Salvesen Mindroom Research Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
School of Health Sciences, University of Dundee, Dundee, UK.
BMC Health Serv Res. 2024 Jun 14;24(1):728. doi: 10.1186/s12913-024-11178-7.
Universal health visiting has been a cornerstone of preventative healthcare for children in the United Kingdom (UK) for over 100 years. In 2016, Scotland introduced a new Universal Health Visiting Pathway (UHVP), involving a greater number of contacts with a particular emphasis on the first year, visits within the home setting, and rigorous developmental assessment conducted by a qualified Health Visitor. To evaluate the UHVP, an outcome indicator framework was developed using routine administrative data. This paper sets out the development of these indicators.
A logic model was produced with stakeholders to define the group of outcomes, before further refining and aligning of the measures through discussions with stakeholders and inspection of data. Power calculations were carried out and initial data described for the chosen indicators.
Eighteen indicators were selected across eight outcome areas: parental smoking, breastfeeding, immunisations, dental health, developmental concerns, obesity, accidents and injuries, and child protection interventions. Data quality was mixed. Coverage of reviews was high; over 90% of children received key reviews. Individual item completion was more variable: 92.2% had breastfeeding data at 6-8 weeks, whilst 63.2% had BMI recorded at 27-30 months. Prevalence also varied greatly, from 1.3% of children's names being on the Child Protection register for over six months by age three, to 93.6% having received all immunisations by age two.
Home visiting services play a key role in ensuring children and families have the right support to enable the best start in life. As these programmes evolve, it is crucial to understand whether changes lead to improvements in child outcomes. This paper describes a set of indicators using routinely-collected data, lessening additional burden on participants, and reducing response bias which may be apparent in other forms of evaluation. Further research is needed to explore the transferability of this indicator framework to other settings.
全国家庭访视服务在英国已经有超过 100 年的历史，是儿童预防保健的基石。2016 年，苏格兰推出了新的全国家庭访视服务模式（UHVP），增加了访视次数，特别关注第一年，在家庭环境中进行访视，并由合格的健康访视员进行严格的发育评估。为了评估 UHVP，使用常规管理数据开发了一个结果指标框架。本文介绍了这些指标的制定过程。
使用利益相关者制作了一个逻辑模型来定义结果组，然后通过与利益相关者的讨论和对数据的检查，进一步细化和调整措施。进行了功效计算，并对选定指标的初始数据进行了描述。
在八个结果领域中选择了十八个指标：父母吸烟、母乳喂养、免疫接种、口腔健康、发育问题、肥胖、事故和伤害、儿童保护干预。数据质量参差不齐。审查的覆盖率很高；超过 90%的儿童接受了关键审查。个别项目的完成情况更加多变：92.2%的儿童在 6-8 周时有母乳喂养数据，而 63.2%的儿童在 27-30 个月时有 BMI 记录。患病率也差异很大，从三岁时有 1.3%的儿童的名字在儿童保护登记册上超过六个月，到 93.6%的儿童在两岁时已接种所有疫苗。
家庭访视服务在确保儿童和家庭获得正确的支持，为他们提供最佳的人生起点方面发挥着关键作用。随着这些计划的发展，了解变化是否导致儿童结果的改善至关重要。本文使用常规收集的数据描述了一组指标，减轻了参与者的额外负担，并减少了其他形式的评估中可能出现的回应偏差。需要进一步研究探讨将这一指标框架应用于其他环境的可转移性。
