BMJ 1999;319:376-379 ( 7 August )

Education and debate

Methods in health service research

Evaluation of health interventions at area and organisation level

This is the second of four articles

Obioha C Ukoumunne, research associate ^a,  Martin C Gulliford, senior lecturer ^a,  Susan Chinn, reader ^a,  Jonathan A C Sterne, senior lecturer ^a,  Peter G J Burney, professor ^a,  Allan Donner, chairman ^b. 

^a Department of Public Health Sciences, Guy's, King's, and St Thomas's School of Medicine, King's College, London SE1 3QD, ^b Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada N6A 5C1 Edited by Nick Black. 

Correspondence to: MC Gulliford martin.gulliford@kcl.ac.uk

The first 150 words of the full text of this article appear below.

Healthcare interventions are often implemented at the level of the organisation or geographical area rather than at the level of the individual patient or healthy subject. For example, screening programmes are delivered to residents of a particular area; health promotion interventions might be delivered to towns or schools; general practitioners deliver services to general practice populations; hospital specialists deliver health care to clinic populations. Interventions at area or organisation level are delivered to clusters of individuals.

The evaluation of interventions based in an area or organisation may require the allocation of clusters of individuals to different intervention groups (see box 1). ^{1 2} Cluster based evaluations present special problems both in design and analysis.³ Often only a small number of organisational units of large size are available for study, and the investigator needs to consider the most effective way of designing a study with this constraint. Outcomes may be evaluated either . . . [Full text of this article]

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