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)
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1
Q

Give 2 definitions for evaluation

A

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
Q

Give some examples of types of evaluation in healthcare

A

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

3
Q

Give 2 frameworks for health service evaluation?

A

Donabedian’s:

  1. Structure
  2. process + output
  3. outcome

Maxwell’s 3A’s and 3 E’s

4
Q

What is evaluated in terms of ‘structure’ of a health service?

A

What there is

Buildings, staff, equipment

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

5
Q

What is evaluated in terms of ‘process’ of a health service?

A

What is done

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

6
Q

What is evaluated in terms of ‘outcome’ of a health service?

A

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
Q

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

A

death, disease, disability, discomfort, dissatisfaction

8
Q

What is an example of a PROMs?

A

Oxford hip score questionnaire

9
Q

How can Quality of healthcare be evaluated?

A

Donebedian’s: structure, process, outcome

OR

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

Effectiveness, efficiency, equity

Acceptability, accessibility, appropriateness (relevance)

10
Q

Describe the 3 Es of maxwell’s dimensions of quality

A

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
Q

Describe the 3 As of maxwell’s dimensions of quality

A

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?]

12
Q

What are the two methods of evaluation of health services?

A

Qualitative

Quantitative

13
Q

What is qualitative evaluation? Give some examples

A

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
Q

Give examples of quantitative evaluation?

A
  • Routineley collected data (e.g. hospital admissions + mortality)
  • Review of records (medical, administrative)
  • Surveys
  • Other special studies
15
Q

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”

A

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
Q

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

A

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

Effectiveness, efficiency, equity

Acceptability, accessibility, appropriateness (relevance)

17
Q

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)

A
  • 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
18
Q

What is the basic framework for evaluating health services?

A

structure, process, outcome

19
Q

Exam Q: how can “outcome” be classified?

A

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

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

20
Q

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

A

Structure: Number of orthopaedic surgeons / 1000 population

Process: number of operations in 1 year for OA

Outcome: Oxford hip score