Redesigning any health care service involves trade-offs between various aspects of quality and costs. The Postnatal Resource Allocation Model (PRAM) supports the debate about different options, and the allocation of resources throughout postnatal care. For example, it might be proposed to make further reductions in the hospital stay for some categories of mothers, with some of the cost savings being invested in additional resources in community with additional home visits for some mothers. PRAM helps everyone appreciate the likely effects of such changes helping stimulate constructive debate about redesign options.
PRAM is a development of Programme Budgeting and Marginal Analysis (PBMA), incorporating more subjective data, in a similar manner to Multi-Criteria Decision Analysis. While PRAM was developed in the specific context of postnatal care, it is intended to be a generalizable tool. Indeed, the design is based on earlier work studying the Balance of Care, between acute and community, for a variety of services. Particular innovations in PRAM include:
A high level “patient pathway” with the key design/ resource options. The key steps and possible interventions are specified, including the resource inputs. Different pathways may be specified for different patient groups reflecting their distinct needs.
The consequences for the quality of care, using the international quality domains as a basis. These domains are interpreted in the specific context of postnatal care, including key quantitative indicators.
A model of the relationship (the “impact matrix”) between the option/ resource allocation selection and the cost and quality of care is based on a synthesis of evidence including key literature and the results of other studies.
The final assessment of proposed options’ quality depends on the relative importance of the various quality domains. Different sets of weights may be specified reflecting the priorities of different stakeholders.