Evaluation of health services

Question 1

What is the framework for the evaluation of health services?

Answer 1

Structure
Process
Outcomes

Question 2

What are the 4 components of the Planning cycle?

Answer 2

Needs assessment
Planning
Implementation
Evaluation

Question 3

What is an example of structure?

Answer 3

What is done - Buildings, staff, equipment

For example
Number of ICU beds per 1000 population
Number of vascular surgeons per 1000 population
Locations where screening is provided

Question 4

What is an example of process?

Answer 4

What is done
Examples:
1) Number of patients seen in A & E
2) The process through which patients go in A&E
3) Number of operations performed

Question 5

What are 2 ways to classify outcome?

Answer 5

Classification 1:

1) Mortality e.g. 30 day mortality rate
2) Morbidity e.g. complication rates
3) Quality of life / Patient Reported Outcome Measures i.e Oxford Hip Score
4) Patient satisfaction

Classification 2:

1) Death
2) Disease
3) Disability
4) Discomfort
5) Dissatisfaction

Question 6

What are some issues with health outcomes?

Answer 6

1) Link (cause and effect) between health service provided and health outcome may be difficult to establish i.e due to confounding
2) Time lag between service provided and outcome may be long
3) Need large sample sizes to detect statistical differences
4) Data may not be available
5) There may be issues with data quality
–> consider CART – Completeness, Accuracy,
Relevance, Timeliness

Question 7

When assessing the quality of health services, Maxwell’s

classification lists six dimensions. List the six dimensions and elaborate on them.

Answer 7

(3 x A +Es):
Effectiveness - Does the intervention / service produce the desired effect?
Efficiency - Is the output maximised for a given input (or is the input minimised for a given level of output)?
Equity - Are patients being treated fairly?
Acceptability - How acceptable is the service offered to the people needing it?
Accessibility - Is the service provided? Geographical access; Costs for patients; Information
available; Waiting times
Appropriateness - Is the right treatment being given to the right people at the right time?

Question 8

2 types of methods to perform evaluation? And examples of each?

Answer 8

Qualitative - Observation, Interviews, Focus groups

Quantitative - Routinely collected data, review of records, surveys, special studies i.e using epidemiological methods

Question 9

What is the general framework for evaluating health services?

Answer 9

Define what the service is
What it includes
What are the aims / objectives of the service?
Are they stated and are they appropriate?
Framework: Structure, Process, Outcome
+/- Dimensions of quality
Methodology to be used
qualitative / quantitative / mixed methods
Results, Conclusions and Recommendations