Strategy and tactics of evaluating a large-scale medical care program.

This report describes the evolution of an evaluation unit organized to assess the impact of a changing hospital care program upon the community it serves, Evaluation activities have been developed to suit the specific characteristics of the program to be evaluated and also to provide continuous, in contrast to single-shot, appraisals of programmatic change. Methodological problems encountered in defining and developing the overall program of evaluation are reviewed. The rationale for the organization of a clinical assessment teamone of the component evaluation activities-is also described, THE RECENT EMERGENCE of a variety of large-scale medical care programs which seek to extend traditional patterns of medical care services in new ways or otherwise modify them has created urgent challenges for those concerned with evaluation of their efficacy. The magnitude of some of these programs, the complexity of the services offered, and the peculiarities of their origins and development call for new evaluation strategies. The material which follows reports early experiences of an evaluation unit whose activities were designed to assess a program in which the resources of a community general hospital center were merged,