The NAO report states: "The Department [of Health] now needs to gain a better understanding of the different ways to commission personalised services for users, and how these lead to improvements in user outcomes".
No wonder Amyas Morse, head of the NAO, says: "The department now needs to gain a better understanding of the different ways to commission personalised services for users and how these lead to improvements in user outcomes".
A separate paper [ 17] reports the design, methodology, and main service user outcomes.
Service providers working within health systems may improve patient, client and service user outcomes.
Additional limitations include a follow-up period of 6 months only, and lack of service user outcomes.
The sample size was calculated for the broader study on the basis of three service user outcomes using p = 0.05 and 80% power.
Longer term evaluation of this intervention is needed to examine user outcomes and determine its effectiveness, and also to assess the effects of additional time on implementation.
The limitations of the study are the lack of control over how the intervention is delivered, the short follow-up period, and the lack of assessment of service user outcomes.
In keeping with an instrumental case design (the assumption being that studying CSs and APs in context is instrumental to understanding the impact of these roles on service user outcomes), the cases were purposively selected for the informational representativeness they could yield.
They were also related to CHW and end-user outcome levels, selected as outcome measures and comprising CHW performance in this review.
For example, the absence of well-functioning health services influenced levels of motivation and job satisfaction (at the CHW outcome level) and utilization of services at the end-user outcome level.
