بسم الله الرحمن الرحيم Community Medicine Lec -11-

Learning objectives At the end of this lecture student will be able to : 1-Understand meaning of Health program evaluation. 2-Identify the difference between effectiveness & efficiency of a program. 3-Describe levels of health program evaluation. 4-Categorize criteria of scientific hospital administration. To a level accepted to the accreditation standard of the College.

Evaluation of a health program WHO definition of evaluation: It is the systemic and systematic way of critical analysis of different aspects of current activities and development of the program and its relevance, its formulation, its efficiency, its effectiveness, its cost and its acceptance by all parties involved.

Effectiveness It means the achievement, of the organization and its components, for their efficient goal which was formed for it. e.g. T.B. control program organization if succeed means an effective program. Efficiency It means the way of utilization of resources (manpower and material ) by the organization completely or through its components. Productivity It means the value of a product which achieved by an organization or its components.

Levels of health services program evaluation: 1)Health status outcome. 2)Quality of service estimate. 3)Quantity of service performed. 4)Recipient attitude. 5)Resources made available. 6)Cost of the program.

1) Health status outcome. Aim is to measure the effect of health program in a term of health status changes in the target population(in numerical value). Such studies should be carried out on the basis of comparison with usually another locality not included by such a program(Case-Control); taking in consideration the effect of different factors. e.g.1: Living conditions, genetic factors(T.B. in Jewish and black races )and other epidemiological variables. e.g.2: Immunization program(polio vaccination effect on mortality, morbidity and disability among population after program application.)

2) Estimated quality of services: It means comparing the quality of service, directly or indirectly, with the accepted standard. Such judgment may be given a numerical score. e.g. accuracy rate of appendectomy depending on clinical diagnostic signs for acute appendicitis in comparison to post-operative histo-pathological study results.

3) Quantity of services provided: Certain types of health services may be regarded as generally beneficial to population ; thus, higher rates for providing such services considered favorable than lower rates e.g. nursing services. Problems of, both coverage & utilization, should be considered too. e.g.1- Dental services(prophylactic services, filling, extraction, … etc.)all are needed more than what is available. e.g.2- Immunization rate should cover the whole population in all immunize able diseases. e.g.3- Hospitalization services, all are urban centered.

4) Attitude of Recipient: A survey of people attitude may be used to evaluate certain health services programs. Although such judgment, may often be superficial, but it is a good approach to measure certain criteria for good medical care such as acceptability, accessibility and continuity.

5) Resources made available: This may be viewed as in outpatient clinics: e.g. Doctors / population ratio (1/2500); Doctors/nurses ratio, Hospital beds available for each 1000 population and its distribution.

6) Cost of the program: Since the health services resources are limited, it is important to achieve the stated outcome at the lowest possible cost. It means saving money and resources to meet other needs. We have to compare different methods to have the best and cheapest results with such limited resources. e.g.1 comparison between organization of a home care program, with a long term hospital care program. e.g.2 comparison between fluorination of water to prevent dental carries, with a periodic topical fluoride application to children teeth, or with the addition of it to table salt.

Scientific Hospital administration There are several criteria to assess the scientific level of hospital administration’s perfect performance & type of work, in general or specialized hospital. These criteria include the following: 1)Bed-occupancy rate: It is the average number of days during which the bed is used by a patient per year.It depend on type of hospital: a- Emergency hospital → 70days / year. b- General hospital → days / year. c- Chronic patients hospital e.g. T.B., mental illnesses, → days/year.

2) Period of hospitalization: It is the period that a patient spend staying at a hospital. It is variable according to the nature of disease and nature of hospital. Normal range is 5-13 days/year. Average 9days for males and 11days for females. Long stay reflect chronicity of disease or poor nursing and late doctor care. 3) Result of patient at discharge: It is a sensitive measure about the health services quality towards patient. Cured →best result. Improved or progress → favorable. Deteriorated or worsen → untreated.

Leave hospital Late consultation Late treatment Patient dissatisfaction with disease progress. Patient has been told to consult other doctor or another hospital. Death of patient → critical measure for skillful treatment.

4) Hospital records or statistics: Special record for each case admitted. A- Mortality rate records including case fatality rate. After 48 hours from admission, average rate is 3-4% in medical wards & 1-2% in surgical wards. B- Morbidity rate records including disease specific morbidity rates. C- Specific rates e.g. disability rate ( distributed according to type of disability ).

5) Consultation rate; death conference for example. The high the rate of consultation, the better is the result. It should be within the range of 15-20%. 6) Cross infection rate. Very common specially with clostridium tetanus (rate =1-2%). 7)Complication rate. e.g. hepatitis from blood transfusion 3-4%. 8) Unnecessary or unqualified surgical interventions. e.g. midwifery wards, tonsillectomy, appendicectomy, … etc.

9) Post-mortem rate. This is more occurring for deaths occurring in mental hospitals and rare conditions →30-40% of such cases need post-mortem examination, to safe guard doctors and other hospital staff. 10) Scientific conferences rate. Usually done for diagnostic purposes in certain difficult cases or for teaching purposes about rare cases. (various scientific individuals, with different specialties, are necessary to attend such conferences).