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 • 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 • 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 • 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 • Inputs • Resources, contributing factors • Outputs • Activities (interventions) • Participations (processes) • Outcomes • Short-, medium, and long-term • Assumptions • External factors

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 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 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 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 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 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 • 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 • Toolkit • Measurement http://www.cfmc.org/caretransitions/toolkit_measure.htm • ICPCA NCC contact: Tom Ventura tventura@coqio.sdps.org 303-784-5766

Tracking and reporting • More to come

Questions? CO-ICPCTechnical@coqio.sdps.org The ICPC National Coordinating Center – www.cfmc.org/caretransitions Change Starts Here.

Change Starts Here .