A multi-step approach to developing a health system evaluation framework for community-based health care

Area of Science:

• Health Services Research
• Public Health Policy
• Healthcare Evaluation

Background:

• Community-based health care (CBHC) represents a paradigm shift towards integrating health services within communities.
• Variations in CBHC system approaches necessitate a standardized framework for outcome and impact evaluation.
• This study addresses the need for a CBHC-specific evaluation framework within a Canadian provincial health ministry's planning process.

Purpose of the Study:

• To develop a comprehensive evaluation framework tailored for community-based health care (CBHC) initiatives.
• To establish a systematic approach for measuring the outcomes and impacts of integrated community health services.
• To support health system planning and policy development for CBHC programs.

Main Methods:

• A multi-step approach incorporating modified Delphi methodology for indicator conceptualization and prioritization.
• Formative research identified framework elements, health system levels (tiers), and potential CBHC indicators (n=461).
• Two Delphi rounds, followed by a consensus meeting and three stakeholder consultations (scientific, government, public/patient) for refinement and endorsement.

Main Results:

• Delphi rounds resulted in 103 top-tier indicators (Tier 1=19, Tier 2=84) and eight key Tier 1 indicator concepts (e.g., Quality of Life, Access to Integrated Primary Care, Avoidable ED Use).
• The framework demonstrated full coverage of Tier 1 concepts across its elements, with 'indicator narratives' emphasizing systemness and integration.
• Stakeholder consultations affirmed the framework's approach, refined concepts, and provided recommendations for operationalization and contextualization.

Conclusions:

• A novel evaluation framework for conceptualizing and evaluating community-based health care (CBHC) initiatives has been successfully developed.
• The developed framework underscores the critical importance of adopting a health system perspective for effective CBHC evaluation.
• This research provides a valuable tool for assessing the effectiveness and integration of community-based health care services.