of Harkness Fellowship: Nicholas Steel is a 2002–03 Commonwealth Fund Harkness Fellow in Health Care Policy, based at RAND Health in Santa Monica. He is conducting research into the development of technical and patient-centered measures of the quality of health care, for use in national and international population surveys. Immediately prior to his Harkness Fellowship, Steel was an honorary fellow in Cambridge University’s Department of Public Health and Primary Care and a specialist registrar in public health medicine. He was a clinical governance reviewer for the Commission for Health Improvement and a member of the British Medical Association’s Committee for Public Health Medicine and Community Health for England. Previously, he was a practicing family physician and held a National Health Service research fellowship. Steel has experience of different health care systems, having worked as a physician in primary and secondary care in England, Scotland, Australia, and New Zealand. He is also a member of the Faculty of Public Health Medicine of the Royal College of Physicians, where he served as a faculty training accreditation visitor. He was awarded a 1999 Tripos Prize for public health from Trinity College, Cambridge University.

Project: The immediate objective of Steel’s project was to develop a module or set of population survey questions about health care quality for several disabling conditions, to be used in population-based interview surveys (e.g., English Longitudinal Study of Aging, U.S. Health and Retirement Survey).  She developed a set of quality indicators through a formal Delphi group, and validated these through field pilots. 

Career Activity Since Fellowship

• Clinical Senior Lecturer in Primary Care, University of East Anglia, 2004
• National Primary Care Researcher Development Award, 2003
• Clinical Senior Research Associate and Honorary Consultant in Public Health Medicine, University of Cambridge and NHS Norfolk, 2003

E-Mail: n.steel@uea.ac.uk

Harkness-Related Publications

Steel N, Bachmann M, Maisey S, Shekelle P, Breeze E, Marmot M, Melzer D. “Self-reported receipt of care consistent with 32 quality indicators: a national population survey of adults over 50 years old in England.” BMJ 2008;337;a957

Steel N, Clark A, Lang I, Wallace RB, Melzer D. “Racial disparities in receipt of hip and knee joint replacements are not explained by need: Health and Retirement Study 1998 - 2004.” The Journal of Gerontology: Medical Sciences 2008;63:629–634

Steel N, Maisey S, Clark A, Fleetcroft R, Howe A. “Quality of clinical primary care and targeted incentive payments: an observational study.” British Journal of General Practice 2007;57:449-454

Steel N, Bachman M, Maisey S, Shekelle P, Breeze E, Marmot M, Melzer D. “Self reported receipt of care consistent with 32 quality indicators: national population survey of adults aged 50 or more in England.” BMJ 2008; 337;a957.

Steel N, Melzer D, Shekelle PG, Wenger NS, Forsyth D, McWilliams BC, “Developing quality indicators for older adults: transfer from the USA to the UK is feasible,” Quality and Safety in Health Care 2004; 13:260-4.