IMPROVING HEALTH OUTCOMES - A REVIEW OF CASE-STUDIES FROM ENGLISH HEALTH AUTHORITIES

We review a series of case studies from English health authorities tha t have tackled the assessment and improvement of health outcomes. We r eflect their concerns and difficulties and the lessons they learnt. We identified case studies from a telephone survey of 91 representatives of the 100 English health authorities (61 were directors of public he alth). We edited 26 structured case studies which described how they h ad used population health outcome assessments or indicators. The healt h outcome assessments included service reviews, needs assessment proje cts, case-control studies, small area variations analyses, action rese arch, and the use of focus groups. Many case studies highlighted inequ alities in health service delivery. Health authorities chose some topi cs because they were outliers on national indicators, others had found unacceptable inequalities within their district, and others had been concerned that clinicians were not using the most effective interventi ons. Public health departments played a major role in these population -based health outcome assessments. The case studies highlighted the st rengths and weakness of national population-based health outcome indic ators, the difficulties of using information on effectiveness, the rol e of evidence-based process proxies for outcome, the need to extend in formation sources, the involvement of patients and carers, and the dif ficulty of changing clinical behaviour. We make recommendations as to how the Department of Health and NHS Executive could help health autho rities improve the health outcomes of the populations they serve.