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

1. 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

2. Intervention implementation– Reach/dosage of an intervention– Who was affected?

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

Suggested approach

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

2. Select and operationalize outcomes and processes from the logic model.

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

4. 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 Venturatventura@coqio.sdps.org303-784-5766

Tracking and reporting

• More to come

Questions?

CO-ICPCTechnical@coqio.sdps.org

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

Change Starts Here.