Click to edit Master title style Overview
Click to edit Master title style Background Methods and Optimity Matrix have been engaged to undertake a formative evaluation of three sites from the earlier New Models of Care (Accelerate) programme. These sites have since joined Pioneers through the Wave Two selection process. We are sharing the approach and learning with all Pioneers. The NMoC (Accelerate) Programme formative evaluation involves working closely with local health economies to review and provide constructive feedback on the design and implementation of the programme locally and nationally. This Webinar is one of the evaluation feedback mechanisms to help maximise success for each of the health economies involved in the Pioneer Programme.
Click to edit Master title style Learning outcomes By the end of the session you should be able to: • Identify the key steps for planning and implementing an evaluation, including what happens after the evaluation; • Identify the basic principles of economic evaluation; • Utilise the information provided and the key resources to avoid some of the common evaluation pitfalls.
Click to edit Master title style Planning an evaluation in 6 steps 1. Identifying the evaluation audience and objectives; 2. Identifying what type of evaluation is appropriate; 3. Setting out the evaluation governance structure; 4. Deciding and allocating the resources required ; 5. Identify the data requirements; and 6. Setting out the timing of the evaluation.
Click to edit Master title style Understanding the programme logic Logic model sets out what it is the intervention/programme is supposed to achieve and how • Examining the validity of the intervention logic helps to: – Ask the right questions when designing the evaluation; – Detect and analyse flaws or shortcomings that may become apparent in the later stages of the evaluation; and – Identify key lessons learned.
Click to edit Master title style A visual representation of a logic model
Click to edit Master title style Defining the logic model components
Click to edit Master title style Developing an evaluation plan Why develop an evaluation plan? • Identifies how you will conduct the evaluation, what resources you will need, your evaluation objectives and evaluation stakeholders When to develop an evaluation plan? • Start early — before you implement a programme or initiative How to develop an evaluation plan? • 4 main steps: • Clarify programme objectives and goals • Develop evaluation questions • Develop evaluation methods • Set up a timeline for evaluation activities
Click to edit Master title style Setting the right objectives Objectives should always be SMART (specific, measureable, achievable, realistic and time-specific) Should also include an indication of: • What behaviour you are trying to change • Who is the target population for this change • How much change is expected • When this change will be measured (over what time period) For example: • By the end of the programme , 98% participants (people 65+ with 3 or more comorbid conditions) will report successfully receiving day-to-day LTC services in an extensivist clinic setting Should be achievable and consider what can realistically be achieved in terms of scale and scope in the given time and resources
Click to edit Master title style Setting evaluation indicators How will the questions will be answered (indicators) • Are they measureable quantitatively or qualitatively? Decide where this information will come from (data source) • From monitoring data or by collecting information from patients? Decide how you will gather this information (method) • Using surveys, interviews, focus groups or will it come from an existing data source?
Click to edit Master title style Developing evaluation methods Monitoring and feedback systems • Process and outcome measures • Observational system for live monitoring Satisfaction surveys (staff and/or patients) • Goals, process and outcome measures Behavioural surveys Interviews and/or focus groups with patients/staff Wider-measures of impact (incl economic impact)
Click to edit Master title style Establishing a comparison group You need a comparison population to establish what would have happened if there was no change and this can be done by: • Population segmentation and matching with a similar population based on key characteristics; • Participant who were invited, but declined to participate in the programme; and • If no comparison group is possible can use a pre- and post-test with programme participants. Range of statistical techniques to help segment your population by characteristics of interest so that you can match for the purpose of comparing the intervention’s impact • Population segmentation: regression analysis, latent class analysis, etc. • Matching: propensity score matching, etc.
Click to edit Master title style Key concepts for economic evaluation Answers evaluation questions related to effectiveness or added-value To assess cost-effectiveness of interventions, three key pieces of information are needed:
Methods for conducting economic Click to edit Master title style evaluation
Click to edit Master title style Determining the economic benefits In order to convert the costs, health effects and economic benefits into a measure of cost-effectiveness we need to compare an intervention to a counterfactual • A counterfactual is usually what is currently in place (such as usual care) to deal with the problem under consideration. It is quite common for the counterfactual to be a “do nothing” scenario, for example what would happen if no intervention were available • Cost, health effects and economic benefits are calculated for both the counterfactual and the intervention • The incremental costs and economic benefits (the difference) between the counterfactual and intervention is used to generate an Incremental Cost Effectiveness Ratio
Click to edit Master title style An economic decision tree
Click to edit Master title style Determining cost-effectiveness Incremental Cost Effectiveness Ratio (ICER) = Incremental costs / Incremental benefits = (A-B)/ (C-D) ICER =< £20,000 - Cost effective
Click to edit Master title style What to do with evaluation information?
Click to edit Master title style Common pitfalls to avoid Ensure that there is a clear evidence base for the problem you are trying to address with your programme • Documented and evidenced case for change • Might require a feasibility study Build evaluation into programme design • Start early--do not wait until the programme/pilot is over before thinking about evaluating Ensure that your objectives are clear, concise, measurable and achievable • You will need to spend enough time to get these right and to ensure that all involved are on the same page Evaluation requires objectivity • Someone involved in the design and delivery of the programme should not conduct the evaluation • You will need to identify and allocate the appropriate resources for this activity Transparency is crucial • Keep a well documented, auditable paper trail of decisions and decision-making Engage all of the appropriate stakeholders • Know who these are and have a plan for how they will be engaged and when
Click to edit Master title style Useful evaluation resources Personal Social Services Research Unit • Examples of health and social care evaluations: http://www.pssru.ac.uk/index.php CDC Framework for Evaluation • Guidance and materials for pubic health programmes: http://www.cdc.gov/eval/framework/ HM Treasury Magenta Book • Guidance for designing public policy/intervention evaluations: https://www.gov.uk/government/publications/the-magenta-book European Commission’s Evaluation Guidelines • Comprehensive guidance for undertaking evaluation in the context of the EU: http://ec.europa.eu/smart-regulation/evaluation/index_en.htm Better Evaluation • Online evaluation community, guidance, resources and examples: http://betterevaluation.org/ Evaluation Toolbox • Resources and guidance: http://evaluationtoolbox.net.au/ Public Health England Standard Evaluation Frameworks • Specific evaluation frameworks for PH interventions http://www.noo.org.uk/core/frameworks
Scenario discussion 30 minutes
Click to edit Master title style Integrated care scenario Banbridge Integrated Care was launched in April 2014. The service is delivered by a collaboration between Banbrigde Community Health Services, Banbridge NHS Foundation Trust and Borough of Banbridge Social Care. It is open to all adults living in Banbridge with the aim of maintaining independence in the community and preventing unnecessary A&E attendances, hospital and care home admissions and delayed discharges. Users and staff access the service via a single point of contact which incorporates the referral pathways and immediately addresses user needs. Integrated health and social care teams provide a whole system response to intermediate care, hospital discharge, urgent care, and community rehabilitation. All teams have shared access to a re-ablement service.
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