Challenges, solutions and future directions in the evaluation of service innovations in health care and public health

Raine R, Fitzpatrick R, Barratt H, Bevan G, Black N, Boaden R, Bower P, Campbell M, Denis J-L, Devers K, Dixon-Woods M, Fallowfield L, Forder J, Foy R, Freemantle N, Fulop NJ, Gibbons E, Gillies C, Goulding L, Grieve R, Grimshaw J, Howarth E, Lilford RJ, McDonald R, Moore G, Moore L, Newhouse R, O'Cathain A, Or Z, Papoutsi C, Prady S, Rycroft-Malone J, Sekhon J, Turner S, Watson SI, Zwarenstein M
Record ID 32016000691
English
Authors' objectives: Policies and interventions in the health-care system may have a wide range of effects on multiple patient outcomes and operate through many clinical processes. This presents a challenge for their evaluation, especially when the effect on any one patient is small. In this essay, we explore the nature of the health-care system and discuss how the empirical evidence produced within it relates to the underlying processes governing patient outcomes. We argue for an evidence synthesis framework that first models the underlying phenomena common across different health-care settings and then makes inferences regarding these phenomena from data. Bayesian methods are recommended. We provide the examples of electronic prescribing and increased consultant provision at the weekend.
Authors' recommendations: As the field of implementation science comprises a range of different ontological and disciplinary orientations, there is not always consensus on the boundaries of the research agenda or the challenges faced. Explicit discussion about the terminology used in the field would be useful to clarify differences in perspective and conceptual foundations. There is a need to generate an in-depth understanding of intervention design and development by considering the role of theory, the influence of context and meaningful involvement of relevant end-users. Theory-driven, pragmatic evaluation designs are proposed as a solution to produce evidence of intervention effects, and the potential of 'implementation laboratories' is also discussed. A balance has to be sought, however, between rigidly controlled studies and adaptive evaluations that allow emergent changes to the intervention or the implementation process through timely feedback. Practical recommendations would support the development of the field in evaluating the implementation of evidence-based practice.
Details
Project Status: Completed
URL for project: http://www.nets.nihr.ac.uk/projects/hsdr/1514001
Year Published: 2016
URL for published report: http://www.journalslibrary.nihr.ac.uk/hsdr/hsdr04160/#/abstract
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England, United Kingdom
MeSH Terms
  • Humans
  • Delivery of Health Care
  • Forecasting
  • Public Health
  • Health Care Quality, Access, and Evaluation
  • Health Planning
Contact
Organisation Name: NIHR Health Services and Delivery Research programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
Contact Name: journals.library@nihr.ac.uk
Contact Email: journals.library@nihr.ac.uk
Copyright: Queen's Printer and Controller of HMSO
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