Evaluation of health services (contd. from health needs assessment) - part of the planning cycle Flashcards Preview

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Flashcards in Evaluation of health services (contd. from health needs assessment) - part of the planning cycle Deck (20):
1

Give 2 definitions for evaluation

Evaluation is the assessment of whether a service achieves its objectives

OR

Evaluation is a process that attempts to determine as systematically and objectively as possible the relevance, effectiveness and impact of activities in the light of their objectives

2

Give some examples of types of evaluation in healthcare

Evaluation of: health services, single intervention, public health intervention

3

Give 2 frameworks for health service evaluation?

Donabedian's:
1. Structure
2. process + output
3. outcome

Maxwell's 3A's and 3 E's

4

What is evaluated in terms of 'structure' of a health service?

What there is

Buildings, staff, equipment

e.g. number of ICU beds per 1000, number of vascular surgeons per 1000...

5

What is evaluated in terms of 'process' of a health service?

What is done

e.g. number of patients seen in A+E, HOW IS PRIORITY assessed in a/e, number of operations performed

6

What is evaluated in terms of 'outcome' of a health service?

Classification of health outcomes: mortality (30 day mortality rate), morbidity (complication rates), QoL/PROMs, patient safety

Or another classification (5 Ds): death, disease, disability, discomfort, dissatisfaction

7

What are the 5 Ds when evaluating the outcome of a health service?

death, disease, disability, discomfort, dissatisfaction

8

What is an example of a PROMs?

Oxford hip score questionnaire

9

How can Quality of healthcare be evaluated?

Donebedian's: structure, process, outcome

OR

Maxwell's dimensions of quality (3Es + 3As):

Effectiveness, efficiency, equity

Acceptability, accessibility, appropriateness (relevance)

10

Describe the 3 Es of maxwell's dimensions of quality

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?

11

Describe the 3 As of maxwell's dimensions of quality

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
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Appropriateness: Is the right treatment being given to the right people at the right time? [Overuse? Underuse? Misuse?]

12

What are the two methods of evaluation of health services?

Qualitative

Quantitative

13

What is qualitative evaluation? Give some examples

Consult relevant stakeholders as appropriate (e.g. staff, patients, relatives and carers, policy makers,
commissioners as appropriate)

Methods: observation, interviews, focus groups, review of documents / questionnaires

14

Give examples of quantitative evaluation?

- Routineley collected data (e.g. hospital admissions + mortality)
- Review of records (medical, administrative)
- Surveys
- Other special studies

15

Exam Q (will come up): Donabedian’s “structure, process, outcome” is a useful framework to use when carrying out evaluation of health services. Explain what is meant by “structure” and "process"

Structure: What there is (e.g. number of ICU beds per 1000, number of vascular surgeons per 1000)

Process: What is done (e.g. the number of patients seen in A+E)

16

Exam Q (will come up): When assessing the quality of health services, Maxwell’s classification lists six dimensions. List the six dimensions?

Maxwell's dimensions of quality (3Es + 3As):

Effectiveness, efficiency, equity

Acceptability, accessibility, appropriateness (relevance)

17

Exam Q (will come up): Although using measures of health outcomes is desirable in evaluation of health services, there are potential limitations. Explain why it may be difficult to attribute a health outcome to the service provided.

(Issues with health outcomes)

- Link (cause and effect) between health service provided and health outcome may be difficult to establish as many other factors may be involved e.g. case-mix, severity, other confounding factors
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- Time lag between service provided and outcome may be long e.g. between healthy eating intervention in childhood and incidence of Type 2 diabetes in middle age
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- Large sample sizes may be needed to detect statistically significant effects
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- Data may not be available
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- There may be issues with data quality --> consider CART – Completeness, Accuracy, Relevance, Timeliness

18

What is the basic framework for evaluating health services?

structure, process, outcome

19

Exam Q: how can "outcome" be classified?

EITHER: mortality, morbidity, QoL/PROMs, Pt satisfaction

OR 5 D's: death, disease, disability, discomfort, dissatisfaction

20

For hip replacement for OA, use structure/process/outcome to evaluate the service?

Structure: Number of orthopaedic surgeons / 1000 population

Process: number of operations in 1 year for OA

Outcome: Oxford hip score