Article Review of Public Health Program Evaluation

Pez, E. L.-l., Gutierrez-soria, D., & Idrovo, A. J. (2012). Evaluation of a Diabetes Care Program Using the Effective Coverage Framework. International Journal for Quality in Health Care, 24(6), 619 -625.

The article, "Evaluation of Diabetes Care Program Using the Effective Coverage Framework," by Pez et al., investigates coverage effectiveness in a program implemented to control type 2 diabetes. The research problem addressed is effectiveness when confronting challenges hindering detection of illness when a majority of individuals who have type 2 diabetes underutilize health services, and the system fails to search them out systematically. The authors hypothesize that applying effective coverage when monitoring performance of diabetes care program yields practical information useful to improve healthcare services.

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The title captures the primary focus of the study as evaluating diabetes care program using effective coverage framework. Such is evident in the use of observational study design comprising multiple data sources. From the abstract, usage of multiple data sources suits the study settings in the Mexican State of Hidalgo. The choice of an observation design accommodates the use of effective coverage indicator as proposed by the World Health Organization to monitor healthcare interventions. It draws participants from adults that lack social security health coverage alongside patients diagnosed with diabetes. The use of three-fold outcome measures including symptoms of diabetes, education, and preventions approaches aligns well with its primary focus being to evaluate the care program effectiveness.

The evaluation acknowledges that despite widespread measurement of quality of health care services accessed by type 2 diabetes patients, few quantify the effective coverage. It forms the basis for the observational study design to calculate effective coverage on measures undertaken in the type 2 diabetes management program implemented in Mexico. The calculation targeted detection, illness and comorbidity treatment, patient education and monitoring of complications. The care program evaluated applied the principles of staged diabetes management running in thirty clinics where each has a designated doctor and nurse supported by the operations team.

The evaluation design featured adults drawn from a population of 2.6 million individuals. The use the National Health Survey database and National Health and Nutrition Survey proved essential to draw a representative sample. Their use eased the authentication process since both featured cross-sectional, multistage, probabilistic and stratified cluster sampling on levels of utilization of the healthcare services and characteristics of the household. The databases enriched the study representation abilities with their total population exceeding 396,914 individuals. The evaluation adopted the Shengelia quality given its identical outcome as the effectiveness. It eased the assessment of the care program as a health intervention targeting improved health conditions as its fundamental property.

The multiplicity of actions in the program evaluation on detection, education and observing complications makes the exclusive interventions and effectiveness appear insufficient. Secondly, attaining comprehensive measurement of the health gains necessitated applying alternative approaches besides focus on biomedical outcomes. It qualifies the evaluation of informativeness to indicate detection and observation of complications. The assessment of knowledge acquired focused on its influence on behavioral changes through education. It proposes that the assessment forms basis to improve the healthcare services guided by clinical goals to track their effectiveness. An expanded approach during measurement of elements would become the basis for improving the quality of healthcare services that extends to monitoring potential complications.

The evaluation accommodates metabolic control, detection of illness, education, and observation of complications in the assessment. It hypothesizes that the adoption of clinical actions capable of controlling illness would equally help to prevent the related complications. As such, the detection of illness sought measurement of prevalence rates on the population who lacked affiliations to institutions that provided healthcare services. It supported the view that those adults are qualified for medical care from the health institution where they expect to get effective coverage in the care program. The authors hypothesized that metabolic control such as maintenance of fasting food glucose below critical values would reduce complications. Lastly, they proposed that educative care program would reinforce knowledge of the illness, treatment available and complications associated with type 2 diabetes.

The statistical analysis used data obtained from three databases from two national surveys merged using meta-analysis and independent registries of the care program. Comparison checks relied upon the X2 test-analysis with results tabulated guided by each hypothesis. Lower educational level and underutilization of detection action were evident. A lower effective coverage characterized the care program with several clinical actions conducted sparingly. The huge gap existing between healthcare services users and non-users supported the expansion of type 2 diabetes care program. Affordability gap in medical actions involving pay-for-services shows that extending insurance benefits to a majority of Mexicans would attain increased coverage in the care program. However, the use of electronic records prepared by clinical physicians who may capture the expected rather than their actual actions exposed the evaluation to biased documentation. Consequently, a comprehensive evaluation of effective coverage necessitates the involvement of physical examinations.

The results showed that high incidences of renal disease caused by type 2 diabetes and rising diabetic population support a need to implement healthcare system changes. The interpretation showed that effective coverage framework should feature comprehensive indicators on access, process, and results to improve the control initiatives. The program rationale holds that the focus on intermediate outcome limits the effective coverage indicator. The accommodation of accessibility, responsiveness, and affordability would help resolve the quality gaps experienced in diabetes care programs. The absence of in-depth understanding and support for adequate controls makes type 2 diabetes a clinical problem and healthcare system challenges. Attaining extensive testing for effective coverage necessitates explicit investigation of accessibility, affordability, and responsiveness with each integral to realized improved control for type 2 diabetes.

The article makes rich references to related literature to support the evaluation approach and findings captured in the study. An extensive reference supports the article, including the Journal of American Medical Association, Diabetologia, Diabetes Care, alongside the Journal of Epidemiol Community Health and International Journal of Quality Health Care. The references made to Health Economics, Medical Care and Bull World Health Organization provides the basis to align the evaluation to the study hypotheses. However, shallow references dominate over the inclusion of multiple journals as listed above.

The article concludes that accommodating effective coverage features to evaluate diabetes care programs has potential to resolve the clinical problem. The extensions hypothesized to support the evaluation shows potential ineffective coverage approach to accomplished continued improvement required by type 2 diabetes patients. The likely existence of bias in electronic records from clinical physicians obligates further studies using physical examination to validate and enhance the assessment of effective coverage framework. The evaluation of effective coverage should feature a direct approach that assesses process, actions, structure, and outcomes in the type 2 diabetes care program. It will ensure systematic search for individuals underutilizing healthcare services, hence ease early detection and adequate education and control over complications to improve healthcare outcome.