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EDITORIALS: N J Naftalin and M A Habiba Keeping patients out of hospital BMJ 2000; 320: 262-263 [Full text]

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Multidimensional assessments for new practices needed

Leslie Reti   (6 February 2000)

Multidimensional assessments for new practices needed 6 February 2000
Leslie Reti, Head of Gynaecology Unit,University of Melbourne Royal Women's Hospital, Melbourne, Australia Send response to journal: Re: Multidimensional assessments for new practices needed	Naftalin and Habiba are to be congratulated for their balanced advice on adopting new models of clinical care delivery. Too often, single interest groups selectively quote one dimension of evidence such as patient satisfaction or cost as justification for clinical practice change. A multidimensional assessment of at least outcomes, as suggested by Eugene Nelson, is preferable. He recommended the clinical value compass encompassing clinical outcomes, functional outcomes, satisfaction and cost. Naftalin and Habiba urge adding proof of clinical effectiveness to patient satisfaction, I would hasten to add appropriateness - not how effective, but should we be doing it at all? Equity of access - can the right people get the care at the right time at the right place in an understandable, affordable way? And finally, safety - a dimension of effectiveness that needs to be built in and systematically monitored. Let's continue to improve our practices on sound evidence from multiple relevant domains. Nelson EC et. al. Improving health care, Part 1: The Clinical value compass J on Quality Improvement 22(4):243-58,1