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Change Starts Here. The One about Logic Models ICPC National Coordinating Center.

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Change starts here

Change Starts Here.

The One about Logic Models

ICPC National Coordinating Center

This material was prepared by CFMC (PM-4010-096 CO 2011), the Medicare Quality Improvement Organization for Colorado under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.


Measurement for ic 4

Measurement for IC-4

  • Time series outcomes

    • Effect on root cause/driver

    • Success of the intervention

      • Rates; scores; rating scales

      • Best-fit line or other signal indicating improvement

      • What to do about outcomes not well portrayed as time-series

  • Intervention implementation

    • Reach/dosage of an intervention

    • Who was affected?

      • Counts

      • Rates among eligible population (offered, refused, completed)


Suggested approach

Suggested approach

  • Map out a detailed, community-level logic model of the intervention strategy.

  • Select and operationalizeoutcomes and processes from the logic model.

  • Develop and enforce the system for tracking implementation and outcome.

  • Effectively report time series data.


Logic model

Logic model

  • Visual representation, roadmap

    • How a program is expected to work

    • Context of the real world where the program is implemented

    • Conceptual

      • Essential components

      • Formatting is not prescriptive per se

  • Utilized in program planning, management, evaluation and communication

    • ICPCA reporting (deliverable C.4)


Logic model components

Logic model components

  • Inputs

    • Resources, contributing factors

  • Outputs

    • Activities (interventions)

    • Participations (processes)

  • Outcomes

    • Short-, medium, and long-term

  • Assumptions

  • External factors


Getting started inputs

Getting started: inputs

Resources and contributions to be made

  • Intervention evidence base

  • Existing partnerships and programs

  • Provider engagement; community-building

  • Demand from community stakeholders

  • Funding and support from local, regional, statewide or national initiatives (e.g., ICPCA)

  • Human resources

    • Staff (e.g., providers, community organizations, QIOs and other health care organizations)

    • Volunteers

  • Instrumental resources

    • Existing tools, technology, supplies, facility space


Getting started assumptions

Getting started: assumptions

Beliefs about how the program will work in the community

  • Reported knowledge

    • Health care service delivery and utilization

    • Health behaviors

    • Community organizing

    • Other care transitions initiatives

  • RCA and other direct observations


Outputs

Outputs

What is done by whom; those who are affected

  • Selection of interventions targeting drivers of poor transitions and readmission

    • Data from at least one intervention must be tracked

  • Tracking of intervention implementation

    • Rates of recruitment and attrition

    • Percent of eligible population affected by interventions


Outcomes

Outcomes

Expected short-, medium-, and long-term changes and improvements

  • Short-term

    • Specific improvements in the targeted driver or root cause

  • Medium-term

    • Related outcomes along the causal path

  • Long-term

    • Improved care transitions

    • Avoided readmission

    • Improved health care utilization

  • Implications of potential negative changes or non-changes


External factors

External factors

Conditions influencing the program’s success, beyond the team’s control

  • Organizational and systemic changes

    • e.g., corporate mergers, leadership turnover

  • Developments in health policy

  • Economic shifts

  • Natural disasters


Selecting outcomes ideals

Selecting outcomes: ideals

Advice from the 9th SOW Care Transitions Theme:

  • Measureable

    • Can be operationalized and clearly measured

  • Plausible

    • Is reasonably tied to the root cause

  • Moveable

    • Is likely to change in a clinically meaningful way

  • Compelling

    • Observed changes tell the story of improvement

  • Practical

    • Time series data are readily collected


Selecting outcomes smart criteria

Selecting outcomes: SMART criteria

  • Specific

    • Concrete; represents what, or who, is expected to change

  • Measureable

    • Can be seen, heard, counted, etc.

  • Attainable

    • Is likely to be achieved

  • Results-oriented

    • Generates meaningful, valued results

  • Timed

    • Has an acceptable target date


Resources

Resources

  • Toolkit

    • Measurement

      http://www.cfmc.org/caretransitions/toolkit_measure.htm

  • ICPCA NCC contact: Tom Ventura

    [email protected]

    303-784-5766


Tracking and reporting

Tracking and reporting

  • More to come


Questions

Questions?

[email protected]

The ICPC National Coordinating Center – www.cfmc.org/caretransitions

Change Starts Here.


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