Using evidence to inform equity assessment in health services

The Equity Assessment Cardiac Rehabilitation (EACR) study uses a hospital outpatient cardiac rehabilitation (CR) program as the vehicle for demonstrating ways of using evidence to inform equity assessment in health services. This is achieved by demonstrating methods which policy and decision-makers can use to measure, deconstruct and interpret inequalities in service access, defined by selection and utilisation. Some of these methods are familiar in epidemiology and health services research and others less so. Chapter 1 defines equity and equality in health, and introduces the conceptual classification used here to analyse socio-behavioural factors that impact upon utilisation of the hospital outpatient CR program. Chapter 2 reports the results of a search of the international literature on ways of similarly addressing inequalities and inequities in healthcare services and programs, and also factors associated with the recruitment and retention of patients to hospital outpatient CR programs. Chapter 3 describes the methods used in the development and construction of the EACR patient cohort. Chapter 4 explains the theoretical basis for the statistical applications demonstrated in this dissertation. Analyses are conducted on the cohort in accordance with patients’ index hospitalisation. Chapter 5 applies multi-variable logistic regression to analyse factors associated with CR invitation and Chapter 6 uses similar methods to analyse factors associated with attendance for invited patients and Chapter 7 tests the effects of invitation and attendance on survival in accordance with age and gender. Using the results of the regression models presented in Chapter 5, Chapter 8 demonstrates post-estimation non-linear decomposition of gender-based inequalities in invitation to CR. This is a novel application in health services research. Chapter 9 concludes this body of work.