This book approaches the study of outcomes by placing them in the context of a health services delivery model. The model is useful for organizing the variables that affect service delivery, hypothesizing relationships that might exist, and framing questions to investigate the outcomes of service delivery. The model helps the clinician identify the data to organize, the types of interventions to examine, and the types of outcomes to measure.
A MODEL OF HEALTH SERVICES DELIVERY
A simplified version of the model was first introduced by Donabedian (1966) to measure quality in health care and was adapted to explain general health services delivery (Holzemer & Reilly, 1995; Nelson, 1996). The basic components of the Health Services Delivery Model are the inputs and the processes, which combine to result in outcomes. Figure 6.1 illustrates the categories of the inputs, processes, and outcomes of a generic health service model.
Generic model of health-care systems.
Inputs are those characteristics or variables that define a particular service setting. In health service settings, the characteristics are related to the patients (or clients), the service providers, and the settings. The patients/clients are individuals or groups of people who receive services. They are typically described by diagnosis, age, and reason for referral. The providers are those people who give the services; their characteristics can include type of profession, specialized training or certification status, and years of experience. The settings are the places where services might be provided. Settings can be described by the level of care rendered; e.g. acute care hospitals, residential rehabilitation centers, outpatient clinics, or schools. They can also be categorized by their geographic location (e.g., country or state; demographic levels of urban, suburban, or rural), by the type of health-care system they are in (e.g., government sponsored, private, socialized), or by a type of service that is provided (e.g., general versus niche practice). In order to measure outcomes and manage practice through outcome data, it is important to record the unique characteristics of the clients, providers, and settings.
Processes are the activities or services that patients or providers participate in. Patient processes include receipt of direct care, use of home exercise programs, and participation in a support group. Provider processes include the types of examination procedures used, direct interventions delivered, and indirect interventions such as educational activities or patient advocacy with social service agencies. Setting processes include billing and scheduling procedures, documentation procedures, and continuous quality improvement ...