Things to remember

Question 1

Bradford Hill criteria

Answer 1

Criteria to assess causality

Strength of association- The greater the association the more likely it is due to causation (not true in reverse)

Biological plausibility

Consistency of findings

Temporal sequence

Dose response

Specificity - If the exposure causes on or more outcomes.

Coherence - No conflict with the natural history of the disease

Reversibility- remove risk, disease reduces

Analogy- similar to other established cause-effects

Question 2

Donabedian Framework

Answer 2

Assess quality of healthcare

Structure (staff, budgets etc)
+ Easy to measure
- May not be comparable

Process ( Procedures, referrals, prescriptions)
+ Easy to measure
+ Can be directly related to outcomes
- Some don’t predict outcomes

Output (No of operations)
Outcome ( Health status)
+ Aim of service
+ Can use surrogate end points
- Affected by case mix
- Long term
- Costly

Question 3

Screening : Planning

Answer 3

Consider:
Who is eligible
How often to screen
Invitations
Quality assurance

Wilson and Jungner criteria-
Disease is :
Important, pre clinical stage/natural history known. latent period.
Test is:
Valid, simple/cheap, acceptable, reliable
Follow up:
Agreed policy in place, facilities to diagnose/treat, Treatment available
Overall:
Evidenced, Acceptable, Opportunity cost balanced, adequate staffing/facilities, Clear management, patient able to make an informed choice.

Question 4

Public Health Outcome indicators

Answer 4

Reflect the effect of healthcare and PH policy and activities (at population level)
E.g suicide in MH, 30 day mortality post op, life expectancy vs healthy life expectancy.

Uses
Prompt assessment of local outcomes (in relation to targets)
Monitor variation in healthcare
Monitor trends in healthcare
Monitor QoL as part of a HNA

Characteristics
- Relevant
- Valid
- Practical - Available at local level, costs to gather, clear methods, Suitability (to compare groups), easy to gather.
- Meaning- can it show variations effectively? Can it show were processes have failed?
- Value- will the indicator allow for change? Open for abuse (gaming, unintended consequences?)

Question 5

PBMA

Answer 5

Programme budgeting and marginal analysis (PBMA) involves planning and allocating expenditures across health programmes and allocation of resources between prevention, primary, secondary and tertiary care.

The goal is to balance spending across disease areas to ensure an appropriate balance is attained for the population covered.

How much do we spend and what sort of outputs and outcomes do we see?
How do we compare with other health bodies/authorities (spend, productivity and efficiency)?
What are the programme objectives (prevention, rapid diagnosis and treatment, support for patients and their carers)?
How can we deliver programme objectives with the given level of resources?
Marginal analysis informs the direction of travel – added (lost) benefits and added (lost) costs of a proposed change in the allocation of resources.

Uses
- managing finite resources.
- assumes rational behaviour i.e. the decision maker chooses the course of action that offers the highest ratio of marginal benefits to marginal costs.
- address both technical efficiency and allocative efficiency.

Problems
coding of data by healthcare
organisation, year on year differences in the way the programme budget information is collecting, hence reducing the ability to compare year on year trends.