Karen Quinsey

Towards a measure of function for home and community care services in Australia: Part 2 - Evaluation of the screening tool and assessment instruments

The National Home and Community Care (HACC) Dependency Data Items Project was established to recommend, for national use, validated and reliable instruments for measuring the dependency of people eligible for HACC services. In Stage 2 of the project - reported here - a screening tool and assessment instruments selected in Stage 1 of the project were field-tested in a range of HACC agencies. The performance of the screen and the associated assessments was evaluated, as was their acceptability to HACC staff and clients. The results suggest that all of the five instruments are suitable for the target population of HACC services and they can be used effectively across a broad range of service types and by providers of diverse professional backgrounds.

The Griffith Area Palliative Care Service (GAPS): an evaluation of an Australian rural palliative care model

Abstract Quantitative and qualitative data, including service utilisation, health records, a provider survey and participant observation, were used to describe the impact of a new model of palliative care on patients, carers and staff in rural Australia. A total of 95 patients were enrolled between October 2001 and February 2003, for an average of 147 days. Deaths per month averaged 3.5. Participating general practitioners were positive about the model. The experiences of 14 patients or carers and 3 people who had cared for a relative with terminal illness prior to the new model were also positive. As one illustration, patients and carers commented that trips to the emergency department prior to the GAPS programme often involved long waiting times and unnecessary investigations and that this had now improved. The elements of the model that worked most effectively were weekly case conferences, the on-call nursing roster, patient-held records and shared protocols and procedures. The model achieved its aim of improving palliative care services and still continues with some modifications. The generalisability of the model is now being tested in eight rural and remote communities across Australia.

Evolution of a multilevel framework for health program evaluation

A well-conceived evaluation framework increases understanding of a programs goals and objectives, facilitates the identification of outcomes and can be used as a planning tool during program development. Herein we describe the origins and development of an evaluation framework that recognises that implementation is influenced by the setting in which it takes place, the individuals involved and the processes by which implementation is accomplished. The framework includes an evaluation hierarchy that focuses on outcomes for consumers, providers and the care delivery system, and is structured according to six domains: program delivery, impact, sustainability, capacity building, generalisability and dissemination. These components of the evaluation framework fit into a matrix structure, and cells within the matrix are supported by relevant evaluation tools. The development of the framework has been influenced by feedback from various stakeholders, existing knowledge of the evaluators and the literature on health promotion and implementation science. Over the years, the framework has matured and is generic enough to be useful in a wide variety of circumstances, yet specific enough to focus data collection, data analysis and the presentation of findings.