Benning, Amirta (2011)
Ph.D. thesis, University of Birmingham.
This thesis describes study designs for the robust evaluation of complex patient safety interventions. Fundamentally, study designs available to measure the effectiveness of patient safety interventions fall into two categories – those that use contemporaneous controls, and those that do not. A review of the recent literature (245 citations) revealed that most studies were single-centre (63%), and the majority of these did not use contemporaneous controls (84%); whilst in multi-centre studies (37%) the number of studies using contemporaneous controls (49%) equalled the number of studies that that did not (51%). Studies that do not use contemporaneous controls dominate the literature, but they are weak and subject to bias. The thesis further discussed a case-study, as an exemplar for the evaluation of a highly complex patient safety intervention – the Safer Patients Initiative (SPI), which sought to generically strengthen hospitals, whilst improving frontline activities. The evaluation was a before and after study, with contemporaneous controls. It used mixed-methods, so that the triangulation of a one type of research finding could be reinforced when corroborated by the finding of another type. Uniquely, it also, compared the rates of change across control and SPI hospitals – an approach referred to as the “difference-in-difference” method.
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