A COMPREHENSIVE EVALUATION OF COMPLEX INTERVENTIONS IN HEALTH: INFORMING DECISION MAKERS

Abstract

Model of Care has been designed in Saudi Arabia to improve health outcomes for the population alongside the rationale of allocating financial resources. This Model of Care based on six “systems” of care (keep me well, planned care, maternity care, chronic care, urgent care, and end of life care) and delivers 42 integrated interventions that cut across all systems of care. Thus, the key aims of this thesis are to comprehensively evaluate the impact of reform efforts on different models of health care delivery in Saudi Arabia, using a comprehensive hospital database from one site (King Abdullah Medical Complex in Jeddah city, Saudi Arabia) that implemented the Model of Care. The obtained data were analysed to assess whether King Abdullah Medical Complex was able to: 1) reduce the emergency department visits; 2) improve health outcomes in patients receiving home healthcare services; 3) reduce the average length of stay in hospital; and 4) improve the health referral system. An additional set of data on the population distribution and the primary healthcare centre’s locations of Jeddah Second Cluster–Jeddah city were obtained from open-access web-based sources to investigate the spatial accessibility of the existing primary healthcare. Data analyses revealed that the number of cases attending the emergency department significantly decreased following the introduction of the urgency transfer policy. In Home Healthcare, three significant explanatory variables of mortality [age, having a major diagnosis (diabetes mellitus, cerebrovascular diseases, and bedridden), and having more cancelled visits] were identified. In addition, the findings suggested that the number of patients admitted to the hospital were far greater after the bed management initiative began than before it was implemented. Introducing e-referral systems has improved scheduling,decreased variation among clinics and improved patient access and would likely improve the closing rates of the referral loop. However, the capacity of primary healthcare centers does not appear to be enough to satisfy the demands of the population. In Jeddah’s Second Cluster–Jeddah city, the population density varies significantly between districts, with services concentrated in some highly populated areas. It is anticipated that the findings of this single site implementing the Model of Care will be explored further at other hospital complexes within Saudi Arabia, to enhance Model of Care refinement and success.