The conceptual framework of Women's Health Centres (WHCs), created in the late nineteen seventies, has recently been reconsidered, firstly from the perspective of gender research and secondly within the quality of care discussion of the nineties that emphasis patient-centred care. The crucial questions raised include: whether WHCs are still needed, i.e. do they still serve particular populations and offer care not available elsewhere, or has mainstream gynaecology absorbed the key concerns that had led to the creation of WHCs.
This project addresses the questions whether working approaches characterising WHCs influence patients' health development and outcome in a particular way, and, in a broader sense, whether particular working approaches in gynaecological care settings have an impact on patient outcomes. Main working hypotheses:
1. There is a variation of working philosophies and -approaches regarding women's health care across nine gynaecological care settings in the Basel region.
2. Associations of working philosophies and -approaches with patient outcomes are more pronounced in long-term patients than in new patients (i.e. variations are not only due to prior patient characteristics and patient self-selection, but also an effect of working approaches.
The project aims to evaluate a range of gynaecological care settings with regard to the impact of their working philosophy and -approach on patient outcomes.
Firstly, it aims to assess, across nine gynaecological care settings in the Basel region:
- The variation of working philosophies and approaches (attitudes, processes, structures)
- Differences between the participating practices with regard to patient characteristics
- Differences with regard to patient outcomes
Secondly, it aims to analyse to what extent and how the practices' working philosophy and -approach is associated with patient outcomes.
The project evaluates 9 gynaecological care settings in the Basel region: a WHC created in 1980, 7 additional private gynaecological practices in the Basel region, and the outpatient department of the University Hospital's Women's Clinic. It employs a mixed methodology approach, involving both qualitative and quantitative methods. Qualitative methods are used to assess the characterisation of the working philosophy and -approach. They include qualitative interviews with gynaecologists, staff and patients; participant observation in the care settings; and analyses of written patient information. The qualitative part aims to order the participating practices on a ranking scale of working approaches with regard to key elements of care provided by WHCs. Quantitative methods are used to firstly compare patient characteristics across participating practices, and secondly to analyse the association of working philosophy and -approach (being the exposure of interest) with patient outcomes. The patient population consists of 2'700 patients: on one hand, new patients, i.e. patients consulting for the first time (150 in each of the nine participating gynaecological care settings); on the other hand, long-term patients, i.e. patients who have consulted the respective practices for at least 10 years (again 150 in each care setting). Since a higher number of gynaecologists is working in the WHC (5 gynaecologists, 5 lay women) while only one in the other practices, additional 450 new and 450 long-term patients are included from this setting to examine whether the working approaches differ within the WHC. Patient characteristics are assessed by questionnaire and firstly analysed cross-sectionally. The impact of the working approach of participating practices (stipulated in terms of the ranking variable assigned in the qualitative part of the study) on patient outcomes (body awareness, indicators for empowerment, health outcomes, receipt of specific preventive services, health behaviour, use of medical technology, and satisfaction with care received) will be analysed. For this purpose, the rank correlation between DP (difference between averaged outcomes of long term and new patients in practice P) and rP (rank of practice P from the qualitative assessment) will be tested. This will be done with and without prior adjustment of outcomes for potential confounders.
Expected value of the project
This evaluation study contributes to the broader current concern with quality of care. It should shed light on whether there are specific characteristics which cause patients to consult in a women's health centre; whether distinct ambulatory care settings serve particular groups of women; and whether an effect on patient outcomes can be observed from the practices' working approach in delivering health care. The findings will contribute to the development of good practice in ambulatory gynaecological care settings.