17 Evaluation of Health Services

Question 1

Process

Answer 1

The activities that constitute health care usually carried out by professional personnel, but also including other contributions to care, particularly by patients and their families
Include diagnosis, treatment, rehabilitation, prevention and patient education
“Variations in health care use”

Question 2

Outcome

Answer 2

Changes (desirable or undesirable) in individuals and populations that can be attributed to health care
They include changes in health status, knowledge acquired by patients and family members that may influence future care, the behavior of patients or family members that may influence future health, the satisfaction of patients and their family members with the care received and its outcomes
“What was achieved”

Question 3

3 examples of measures of process

Answer 3

Regular check up - annual number
Careful history taking - using standard questions
Attentive follow up - number and using standard questions

Question 4

4 examples of measures of outcome

Answer 4

Early detection - stage of cancer at diagnosis
Longer survival - 5 year survival rate
Better quality of life - asking patients
Lower mortality - mortality rate

Question 5

2 Challenges in measures of process

Answer 5

What constitutes “good care” is based on expert opinions

Process of care may not lead to improved health

Question 6

Challenge in measures of outcome

Answer 6

Difficult to be sure that what we did in health care led to these outcomes (might be confounders)

Question 7

Efficacy

Answer 7

Does it work in an ideal world?
The ability of the science and technology of health care to bring about improvements in health when used under the most favorable circumstances

Question 8

Effectiveness

Answer 8

Does it work in the real world?

The degree to which attainable improvements in health care are attained

Question 9

Efficiency

Answer 9

Technical efficiency

Cost effectiveness efficiency

Question 10

Technical efficiency

Answer 10

Do not waste resources

Question 11

Cost effectiveness efficiency

Answer 11

Produce each outcome at least cost

Question 12

What order should the three E’s be satisfied in?

Answer 12

Efficacy
Effectiveness
Efficiency

Question 13

Evaluating health services often focuses on which E?

Answer 13

Effectiveness
Because health services do not happen in the lab but they do in the real world
Often difficult, expensive, and/or unethical to do efficacy studies

Question 14

What study design should you use to address efficacy?

Answer 14

Randomized design

Question 15

4 problems with randomized designs for evaluating health services

Answer 15

Expensive
Short follow up
Unethical
Unrealistic

Question 16

What study design should you use to address effectiveness?

Answer 16

Non-randomized design

Borrow useful elements from experimental design, such as control groups, before/after comparisons, etc

Question 17

Cohort study

Answer 17

Take defined population, non-randomized into exposure and non exposure groups, measure disease or absence of disease

Question 18

Case control study

Answer 18

Take cases and controls, and look back if they had the exposure or not
Recall bias is a problem