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 (25):
1

What are the 4 stages of the planning cycle for health services?

Needs assessment --> planning --> implementation --> evaluation

2

What are Bradshaw's needs?

- Felt need – individual perceptions of variation from normal health

- Expressed need – individual seeks help to overcome variation in normal health (demand)

- Normative need – professional defines intervention appropriate for the expressed need

- Comparative need – comparison between severity, range of interventions and cost

3

What are the 3 approaches to HNA?

Epidemiological, comparative, corporate

4

What is the epidemiological approach to a health needs assessment?

Define your issue, assess the size of it (incidence/prevalence), assess the services available for this issue, assess if this is matching the evidence base for effectiveness and cost-effectiveness, assess the care (using quality and outcome measures e.g. QOF) and assess for any unmet need and any unneeded services --> using all of this, make recommendations

Problems: data – may not be available/high quality, doesn’t consider felt needs, reinforces biomedical approach

5

What is the comparative approach to a health needs assessment?

take two populations/areas and compare the services received by one of them, with another – fairly quick and cheap, and can measure the variation

Problems: data not available/high quality, difficulties finding a comparable group, and also it’s possible that neither group is using the ideal services! No assessment against current evidence.

6

What is the corporate approach to a health needs assessment?

Collect the views of the “stake holders” e.g. The patients/service users, GPs, other health professionals etc – ask them what they think is needed

Problems: blurs the difference between need and demand. Vulnerable to influence by political and personal views etc.

7

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

8

Give some examples of evaluation in healthcare

Evaluation of health services

Evaluation of single intervention (RCT evaluation new Ca drug)

Evaluation of public health interventions (e.g. epidemiological study evaluating impact of smoking ban on health)

9

What is the framework for health service evaluation?

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

10

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

Buildings, staff, equipment

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

11

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

12

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

13

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

death, disease, disability, discomfort, dissatisfaction

14

What is an example of a PROMs?

Oxford hip score questionnaire

15

How can Quality of healthcare be evaluated?

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

Effectiveness, efficiency, equity

Acceptability, accessibility, appropriateness (relevance)

16

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?

17

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

18

What are the two methods of evaluation of health services?

Qualitative

Quantitative

19

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

20

Give examples of qualitative evaluation?

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

21

Describe the general framework of evaluation

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

22

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

Evaluating Buildings, staff, equipment involved in the health service

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

23

Exam Q: 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)

24

Exam Q: 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
􏰀
- 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
􏰀
- Large sample sizes may be needed to detect statistically significant effects
􏰀
- Data may not be available
􏰀
- There may be issues with data quality --> consider CART – Completeness, Accuracy, Relevance, Timeliness

25

What is the basic framework for evaluating health services?

structure, process, outcome