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Health
care services can be evaluated at three levels.
- First,
the efficacy of an intervention (whether a treatment benefits
patients when delivered under ideal and highly
controlled conditions) can be assessed relative
to a control group receiving a placebo, attention, or sham
treatment.
- Second,
the effectiveness of an intervention (whether a treatment benefits
patients when delivered under "real
world" conditions) can be assessed relative
to patients receiving care as usual.
- Third,
the effectiveness of multi-faceted health care system changes
(a set of interventions provided by
changing the organization and delivery of care) can
be assessed relative to patients receiving care that has
not been improved.
This chapter
focuses on the third level of health care evaluation: assessment
of multi-faceted changes to the organization and delivery of care.
It examines:
- How health
care systems can be changed to improve outcomes
- Components
of high quality care for chronic illness,
and
- Methods
of evaluating multi-faceted health care system change.
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