Analysis & Evaluation of Health Care Systems By Thomas T.H. Wan, Ph.D.

Excerpted from the Preface for Analysis and Evaluation of Health Care Systems: An Integrated Approach to Managerial Decision Making, by Thomas T.H. Wan.

Copyright © 1995 by Health Professions Press, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

Preface

In conducting managerial studies, the investigator must select appropriate analytical frameworks and research methods to deal with the study problem. Depending on the nature of the study problem, the form of research design, and the type of data available to an investigator, a variety of statistical analyses can be performed in order to draw appropriate inferences from the observed facts or phenomena. The use of statistical designs and analyses may serve the following purposes: 1) to provide descriptive or classificatory profiles or health care concepts in determining the structural or theoretical domains of a series or measures, 2) to illustrate the associations among several related variables with a cross-sectional survey design, 3) to trace past events retrospectively and determine the likelihood of their being considered causative agents for explaining managerial problems, 4) to identify prospectively a single factor or multiple factors as possible causal factors of the study problem, 5) to predict or forecast the future trend of health care demand for a specific type of service, and 6) to assess and evaluate the independent and interaction effects of interventions on health care outcomes or on performance of health care organizations.

Ten chapters illustrate the above-listed purposes in this book. Chapter 1 presents a comprehensive overview of the health systems approach to health care management problems. Chapter 2 illustrates scientific procedures in identifying and framing research inquiries for managerial studies. Chapter 3 discusses the issues in measurement and quantification of variables in the area of health services research.

Two chapters cover analytical designs that can help explore the relationships among multiple variables. Chapter 4 presents an example of performing a cross-sectional analysis of survey data. In this chapter hypothesis testing and inferential statistics are presented and the concepts of sampling are explained. Chapter 5 introduces time-span or longitudinal study designs, including retrospective and prospective studies.

Chapter 6 offers managerial applications of epidemiology in health services management and research. Chapter 7 gives a step-by-step procedure for making a yearly forecast and an intermediate forecast of hospital bed need in a community general hospital. Regression and analysis of variance are introduced in this chapter.

A useful evaluation of health care programs or managerial interventions must be conducted while recognizing a number of essential contingencies, such as the content and context of the program being assessed, the conceptual approach for the evaluation, the feasibility of data collection, the design or methodology, and the analytical training and skills of the evaluator. Chapters 8 and 9 present the principles and methods for conducting evaluation research. Chapter 8 explains evaluation concepts, principles, and approaches, and Chapter 9 introduces a variety of experimental evaluation designs and analyses.

The assessment of organizational performance is an essential part of managerial studies. Multiple indicators can be used to determine the level of performance of a health organization such as a community hospital. For example, because of better management or more efficient use of resources to optimize organizational performance, certain hospitals or service agencies would perform well on measures of quality. Other hospitals or organizations would perform relatively poorly if they do not effectively manage and efficiently use resources. Chapter 10 analyzes how organizational factors may influence patient care outcomes and other performance indicators.

Health services researchers recognize the power of an integrated approach to managerial problems employing epidemiology, social science methodology, and systems analysis. This book is an attempt to bring together in one volume a variety of quantitative methods and evaluation research designs and to provide useful information to graduate students in health services administration and public health. The book articulates the current issues in organizational performance and assessment. It has minimized the use of complex statistical language to the point where students of health care management and administration with an interest in assessing health care outcomes should feel comfortable with the format of illustration and analysis.