Table 2 Criteria and definitions
Resource impact | Impact on system-wide resource use |
Quality of Life | This criterion deals with the absolute change in quality of life, i.e. a service that has a limited impact on quality of life could not rate to the top of the scale on this criterion. |
Patient/ provider satisfaction | Deals with benefits of the service other than the direct impact on the underlying condition, for example, a service that is very personalized will rate higher here because, presumably, the provider would be able to allow to a greater extent for the client’s preferences [for example, regarding the nature of the activities, the location, the timing, the setting- group or alone]. |
Integration | This criterion is about the continuum of care [and goes beyond the health care system]. Does the service address a gap in the continuum of care that facilitates the clients’ transition from one program or service to another? |
Access | This criterion measures the impact of the provision of a given service on the current utilization of other services, thereby possibly making these other services more accessible. For example, if a given service results in fewer hours per week of home care being required, then this service has freed up those hours for someone else to use. Some services will free up resources that way and some won’t. |
Equity | Impact of the service on the health status of groups where there is an avoidable, unfair, and remediable health status gap. |
Effectiveness | This is about the absolute effectiveness of the service. Just because a service is the best that can be done for an underlying condition does not mean that it is highly effective. Also effectiveness is measured with respect to the impact on the underlying condition itself or the impact on the consequences of the underlying condition. |
Appropriateness | This criterion deals with the high level degree of match between a given service and the overall needs of the population, defined as the combination of the number of persons with the underlying condition and the impact of the underlying condition on quality of life. We should also consider here the availability of possible alternatives. Alternatives to be considered here can be privately provided services but also different services that are publicly funded. We are getting at the idea of the possibility of substitution with this criterion. |
Acceptability | This deals with the relative ‘displeasure’ associated with the service delivery- amount of pain, discomfort |
Implementation challenges | Risks associated with the implementation of given service change [for example, increased volume] but also degree of support- this would be measured, amongst other considerations, by the extent of public pressure in favour of a service. |
Impact on future use of health care services [3+years] | This criterion is about the extent to which the provision of a physiotherapy service now is likely to affect the overall use of health care services down the road [at least three years from now]. |