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Flashcards in 17 Evaluation of Health Services Deck (18)
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1

Process

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"

2

Outcome

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"

3

3 examples of measures of process

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

4

4 examples of measures of outcome

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

5

2 Challenges in measures of process

What constitutes "good care" is based on expert opinions
Process of care may not lead to improved health

6

Challenge in measures of outcome

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

7

Efficacy

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

8

Effectiveness

Does it work in the real world?
The degree to which attainable improvements in health care are attained

9

Efficiency

Technical efficiency
Cost effectiveness efficiency

10

Technical efficiency

Do not waste resources

11

Cost effectiveness efficiency

Produce each outcome at least cost

12

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

Efficacy
Effectiveness
Efficiency

13

Evaluating health services often focuses on which E?

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

14

What study design should you use to address efficacy?

Randomized design

15

4 problems with randomized designs for evaluating health services

Expensive
Short follow up
Unethical
Unrealistic

16

What study design should you use to address effectiveness?

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

17

Cohort study

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

18

Case control study

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