Innovation in Evaluating the Impact of Integrated Service-Delivery: The Integra Indexes of HIV and Reproductive Health Integration.
Innovation in Evaluating the Impact of Integrated Service-Delivery: The Integra Indexes of HIV and Reproductive Health Integration.
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DOI：
10.1371/journal.pone.0146694
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Integra Initiative
中科院分区：
文献类型：
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作者：
Mayhew SH;Ploubidis GB;Sloggett A;Church K;Obure CD;Birdthistle I;Sweeney S;Warren CE;Watts C;Vassall A;Integra Initiative
评估综合医疗保健复杂干预措施的知识体系既缺乏“综合服务提供”的共同定义，也缺乏衡量影响的标准措施。利用多种数据来源结合统计建模，本研究的目的是制定艾滋病毒-生殖健康（艾滋病毒- rh）服务整合的衡量标准，可用于评估服务整合的程度，以及整合可能对客户健康有益或降低服务成本的程度。数据来自Integra倡议的客户流（斯威士兰的8263名客户和肯尼亚的25539名客户）和2008-2012年间在肯尼亚和斯威士兰提供生殖健康服务的40家诊所实施的成本计算工具。我们使用潜在变量测量模型，利用这些数据得出HIV-RH整合的维度，量化了肯尼亚和斯威士兰HIV和RH服务之间整合的程度和类型。该模型在设施层面产生了两个清晰且不相关的集成维度，从而导致两个子指数的发展：结构集成指数（综合物理和人力资源基础设施）和功能集成指数（向客户提供综合服务）。研究结果强调了多维度整合评估的重要性，表明结构性整合不足以实现对客户的综合护理服务。“功能集成”。这些指标是评价复杂的多服务干预措施的重要方法贡献。它们有助于解决需要通过纳入功能整合措施来扩大对艾滋病毒- rh综合护理的传统评估，以避免就其对健康结果的“影响”得出误导性结论。这对寻求在资源有限的环境中促进一体化的决策者尤其重要。
The body of knowledge on evaluating complex interventions for integrated healthcare lacks both common definitions of ‘integrated service delivery’ and standard measures of impact. Using multiple data sources in combination with statistical modelling the aim of this study is to develop a measure of HIV-reproductive health (HIV-RH) service integration that can be used to assess the degree of service integration, and the degree to which integration may have health benefits to clients, or reduce service costs. Data were drawn from the Integra Initiative’s client flow (8,263 clients in Swaziland and 25,539 in Kenya) and costing tools implemented between 2008–2012 in 40 clinics providing RH services in Kenya and Swaziland. We used latent variable measurement models to derive dimensions of HIV-RH integration using these data, which quantified the extent and type of integration between HIV and RH services in Kenya and Swaziland. The modelling produced two clear and uncorrelated dimensions of integration at facility level leading to the development of two sub-indexes: a Structural Integration Index (integrated physical and human resource infrastructure) and a Functional Integration Index (integrated delivery of services to clients). The findings highlight the importance of multi-dimensional assessments of integration, suggesting that structural integration is not sufficient to achieve the integrated delivery of care to clients—i.e. “functional integration”. These Indexes are an important methodological contribution for evaluating complex multi-service interventions. They help address the need to broaden traditional evaluations of integrated HIV-RH care through the incorporation of a functional integration measure, to avoid misleading conclusions on its ‘impact’ on health outcomes. This is particularly important for decision-makers seeking to promote integration in resource constrained environments.