SEEP-CI: A Structured Economic Evaluation Process for Complex Health System Interventions
Abstract
:1. Introduction
2. Materials and Methods—Development and Outline of the SEEP-CI
2.1. Description of Case Study
2.2. Description of Challenges for the Economic Evaluation of Complex Health System Interventions Such as REACHOUT
2.2.1. Dispersed Impacts
2.2.2. Non-Standardized Interventions
2.2.3. Complex Causal Relationship between Intervention and Outcome
2.2.4. Impact Conditional on Health System Functioning
3. Results—Development of the SEEP-CI and Illustrative Application to an Evaluation of Embedding QI in Community Health Programs
3.1. Development of the SEEP-CI
3.2. Description of the SEEP-CI
3.2.1. Identify and Categorize Outcomes of the Intervention
3.2.2. Develop a Conceptual Model Outlining the Causal Relationship between the Intervention and the Outcomes Identified in Step One
- (i)
- understand what the proximal goal of the intervention is, such as delivering a training package to a specific cadre of health workers
- (ii)
- specify the relationship between this goal and health care delivery e.g., better trained workers might miss fewer cases where referral to specialists was required
- (iii)
- determine the consequences of changing health delivery e.g., whether more appropriate referrals might improve survival rates
- (iv)
- identify potential feedback loops e.g., improved survival might increase patient willingness to engage with the health system, leading to more opportunities for health workers to learn through experience
3.2.3. Identify Key Intrinsic Outcomes that Will Drive the Adoption Decision
3.2.4. Estimate the Cost of Delivering the Intervention, and the Threshold Change in the Key Intrinsic Outcome(s) Required for the Intervention to Be Cost-Effective
3.2.5. Identify Proximal Instrumental Outcomes that are Likely to Cause Changes in the Key Intrinsic Outcome(s) Identified in Step Three, and Estimate the Effectiveness of the Intervention in Terms of These Proximal Outcomes
3.2.6. Assess the Strength of the Case for Investing in the Intervention
3.3. Application of the SEEP-CI to Evaluation of Embedding QI in Community Health Programmes
3.3.1. Identify and Categorize Outcomes
3.3.2. Develop a Conceptual Model of Causal Links between Outcomes
3.3.3. Identify Key Intrinsic Outcomes
3.3.4. Estimate the Costs of Delivering the Intervention, and the Threshold Change Required for the Intervention to Be Cost-Effective
3.3.5. Identify the Key Proximal Instrumental Outcomes for the Intervention, Estimate the Effectiveness of the Intervention on these Outcomes, and Assess the Strength of the Case for Investing in the Intervention
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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PROXIMAL | DISTAL | |
---|---|---|
INSTRUMENTAL | Supervisory support for CTC providers CTC provider motivation Number of quality improvement (QI) meetings Number of QI initiatives proposed Number of QI teams trained in the global curriculum | Utilization of health clinics Community satisfaction with CTC providers CTC provider turnover Uptake of vaccinations |
INTRINSIC | Costs of training Staff wellbeing | Maternal mortality DALYs Deaths due to diarrhea |
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Madan, J.; Bruce Kumar, M.; Taegtmeyer, M.; Barasa, E.; Singh, S.P. SEEP-CI: A Structured Economic Evaluation Process for Complex Health System Interventions. Int. J. Environ. Res. Public Health 2020, 17, 6780. https://doi.org/10.3390/ijerph17186780
Madan J, Bruce Kumar M, Taegtmeyer M, Barasa E, Singh SP. SEEP-CI: A Structured Economic Evaluation Process for Complex Health System Interventions. International Journal of Environmental Research and Public Health. 2020; 17(18):6780. https://doi.org/10.3390/ijerph17186780
Chicago/Turabian StyleMadan, Jason, Meghan Bruce Kumar, Miriam Taegtmeyer, Edwine Barasa, and Swaran Preet Singh. 2020. "SEEP-CI: A Structured Economic Evaluation Process for Complex Health System Interventions" International Journal of Environmental Research and Public Health 17, no. 18: 6780. https://doi.org/10.3390/ijerph17186780