Evaluating whole system reforms

A structured approach for selecting multiple outcomes

Bibliographic Data

ID21467993
AuthorsAlfariany Fatimah (0000-0001-7164-5170, University of Manchester, corresponding author), Philip Britteon (0000-0002-7766-0336, University of Manchester), A Turner (0000-0003-4139-941X, University of Manchester), Laura Anselmi (0000-0002-2499-7656, University of Manchester), Stephanie Gillibrand (0000-0003-1007-8824, University of Manchester), Paul Wilson (0000-0002-2657-5780, University of Manchester), Madeline Sutton (0000-0002-6635-2127, University of Manchester), Yiu-Shing Lau (0000-0002-3915-4168, University of Manchester)
Year2023
Volume138
Pages104933
Publication date2023-12-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueHealth Policy (JOURNAL)
Journal identifiersISSN: 0168-8510 • E-ISSN: 1872-6054
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.healthpol.2023.104933
PMID37913582
OpenAlexW4387843397
LanguageEN
Citations received3
References cited17

Whole-system reforms, including devolution and integration of health and social care services, have the potential to impact multiple dimensions of health system performance. Most evaluations focus on a single or narrow subsets of outcomes amenable to change. This approach may not: (i) capture the overall effect of the reform, (ii) identify the mechanisms through which system-wide changes may have occurred, (iii) prevent post-hoc selection of outcomes based on significant results; and (iv) facilitate comparisons across settings. We propose a structured approach for selecting multiple quantitative outcome measures, which we apply for evaluating health and social care devolution in Greater Manchester, England. The approach consists of five-steps: (i) defining outcome domains based on a framework, in our case the World Health Organisation's Health System Performance Assessment Framework; (ii) reviewing performance metrics from national monitoring frameworks; (iii) excluding similar and condition specific outcomes; (iv) excluding outcomes with insufficient data; and (v) mapping implemented policies to identify a subset of targeted outcomes. We identified 99 outcomes, of which 57 were targeted. The proposed approach is detail and time-intensive, but useful for both researchers and policymakers to promote transparency in evaluations and facilitate the interpretation of findings and cross-settings comparisons

Business · Economic growth · Economics · Health care · Healthcare system · Management science · Process management · Computer Science · Global Maternal and Child Health · Healthcare Policy and Management · Medicine · Primary Care and Health Outcomes · Health Policy

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