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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

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

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
  • Toolkit
    • Measurement

  • ICPCA NCC contact: Tom Ventura

[email protected]



[email protected]

The ICPC National Coordinating Center –

Change Starts Here.