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At least 19 recordsLinked to original sources
PubMed2004

[Epidemiology, research, and health services evaluation].

Health services epidemiological research generally involves testing the efficacy of new programs or strategies and the evaluation of health services quality. Repeating the evidence-based medicine model that has flourished in the clinical field, evaluations of public health programs' effectiveness has preferentially proposed and employed randomized studies as a way of guaranteeing a scientific standard of credibility in the results. A new trend among researchers of epidemiology applied to health services has challenged this premise and proposes that randomized studies be adapted to encompass the broad causal chain linking the implementation of programs to a given impact indicator. Others designs are proposed at different levels of causal inference, but sufficiently rigorous for their results to be reliable.

Epidemiology↗
PubMed1989

The politics of evaluating Aboriginal Health Services.

Evaluation of Aboriginal Health Services (AHSs) has become a topic of importance to service providers and governments in recent years. This paper examines some of the difficulties AHSs have in conducting evaluation and presents an example of an inappropriate evaluation methodology as proposed by the Commonwealth Department of Aboriginal Affairs (DAA) in 1986. The paper examines the contradictory nature of the DAA proposal and the mistrust it has engendered in many AHSs. It then highlights some of the political difficulties in developing meaningful national and community health objectives as a basis for sound evaluation of health services. The paper concludes by identifying some of the processes whereby more appropriate evaluation methodologies might be developed and suggests that negotiation and consultation with the Aboriginal communities and their health services are imperative to successful evaluation.

Australia↗
PubMedDate not supplied

[Mental health services evaluation].

The evaluation of the community mental health services to the chronic mental health patients is one of the areas of more interest since the psychiatric reform began. To carry out an evaluation of the attention in depth it is necessary to keep in mind many different aspects. The new conception of the mental health services has implied a change in the whole system. The evaluation process can be divide in three levels: structures, processes and results which are interrelated to each other. For each one of these levels specific indicators exist and all should complete a minimum requirements as being valid, objectives, sensitive and specific. For a good evaluation and planning of mental health services is necessary to know what type of services are implied in the attention, which are the patients that go to the services and which are the changes that have taken place in this patients.

Chronic Disease↗
PubMed1996

[Training human resources in epidemiology and health services evaluation]

The topics and bibliography pertaining to Epidemiology and Health Services Evaluation are discussed in the light of our experience with graduate courses at the Brazilian National School of Public Health (ENSP), Oswaldo Cruz Foundation (FIOCRUZ). The authors believe that the essential element of evaluation is the assessment of interventions, and that the evaluator's role is to analyze health care as a protective (or risk) factor among other health determinants. Epidemiology has been considered noteworthy due to its ability to integrate health services/programs evaluation as its research subject. In our courses on this subject, the main epidemiological study designs applied to health services research are presented in one section, followed by a discussion about accuracy and reliability of measures and classifications. A third section of the course comprises theoretical and practical assumptions of evaluation models, and the fourth section develops the notion of the quality of health care quality assessment (meta-evaluation). The pivotal issue in the organization of the course is the expansion of research from the academy to health services, implying acknowledgement of the mutual benefit this partnership can bring about.

Journal Article↗
PubMed1997

[Concepts in social research: links with the field of health services evaluation]

This paper discusses theories and research perspectives from the social sciences and their role in constituting the field of "health services evaluation". The objective is to present less explored theoretical fields such as the "comprehensive" and "dialectical" approaches. Finally, the study presents a methodological proposal based on a qualitative approach to the evaluation of health services and projects.

Journal Article↗
PubMed2003

Mystery shopping in health service evaluation.

BACKGROUND: Over the last 5 years, primary care telephone triage systems have been introduced in the United Kingdom, United States, Australia, and most recently in New Zealand. Evaluation of the clinical safety of such systems poses a challenge for health planners and researchers. AIM: To evaluate the use of simulated patients in the assessment of aspects of clinical safety in a pilot New Zealand primary care telephone triage service. DESIGN OF STUDY: 'Mystery shopping', an evaluation strategy commonly used in market research, was adapted by using simulated patients for telephone triage service evaluation. SETTING: New Zealand. METHODS: Four scripted clinical scenarios were developed by academic general practitioners, validated in student teaching situations, and then used by simulated patients to make 101 telephone calls. The scenarios were designed to necessitate a referral to a medical practitioner for further investigation. The documentation kept by the callers was compared with the call records from the telephone triage company, and both were analysed for capture and handling of the clinical safety features of each scenario. In cases where the endpoint was not a medical assessment, possible reasons for this were explored. RESULTS: Records were retrieved for 85 telephone calls. Considerable triage variability was discovered. There were discrepancies between expected and actual triage outcomes with 51% of analysed calls resulting in a self-care recommendation. A number of reasons were identified both for the triage variability and the unpredicted outcomes. Audiotaping of consultations would have enhanced the credibility of the evaluation but it would have carried ethical constraints. CONCLUSION: Simulated patients can be used to evaluate the limitations of health services and to identify areas that could be addressed to improve patient safety. Evaluation of patient satisfaction with services is not sufficient alone to evaluate safety.

Adult↗
PubMed1996

[Household surveys as an evaluation tool for health services: a case study from the Southeast region of the Greater São Paulo Metropolitan Area, 1989-1990]

The increasing importance of health evaluation has raised the need of incorporating epidemiological methodology to assess both technologies and health services. Evaluation of health services performance requires population data to identify the unmet demand and patterns of health services utilization. Such data can be obtained through household surveys. A household survey in the Greater São Paulo Metropolitan Area identified the pattern of health services utilization by the local population. This pattern, which reflects current organization of health services, pointed to a low coverage level by local services, including public clinics, different profiles for users of private and public services, and a large demand for health services outside the area, mainly for childbirth. The information obtained through these surveys produces a "base line" for health planning and further evaluation and is central to the assessment of existing services. The advantages of household surveys in health services evaluation should be analyzed in relation to the potential use of such data and study costs, thereby designing the best cost-benefit relationship for each specific situation.

Journal Article↗
PubMed1993

Quality and effectiveness of occupational health service evaluated by the providers.

In a debate on the desired occupational health service in The Netherlands all parties involved seemed to be rather unsatisfied with current practice. Therefore a study was set out on the quality of the service to 51 client organizations as seen by the parties involved. In the first phase the viewpoint of the occupational health teams was studied; the second phase among clients was planned later. As it was not feasible to use proper measures of effectiveness, i.e. of outcome in terms of health, the interview was used as method directed at the evaluations of the teams themselves. It focused on the adequacy of the activities of the teams in view of the health problems and risks in the client organization and on the necessary interaction with the clients in order to reach effective service. Although a self-evaluation-method like this has its limitations, results are relevant for the debate on the quality of OHS in The Netherlands. Many occupational health teams want more capacity for preventive activities and to devote more time to these activities to enhance the quality of their service and be more effective. It is argued that for the same purpose the teams themselves should strive for good relations with their clients.

Evaluation Studies as Topic↗
PubMed1980

Expanding home health services: evaluation of the federal grant program.

The federal Home Health Grant Program was initiated in 1976 and is intended to increase the provision of home health services by means of grants for the expansion of existing home health agencies and the development of new ones. The evaluation of the grant program is summarized in this article, emphasizing the visit increases generated by grantees and the factors associated with successful grantee performance. Although the grantees were generally successful in increasing visits, grantee performance varied considerably in terms of certain agency and locational characteristics. In particular, Visiting Nurse Association agencies demonstrated considerably better performance than other types of agencies.

Evaluation Studies as Topic↗
PubMed1995

[Evaluation and quality assurance of mental health services].

Evaluation and quality assurance are primary issues in mental health care today. An up-date of current knowledge and experience in this domain is the main objective of this paper. The authors begin by describing the reasons that justify the current interest in this subject, defining concepts and summarizing the most relevant historical antecedents. This is followed by a discussion of the main methodological aspects--basic concepts (particularly those related to structure, process and outcome), specific issues in mental health service evaluation, difficulties in the implementation of evaluation procedures and choice of indicators. Special attention has been given to the most recent developments in mental health service evaluation--namely those related to assessment needs and quality of life measurement. The impact of the regular use of evaluation instruments on the transformation and development of mental health services is also discussed. The contributions that can be made by evaluation procedures to the definition of mental health policies and to overcome mental health service deficiencies are stressed. Finally, the necessity of joining efforts in order to generalize the use of evaluation and quality assurance instruments in the mental health services in this country is pointed out.

Humans↗
PubMed1978

Program evaluation as health services research.

Evaluation of health program is necessary for more rational allocation of scarce resources. Steps in evaluation include: 1)Specification of the program goals, 2) Description of the program, 3) Definition and measurement of outcome, 4) Assessment of intervening variables, 5) Analysis of data, and 6) Implementation of findings. Examples from impirical evaluation studies are presented to illustrate one practical application of these steps. While the random controlled trial is a most powerful tool, it is very difficult to apply in complex human services programs. In the future, more use of multivariate matching of groups to approximate a quasi experimental situation will be needed. Education of health professionals in methods of evaluation is necessary to promote planned improvement in health services.

Boston↗
PubMed1997

Integrating children's health services: evaluation of a national demonstration project.

OBJECTIVES: Increasingly, the public and private sectors are turning to "service integration" efforts to reduce, if not eliminate, barriers to needed care created by categorical programs. In 1991, the Robert Wood Johnson Foundation established a new national demonstration project, called the Child Health Initiative, intended to test the feasibility of developing mechanisms at the community level to coordinate the delivery of health services and to pay for those services through a flexible pool of previously categorical funds. This article presents the findings of an independent evaluation of the Child Health Initiative. METHOD: The evaluation utilized a combination of qualitative methods to assess and describe the experiences of the communities as they developed and implemented integrated health services. It used a repeated measures design involving two site visits and interim telephone interviews, as well as review of documents. RESULTS: Overall, the demonstration project achieved mixed success. Both care coordination and the production of community health report cards were found to be achievable within the relatively short life of the foundation grant. However, many sites experienced significant delays in the production of report cards and implementing care coordination plans because the sites largely did not benefit from the successful models already in existence. Little clear progress was made in implementing the decategorization component of the project. Sites experienced difficulties due to lack of previous experience with this new undertaking, the inability to secure active cooperation from local, state, and federal agencies, the relatively short duration of the project, and other factors. CONCLUSIONS: A number of lessons were learned from this project that may be useful in future decategorization experiments, including (1) a clear understanding of the concept and its applications among all parties is essential, (2) high-level political commitments to the effort are needed between all levels of government, (3) adequate technical assistance should be provided to surmount technical considerations in establishing a workable approach to decategorization, and (4) decategorization and service integration efforts should focus on both the health and social sectors.

Child↗