| Learning Objective #1: Appreciate how health services research (HSR) reflects the complexities of everyday practice in the "real world" | |||
| Learning Objective #2: Understand methods appropriate to HSR, such as cluster randomisation, interventions replicable in everyday practice, and intention to treat analysis |
Efficacy is the extent to which an intervention produces an ideal result under ideal conditions; whilst effectiveness is the extent to which a specific intervention, when used under ordinary circumstances, does what it is intended to do. The “classic” RCT is appropriate for measuring efficacy but has limitations in trials of effectiveness – which is the major focus of HSR.
Approaches suitable for HSR can be illustrated using the example of a major cluster-randomised controlled trial (127 homes, 4000 participants), to evaluate a policy to provide external hip protectors for residents of nursing homes, completed by the presenter in 2003. 1
Hip protectors are underwear with built in protection for the hip. They are designed to disperse or absorb the force of a fall. Early RCTs demonstrated remarkable efficacy (a 50% reduction in the rate of hip fractures in intervention groups).
The research sought to answer the question: “Will a policy of making hip protectors available free of charge in nursing homes be effective in reducing the rate of hip fracture amongst residents?”
The presentation will describe the conduct and outcome of the study. It will detail how the HSR methods used in this evaluation - such as cluster randomisation, interventions replicable in everyday practice, and intention to treat analysis – allow an evaluation of effectiveness which is more directly applicable to practice in the “real world.”
1. O'Halloran PD et al (2004) A cluster randomised controlled trial to evaluate a policy of making hip protectors available to residents of nursing homes. Age Ageing, 33: 582-588