Evaluation of health services Flashcards
Define the evaluation of health services
Assessment of whether a service achieves it’s objectives
Examples of evaluating health services
Single intervention e.g. RCT
PH intervention e.g. impact of a smoking ban
Health economic evaluation e.g. cost-effectiveness of intervention
Health technology assessment e.g. systematic review, economic evaluation and mathematical modelling
Framework for health service evaluation
Donabedian Structure
What is the Donabedia Structure
Structure:
- What is physically there - buildings, staff and equipment
- e.g. number of ITU beds and consultant anaesthetists per 1000 population
Process
- What is done
- e.g. number of patients seen in A&E
Outcome
- Classification of health outcomes
- mortality - e.g. 30 day mortality weight
- morbidity - e.g. complication rate
- QOL or PROM (Patient Reported Outcome Measurement, e.g. Oxford Hip Score)
- patient satisfaction
- Problem with assessing outcome:
- Direct cause and effect could be difficult to assess
- Time lag between implementation and outcome
- May require very large sample sizes to detect statistically significant events
What is Maxwells dimensions of quality?
3Es and 3As
Effectiveness
- Does the intervention produce desired effect
Efficiency
- Is the output maximised? (for a given input)
Equity
- Are the patients being treated fairly?
Acceptability
- How acceptable is the service being offered?
Accessibility
- Costs, geographical access, waiting times, etc.
Appropriateness
- Is the right treatment being given to the right people at the right time?
Qualitative evaluation methods
observation
focus groups
interviews
Quantitative evaluation methods
data - audit
review records
surveys
epidemiological studies
Give a framework for evaluating health services
- Define the service and what it includes
- Aims & objectives of the service - are they appropriate?
- Donabedian’s Structure, Process, Outcome
- Methodology to be used - qualitative or quantitative?
- Results, conclusions and recommendations
