Methods & Means

The project will, in general, use methods drawn from different disciplines, in particular Clinical Research, Clinical Epidemiology, Health Economics and Health Systems Research. The principles and techniques from such disciplines will be applied both to build evidence and develop recommendations in the areas of Health Technology Assessment (HTA), Evidence-based Medicine (EBM) and clinical Practice Guidelines (CPG). Best practices and tools will cover inputs, implementation and outcomes, i.e. the three key central domains necessary to offer managers and providers guidance on how to design, manage and evaluate DS services.

The assessment of DS organization and performance will be conducted adopting several methods. First, semi-structured in depth telephone and face-to-face interviews with key informants, i.e. DS managers and providers from participating MSs. Some interviews will be carried out through focus groups. Secondly, information will be collected through questionnaires submitted to a larger sample of informants.

Thirdly, a set of indicators compiled from routine data will illuminate DS safety and quality issues. The combination of quantitative and qualitative methods will take full advantage of sources of information. Data will play a critical role in the analysis of performance, preventing ideologies and interests to dominate. However, data cannot fully describe our topic in isolation from an analysis of the context in terms of political, social and ethical perspectives. Therefore, as far as DS performance is concerned, the analysis will be data driven, but also consider the broader milieu.

Best practices and standards will be identified through a benchmarking exercise, i.e. comparing performance across nations and local situations in order to detect top organizations, their processes and structures and find out why these distinguish themselves.

The comprehensive documentation of DS best practices and standards will be structured following principles and methods derived from system theory, management and clinical medicine. This approach will facilitate understanding and adoption of these instruments by providers and managers. Best practices and standards  will be promoted through a one week course, open to MSs health policy-makers. The teaching methods and tools will be adapted to the eLearning approach.

The development of measurement instruments to assess compliance by patients and conformity by staff will use methods drawn from continuous quality improvement (e.g. design of checklists to determine degree of conformity) and social sciences (e.g. blueprint of a questionnaire to assess patients and families satisfaction with DS services).