Healthcare Interventions in Improving HealthCare Systems

One of the greatest challenges for healthcare systems in America is how to best utilize health care interventions to improve the delivery of services and enhance the quality of healthcare. While effective interventions are often developed, most are only implemented in the academic settings in which they are developed; and only few are successfully disseminated to the healthcare setting (Kilbourne et al., 2007).

According to Pawson and his colleagues (2014), the structures of modern health care systems are too complex, making it hard for researchers to evaluate and synthesize interventions in a bid to improve healthcare systems. Subsequently, researchers and policy makers come up with multiple and competing interventions that attempt to address the same issue, which compromises their effectiveness. Furthermore, there lacks a proper framework for implementing the interventions that are likely to maintain their relevance once they get transferred across different settings in the health care system.

Due to the large number of interventions that are developed, it would be accurate to conclude that the problem lies mainly in the implementation because the interventions often work during the trial runs. The structures present in different health care organizations require different modes of implementation. For instance, in 2006, the U.S. Centers for Diseases Control and Prevention (CDC) developed a Replicating Effective Project (REP) program that sought to come up with effective strategies to prepare HIV interventions for dissemination (Kilbourne et al., 2007). Although the program was adopted by more than 70 AIDS service organizations from across the U.S., only few reported improved outcomes. It is, therefore, imperative to come up with health care interventions that will improve health care systems, while putting their complex structures into consideration.

Implications

Policy makers often invest large amounts of money in developing healthcare interventions, which go to waste if their implementation is not successful. There is also the challenge of synthesizing these interventions across multiple settings. Pawson and colleagues (2014) state that patients are also disadvantaged because they are relayed from one system to another, often without due care being accorded to balance of care within systems and in the process, the quality of care they receive is compromised.

As of 2013, the Centers for Medicare and Medicaid Services (CMS) reported that the U.S. spends more than 2 trillion in health care costs (CMS, 2014). These costs will continue to increase if interventions fail to improve the quality of healthcare. Moreover, the problem also affects researchers negatively because they often have to choose among multiple interventions that are meant to address the same problem. Lack of system transformations also implies that the health care system will not benefit from evaluation and systematic reviews.

Solutions

Pawson and his colleagues opine that for long lasting changes in the healthcare system, interventions should address administrative, strategic, procedural, and role change. Intervention should also be tailored according to the structure of the health care systems and more attention should be paid to the programs that will stand longest. Separate interventions should introduce different reforms to specific parts of a healthcare service, which will make it easier to identify the problematic areas.

Health care organizations should follow a defined process for choosing, marketing and implementing evidence based interventions. This is essential in achieving the required balance between organizational differences and applicability. Kilbourne and her colleagues (2007) state that to maximize effectiveness, four types of evaluation strategies should be considered. These include: a thorough evaluation of the intervention implementation process, proper measurement of the fidelity of the intervention at the patient and organizational level, the return on investment, and patient level outcome. If all these solutions are applied, interventions will be more effective and they will lead to better patient care and an overall improvement of health care systems.

References

Kilbourne A.M., Neumann, M.S., Pincus, H.A., Bauer, M.S. & Stall, R. (2007) Implementation Science. Vol. (2)1, 1-10

Pawson, R., Greenhalgh, J.,Brennan, C. & Glidewell, E. (2014). Do reviews of healthcare interventions teach us how to improve healthcare systems? Social Science and Medicine Vol. (114)1, 129-137

The Centers for Medicare and Medicaid Services (2014) National Health Expenditure Data. CMS. Gov. Retrieved 23 April 2015 from http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/index.html