Design/methods
Design
Understanding what works and at what cost
Identifying what process and outcome changes have occurred,
and at what cost, provides evidence about the
extent to which the reconfigurations have succeeded in
their objectives of changing the system of service
provision and quality of care. This component of the
evaluation will analyse documentary evidence to establish
the models applied in London and Greater
Manchester; it will also identify whether any changes in
process and outcomes can be associated with these
changes.
In assessing the nature and results of the two reconfigurations,
the evaluation will apply a controlled beforeand-
after design [24]. This will compare the London and
Manchester models in terms of the impact they had on
processes, outcomes, and costs of care. In addition to
comparing London with Greater Manchester pre- and
post-reconfiguration, the analysis will make a wider
comparison with the rest of England. This approach will
permit observed changes to be analysed in the context
of changes that take place in the rest of England over
this period. A two-step approach will be taken to the
analysis of outcomes: in the first instance, the impact of
the reconfigurations on mortality and length of stay will
be investigated; if evidence of impact on these is found,
a more detailed cost-effectiveness analysis will be
undertaken.