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Trinity College Courses
Michelle Silver

Section 1- Investigation health services and health: the scope of research -different research methods are appropriate for addressing different research questions -ex: if comparing MI between men and women – a prospective, longitudinal survey used to compare health outcomes over time in the future -if topic of research is known very little of—qualitative methods are used (observational, in-depth interviews, focus groups) -if cause and effect issues are to be tested then experimental design (randomized controlled trial) is most appropriate, even though it can be impractical and other methods can be employed in times where randomization may seem unethical -triangulated research methods is an approach that addresses different facets and uses combined research methods to complement each other and establish external validity , triangulated research is enhanced by the multifaceted nature of health, the multidisciplinary character of research on health and health services Health Research- emphasis on health services, plays important role in informing the planning and operation of services aiming to achieve health Health System- no accepted definition, has been defined in terms of the structures used to deliver health care, the geographical boundaries of the latter, or the strategies used to attain population health -definition health system research: concerned with improving the health of a community, by enhancing the efficiency and effectiveness of the health system as an integrated part of the overall process of SE development VS. health services research: defined more narrowly in relation to the relationship between health service delivery and the health needs of the population. -identification of the health care needs of communities and the study of the provision, effectiveness and use of health services -Britain/U.S focuses on health services research Chapter 2- Evaluating health services: multidisciplinary collaboration -research on health or health services overlap and it is important to consider the perspective of the lay person in health service evaluation and decision making -other related fields of investigation include audit, quality assurance and the need for effective services Health Services Research -aims to produce reliable and valid research data on which to base appropriate, effective, cost-effective, efficient and acceptable health services at the primary and secondary care levels -health technology assessment = describes wider evaluation of health care interventions in terms of cost and effectiveness -strong emphasis on research and development:  relationship between populations’ need and demand for health services, and the supply, use and acceptability of health services  the processes and structures, including the quality and efficiency, of health services  the appropriateness and effectiveness of health service interventions in relation to effectiveness and cost-effectiveness, including patients perceptions of outcome in relation to the effects on their health, health related quality of life and their satisfaction with the outcome -health service research is distinct from audit and quality assurance, A/Q assessment aims to monitor whether predefined and agreed standards have been met. Health Services research has evaluation as its aim, not monitoring -health services research is broader than traditional clinical research which focuses on biochemical indicators and the measurements of the broader quality of life, health service research should investigate outcome of medical interventions from social, psychological, physical and economic perspectives Assessment of quality -performance indicators and assessment, patient surveys -Donabedian introduced systematic evaluations of structure (inputs and resources, such as staffing, building, funding); process (service delivery, organization and use, including resources, waiting times, admission and discharge procedures, prescribing practices); output (productivity including discharge rates, access, effectiveness, equity); outcome (death, disease, disability) -Maxwell described 6 dimensions of quality: 1) appropriateness 2) social acceptability 3)effectiveness 4)relevance to need 5)equity 6)accessibility (sitting, language, disability, friendly) Higginson stated that quality of care needs to include: 1) effectiveness – achieving intended benefits in the population, under usual conditions of care 2) acceptability & humanity (to the consumer and provider) 3) Equity & accessibility (the provision and availability of services to everyone likely to benefit (in need) 4) Efficiency – greatest benefit for least cost - Adds that the patient empowerment might also be included (may increase control over the services received and each patient should be offered appropriate care) Audit - Maintenance and achievement of health care quality - Aim: improve patient outcome, to develop more cost-effective use of resources, to education health professionals, should leave to changes in clinical practice by reviewing current practices - Criteria for change should address common serious issue, with the end result leading to patient benefit and effectiveness that justifies the investement of the time and effort involved - Audits focus on process, rather than structure or outcomes Medical audit, clinical audit, quality assurance and clinical governance - Medical audit is the systematic critica
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