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Practice Essentials

Evaluating the impact of healthcare interventions using routine data

BMJ 2019; 365 doi: (Published 20 June 2019) Cite this as: BMJ 2019;365:l2239

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  1. Geraldine M Clarke, senior data analyst1,
  2. Stefano Conti, senior statistician2,
  3. Arne T Wolters, senior analytics manager1,
  4. Adam Steventon, director of data analytics1
  1. 1The Health Foundation, London, UK
  2. 2NHS England and NHS Improvement, London, UK
  1. Correspondence to G Clarke Geraldine.clarke{at}

What you need to know

  • Assessing the impact of healthcare interventions is critical to inform future decisions

  • Compare observed outcomes with what you would have expected if the intervention had not been implemented

  • A wide range of routinely collected data is available for the evaluation of healthcare interventions

Interventions to transform the delivery of health and social care are being implemented widely, such as those linked to Accountable Care Organizations in the United States,1 or to integrated care systems in the UK.2 Assessing the impact of these health interventions enables healthcare teams to learn and to improve services, and can inform future policy.3 However, some healthcare interventions are implemented without high quality evaluation, in ways that require onerous data collection, or may not be evaluated at all.4

A range of routinely collected administrative and clinically generated healthcare data could be used to evaluate the impact of interventions to improve care. However, there is a lack of guidance as to where relevant routine data can be found or accessed and how they can be linked to other data. A diverse array of methodological literature can also make it hard to understand which methods to apply to analyse the data. This article provides an introduction to help clinicians, commissioners, and other healthcare professionals wishing to commission, interpret, or perform an impact evaluation of a health intervention. We highlight what to consider and discuss key concepts relating to design, analysis, implementation, and interpretation.

What are interventions, impacts, and impact evaluations?

A health intervention is a combination of activities or strategies designed to assess, improve, maintain, promote, or modify health among individuals or an entire population. Interventions can include educational or care programmes, policy changes, environmental improvements, or health promotion campaigns. Interventions that include multiple independent or interacting components are referred to as complex.5 The impact of any intervention is likely …

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