Evaluating improvements in multistaged health care: the risk-care-outcome cycle

A new method of program evaluation was developed in Israel to assess the impact of improved care on the health of mothers and infants. Care before conception and during the prenatal, intrapartum, and postpartum periods form an interrelated sequence. The method, therefore, evaluates the interplay among risks, health care quality improvements, and outcomes within each stage of care, and measures the impact of improved outcomes on subsequent stages. The expansion or modification of pilot maternal and infant health efforts in 42 Israeli communities will be based on the results of this evaluative effort. The concepts employed in this assessment are applicable in many other situations that involve sequences of health services (eg, preoperative, operative, and postoperative care) where the success of each phase of care affects the risks of the succeeding stage.