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We have described the calculation of sample size when subjects are randomised in groups or clusters in terms of two variances—the variance of observations taken from individuals in the same cluster, sw 2, and the variance of true cluster means, s c 2.1 We described how such a study could be analysed using the sample cluster means. The variance of such means would be s c 2+ s w 2/ m , where m is the number of subjects in a cluster. We used this to estimate the sample size needed for a cluster randomised trial.
This sum of two components of variance is analogous to what happens with measurement error, where we have the variance within the subject, also denoted by sw 2, and between subjects ( s b …
This is the third in a series of six articles describing approaches to and topics for health needs assessment, and how the results can be used effectively
The purpose of needs assessment in health care is to gather the information required to bring about change beneficial to the health of the population. It is generally, but not universally, accepted that this takes place within the context of finite resources.1 “Health gain” can therefore be achieved by reallocating resources as a result of identifying four factors:
The subjects of healthcare needs assessment are the populations and patients who are recipients or potential beneficiaries of health care. Populations, of course, include individual patients. The assessment of individuals' needs may form part of the assessment of a population's needs, but it may be costly and it risks ignoring individuals with needs who do not present themselves for health care. Table 1 shows the circumstances favouring individual needs assessment for planning purposes.
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Table 1
Factors determining basis for assessing healthcare needs
The priority attached to different needs, whether of populations or of individuals, raises philosophical problems. For example, should the principal criterion be the benefit that could potentially be obtained for each individual, or the severity of their presenting condition?2 In other words, should greater priority (a greater assessed need) be attributed to the need for surgery of a patient with early stage colorectal cancer or to the need for hospice care of a terminally ill lung cancer patient? In practice the former, the approach that favours the greater …
