camden coalition of healthcare providers evaluating

Camden Coalition of Healthcare Providers

Evaluating


Agenda:1. Why is evaluating difficult?2. Developing an evaluation framework3. The evaluation timeline


§1 Why isevaluating

difficult?


having data


patients w/ complexities = complex intervention


finding an appropriate

comparison group

~~


regression to the mean


12 12

3

4567

8

9

1011

it takes time!


§2 Developingan evaluation

framework


Process Outcomes


Customized Data System Solutions


Link2Care Dashboard 2 Week Ending 7/26/14

Home Visit in 72 HoursAll Enrolled Patients

PCP in 7 DaysAll Enrolled Patients

Current CMI Panel Size

Graduated

Total Enrolled

0

5

10

15

20

25

30

Days Since Last Patient Encounter

Link2Care Dashboard 2 Week Ending 7/26/14

Home Visit in 72 HoursAll Enrolled Patients

PCP in 7 DaysAll Enrolled Patients

61

Current CMI Panel Size

Graduated

Total Enrolled

Days Since Last Patient Encounter0

5

10

15

20

25

30

35

40

45

50

55

60

65

70

75

80

Running Sum of Currently Enrolled

Removed 'Lossed to Fol-low-up'

Running Panel Size

Dashboards


Actions Taken • Weekly scorecard to measure success and failure

• Daily operations dashboard to identify opportunities

• Weekly root cause deep dives by management team

Problem The stated goal of our intervention was to see our patients once a week in person. Too many failures were occurring and our relationship with patients was diluting

Results• Reduced median days since last engagement

• Dramatically reduced process variability & outliers

WEEK 1 WEEK 10

168 DAYS

38 DAYS

Days Since Last In-Person Engagement


Time N Minimum Maximum Mean Standard DeviationPre 186 2 10 2.9 1.43Post 186 0 11 1.3 1.77

October-1

2

November-12

December-1

2

January-13

Febru

ary-13

March-13

April-13

May-13

June-13

July-13

August-13

September-13

October-1

3

November-13

December-1

30.00

0.50

1.00

1.50

2.00

2.50

Number of 6x month readmissionsby enrollment date


§3 Choosingan appropriate

evaluation timeline


Planning &Data Analysis

Piloting and Early Evaluation

More RobustEvaluation (throughRandomization)

Scaling

Program Timeline


80%

Medical Studies


20%

Healthcare Delivery Studies


KeyIssues

Sample Size

Number of treatment arms

Randomizing before or after consent?

Data (what’s collected administratively?-available for the control group?

When? Timing – not too early and not too late

Time, expertise, and funding to do it right

Why? Clear, credible results on causal effects

Helpful in attracting sustainable funding and scaling a program


Standard ofCare

Key Outcomes: reduced re-hospitalizations and ED visits in 12 month period following discharge

CCHP’s Care Management RCT

n = 138 / 800

camden coalition of healthcare providers evaluating

Documents

data slide

program slide

mean slide

evaluation framework

person engagement slide

complex intervention

enrollment date slide

healthcare delivery