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You are here 1c - Approaches to the assessment of health care needs, utilisation and outcomes, and the evaluation of health and health care. Aspects of healthcare which can be assessed include: Effectiveness — the benefits of healthcare measured by improvements in health Efficiency — relates the cost of healthcare to the outputs or benefits obtained Acceptability — the social, psychological and ethical acceptability regarding the way people are treated in relation to healthcare Equity - the fair distribution of healthcare amongst individuals or groups Healthcare evaluation can be carried out during a healthcare intervention, so that findings of the evaluation inform the ongoing programme known as formative evaluation or can be carried out at the end of a programme known as summative evaluation.

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Steps in designing an evaluation Firstly it is important to give thought to the purpose of the evaluation, audience for the results, and potential impact of the findings. What study design should be used? Level of data collection and analysis - will it be possible to collect what is needed or is it possible to access routinely collected data e. Hospital Episode Statistics if this data is appropriate to answer the questions being asked?

The design should seek to eliminate bias and confounding as far as possible — is it possible to have a comparator group? The strengths and weaknesses of each approach should be weighed up when finalising a design and the implication on the interpretation of the findings noted. Study designs include: a Randomised methods Through the random allocation of an intervention, confounders are equally distributed. Randomised controlled trials can be expensive to undertake rigorously and are not always practical in the service setting. This is usually carried out prospectively.

Development of matched control methods has been used to retrospectively undertake a high quality evaluation.

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There is a need to match controls however the control group selection itself is a major form of bias. It assesses the cost-effectiveness of treatments against current or next best treatments. See economic evaluation section of this website for more details. Researchers-in-residence are an innovative method used in evaluation whereby the researcher becomes a member of the operational team and brings a focus to optimising effectiveness of the intervention or programme rather than assessing effectiveness.

What measures should be used? Inputs - also known as structure describes what has gone into an intervention to make it happen e. How and when to collect data? Trends in health services evaluation Evaluation from the patient perspective has increasingly become an established part of working in the health service. Navigation The uses of epidemiology and other methods in defining health service needs and in policy development Participatory needs assessment Formulation and interpretation of measures of utilisation and performance Measures of supply and demand Study design for assessing effectiveness, efficiency and acceptability of services including measures of structure, process, service quality, and outcome of health care Measures of health status, quality of life and health care Population health outcome indicators Deprivation measures Principles of evaluation, including quality assessment and quality assurance Equity in health care Clinical audit Confidential enquiry processes The use of Delphi methods Economic evaluation Appropriateness and adequacy of services and their acceptability to consumers and providers Epidemiological basis for preventive strategies Health and environmental impact assessment Health Care Evaluation Frameworks.

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Further reading

Inequalities in health e. The impact of political, economic, socio-cultural, environmental and other external influences. Introduction to study designs - intervention studies and randomised controlled trials. Burnam, M.

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Evaluation of Innovative Healthcare delivery Models

Aug 23,