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Published on: June 20, 2020
Development of an outcome indicator framework for a universal health visiting programme using routinely collected
Margaret Horne1, Louise Marryat2,3, D Helen Corby1
1Salvesen Mindroom Research Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
Insights
Scotland developed a new Universal Health Visiting Pathway (UHVP) to improve child health. An indicator framework using routine data was created to evaluate its effectiveness, focusing on key child development outcomes.
Area of Science:
- Public Health
- Child Development
- Healthcare Policy
Background:
- Universal health visiting has been a key part of UK preventative healthcare for over a century.
- Scotland implemented a new Universal Health Visiting Pathway (UHVP) in 2016, emphasizing early years home visits and developmental assessments.
- An outcome indicator framework was developed to evaluate the UHVP using routine administrative data.
Purpose of the Study:
- To describe the development of an outcome indicator framework for evaluating Scotland's Universal Health Visiting Pathway (UHVP).
- To establish a system for monitoring child health outcomes within the context of evolving health visiting services.
Main Methods:
- A logic model was created with stakeholders to define outcome domains.
- Measures were refined through stakeholder discussions and data inspection.
- Power calculations were performed, and initial data were described for selected indicators.
Main Results:
- Eighteen indicators were selected across eight outcome areas including parental smoking, breastfeeding, immunisations, dental health, developmental concerns, obesity, accidents/injuries, and child protection.
- Data quality varied; review coverage was high (>90%), but individual item completion differed (e.g., breastfeeding data at 6-8 weeks: 92.2%, BMI at 27-30 months: 63.2%).
- Prevalence of outcomes ranged widely, from 1.3% on the Child Protection register to 93.6% receiving all immunisations by age two.
Conclusions:
- Routinely collected data were used to develop a set of indicators for evaluating the UHVP, minimizing participant burden and response bias.
- The developed indicator framework supports the assessment of changes in child outcomes within evolving health visiting programs.
- Further research is recommended to assess the transferability of this indicator framework to different settings.
Background:
Universal health visiting has been a cornerstone of preventative healthcare for children in the United Kingdom (UK) for over 100 years. In 2016, Scotland introduced a new Universal Health Visiting Pathway (UHVP), involving a greater number of contacts with a particular emphasis on the first year, visits within the home setting, and rigorous developmental assessment conducted by a qualified Health Visitor. To evaluate the UHVP, an outcome indicator framework was developed using routine administrative data. This paper sets out the development of these indicators.
Methods:
A logic model was produced with stakeholders to define the group of outcomes, before further refining and aligning of the measures through discussions with stakeholders and inspection of data. Power calculations were carried out and initial data described for the chosen indicators.
Results:
Eighteen indicators were selected across eight outcome areas: parental smoking, breastfeeding, immunisations, dental health, developmental concerns, obesity, accidents and injuries, and child protection interventions. Data quality was mixed. Coverage of reviews was high; over 90% of children received key reviews. Individual item completion was more variable: 92.2% had breastfeeding data at 6-8 weeks, whilst 63.2% had BMI recorded at 27-30 months. Prevalence also varied greatly, from 1.3% of children's names being on the Child Protection register for over six months by age three, to 93.6% having received all immunisations by age two.
Conclusions:
Home visiting services play a key role in ensuring children and families have the right support to enable the best start in life. As these programmes evolve, it is crucial to understand whether changes lead to improvements in child outcomes. This paper describes a set of indicators using routinely-collected data, lessening additional burden on participants, and reducing response bias which may be apparent in other forms of evaluation. Further research is needed to explore the transferability of this indicator framework to other settings.
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