Evaluation: Critical assessment on as rigorous a basis as possible of degree health service fulfils stated objectives.

APPROACHES to Evaluation.

Structure - inputs/resources - beds/staff…

1) Donebedian:

Process - activity/resource use - DESCRIPTIVE, Referral patterns, Admission procedure

Output - productivity/throughput
Outcome - effectiveness of activity
- 5ds

• Disease
• Death
• Disability
• Dissatisfaction
• Discomfort

2) Maxwell

Social Acceptability (Humanity) 'the quality of being human'.
Effectiveness
Efficiency (cost/benefits)
Relevance to need
Equity - fair d/n
Accessibility
Locality

- aim to evaluate all 7, but impossible to maximise all dimensions
- mulit-disciplinary input

Mnemonic 'SEE REAL'

3) NHS performance assessment framework - (New & use with Maxwell's)

For High Performance Indicators

Health Improvement Public Health
Fair Access ---- Equity
Appropriate Delivery of effective health ---- EBM
Efficiency ---- Finance
Patient/carer experience ---- complaints/survey
Outcome of NHS care ---- audit

DONABEDIAN APPROACH TO DEFINING or EVALUATING HEALTH CARE

STRUCTURE

Inputs/resources
- Beds
- Staff --> doctors, nurses, porters…
- Building
- equipment
- funding

PROCESS

Activity/use of resources
1. consultation/interpersonal skills
2. Bed occupancy
3. Referral patterns
4. Prescribing practice
5. Admission procedures

How services are delivered organised and used. How resources used?

OUTPUT

Productivity/throughput
- length of hospital stay
- waiting times
- discharge rates
- access
- effectiveness
- equity

OUTCOMES

Effectiveness of activity
/change in health status
- Mortality
- Morbidity
- Complication rate
- Disability
- Quality of life

Lohr '88 5D's:

•Death
•Disease
•Disability
•Dis-satisfaction
•Discomfort

Donabedian = America GURU of Health Care Analysis