HEDIS is a set of standardized performance measures designed

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Monitoring Evaluation

• Summary so far-----
• The mission is understood and we can act within
  its boundaries
• The needs and wants have been identified
• Needs and wants/desires prioritized
• Goals established
• Objectives developed, both process and outcome
  for the community (ABCD)

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Monitoring Evaluation

• Intervention plans complete with programs
  designed and the other Ps completed

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Monitoring Evaluation

• Why are we jumping to Evaluation? What about
  Marketing?
• Within the intervention, part of the program
  planning was undoubtedly
• Marketing (Chapter 13)
• Marketing is the need to communicate effectively
  the messages - throughout the components-

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Marketing is Communication

• Need to communicate- market -effectively the
  messages - throughout the components- including
  when
• determining needs/desires
• setting priorities (How were they determined?)
• determining goals and objectives
• developing intervention strategies
• Marketing could have been in the center as well

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Evaluation as a central component
Evaluation as a central component
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Obj 1. Describe how the evaluation component is
part of the overall management process

• It is seen in management texts as
• controlling (planning, organizing, leading and
  controlling)
• Monitoring
• Benchmarking
• (is the process by which a company compares its
  performance with that of other companies then
  learns how the strongest-performing companies
  achieve their results)

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Obj 1. Describe how the evaluation component is
part of the overall management process

• Public Health See in conjunction with
• monitoring
• controlling --- costs
• Functions of public health
• Assessing
• Assuring
• Policy development

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Obj 1. Describe how the evaluation component is
part of the overall management process

• Measurement vs. Evaluation
• Measurement is the assignment of numbers to
  objectives, events, concepts- - - -
• Evaluation is clarifying, estimating, ranking
  rating, surveying or weighting factors. It
  includes measurement.

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Kinds of evaluation

• Summative is research conducted at the end of a
  program that helps determine whether a program
  was effective and how it might be improved
• Formative is the process of testing and
  assessing certain elements of a program before it
  is implemented fully
• A pilot of materials, methods where data are
  collected on what does and doesnt work.

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Kinds of evaluation

• Impact Evaluates programs methods and
  activities to determine if resulted behavioral
  changes have occurred in client or community
  given the methods/activities.
• Outcome Measurable, measuring a change in one or
  more aspects of the communitys behaviors e.g.
  health status.
• The outcome of the research had an impact on
  the community

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Obj 2. List describe evaluation as a function
of public health

• Core functions of public health are
• Assessment
• Policy Development
• Assurance
• Where is evaluation?

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Evaluation in the core functions of Public Health

• Assessment (chapter 10)
• Assess needs/desires
• Compare to standards- - report differences --
• set priorities and make changes
• Figure 10-3-- review

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Evaluation in the core functions of Public Health

• Policy Development
• Based on gathering and presenting evaluation data
  from programs and services
• e.g. of monitoring SLP vs. providing more fruit
  and vegetables along with education
• Allow companies to calcium fortify favorite
  foods (fortify soda) or get nutrients from foods
  that naturally contain calcium.

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Evaluation in the core functions of Public Health

• Assurance
• development and maintenance of services and
  activities needed to maintain an adequate, safe
  food supply for optimal nutrition and health of
  populations. Assure services !
• Requires monitoring of existing services related
  to needs and determining the difference OR
  EVALUATION

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Obj 3. Differentiate the terms used to measure
quality in providing food nutrition services

• Terms that identify quality control and
  management functions of healthcare organizations
• QA
• TQM
• CQI
• QI

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Obj 4. Describe explain the roles of JCAHO
(JACHO), OBRA, HEDIS

• JCAHO (Joint Commission On Accreditation Of
  Healthcare Organizations-- an accreditation body
• largest accrediting body
• participation is NOT mandatory but hospitals do
  participate

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• Are hospitals the only facilities that are
  accredited by JACHO
• No! Nursing homes, Community Health Centers
• See http//www.jeffdanger.com/JACHO.htm ,
  accessed 2/27/04
• This site has a good and funny description of
  JCAHO
• With readers responses. It is a private site so
  it can say what it wants.
• HCFA Health Care Finance Administration (now
  Center for Medicare and Medicaid)

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JCAHO website

• www.jcaho.org
• See also Montanas Primary Care Association
  JACHO site www.mtpca.org/jcaho-ws.htm
  accessed 2/27/04

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Indicators

• See box p 321
• Clinical
• Process
• Outcome

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• How many JCAHO surveyors does it take to change a
  lightbulb? 25 -

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• One to change the light bulb and twenty-four to
  write the standards ...

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Obj 4. Describe explain the roles of JACHO,
OBRA, HEDIS

• Be able to differentiate
• OBRA-contains goals for caring properly for the
  residents of long-term care facilities and elders

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OBRA

• In 1987, President Ronald Reagan signed into law
  the first major revision of the federal standards
  for nursing home care since the 1965 creation of
  both Medicare and Medicaid 42 U.S.C1396r, 42
  U.S.C. 1395i-3, 42 CFR 483.
• The landmark legislation changed forever
  societys legal expectations of nursing homes and
  their care. Long term care facilities wanting
  Medicare or Medicaid funding are to provide
  services so that each resident can attain and
  maintain her highest practicable physical,
  mental, and psycho-social well-being.

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Why OBRA is not going to improve care

• The Minimum Data Set (MDS) focuses mainly on a
  person's ability to function (eating, continence,
  etc.). The Resident Assessment Protocols (RAPs)
  offer some guidance on defining problems and
  identifying their causes. But they both skip many
  important details, especially about methods for
  making and recognizing appropriate care
  decisions.
• Am Medical Directors Association

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Dietitians Role
Poor advice from surveyors tends to reinforce
outmoded practices. Regulations ask surveyors
"Do the dietitian and the speech therapist
determine the optimum textures and consistency
for the resident's food that provide both a
nutritionally adequate diet and effectively use
oropharyngeal capabilities of the resident?" But
they don't state that coughing and choking during
meals may be caused by conditions that require
evaluation by doctors and nurses before a
dietitian or speech therapist is brought in. The
result? Many nursing homes have shifted the
primary responsibility for diagnosing and
managing anyone with an eating problem to
dietitians and speech therapists. Thus, residents
may receive unnecessary diet restrictions and
doctors and nurses may miss important causes of
eating problems.
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HEDIS-Health Plan Employer Data and Information
Set.

• HEDIS is a set of standardized performance
  measures designed to ensure that purchasers and
  consumers have the information they need to
  reliably compare the performance of managed
  health care plans.
• Health plans can be compared Employer can
  understand value of the health care dollarHolds
  health plan accountable
• http//www.ncqa.org/Programs/HEDIS/ accessed
  3/2002

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Obj 5. Describe the National Nutrition Monitoring
Related Research (NNMRR) Program

• Agencies that monitor - USDA DHHS developed a
  10 year monitoring plan (NNMRR)
• http//www.barc.usda.gov/bhnrc/foodsurvey/pdf/Tren
  ds.pdf

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NNMRR

• Changed
• Recommend a standardized mechanism and
  instrument(s) for defining and obtaining data on
  the prevalence of food insecurity or food
  insufficiency in the United States and
  methodologies that can be used across the NNMRR
  Program and at State and local levels. 04

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• Page 324 National Studies and Surveys
• Appendix 13B Federally funded surveys and
  studies.
• PNSS PedNSS, BRFSS, YRBSS (See Ch 6 assignment
  and review how you would use)

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What is the difference?

• Nutrition Surveys
• Nutrition Surveillance
• Continuous watching over list one ____

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Other Studies/surveys

• NFCS
• CSFII
• NHANES
• NHIS
• US Census
• HDS
• BRFSS
• PNSS

• PedNSS
• NMIHS

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Obj 6. Define cost-effectiveness cost-benefit
analysis (No test questions)

• Cost effectiveness relates to other alternatives
  for achieving the same outcome-- is this the
  effective method over another input or method
• Cost benefits Was the investment a net gain or
  loss. WIC 1 saves 3 in intensive care costs

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• What is the cost savings for AIDs patient who
  received MNT?
• What was the cost savings for an Arizona
  dietitian treating a patient with gestational
  diabetes?
• What is the difference in cost between delivering
  a very-low birth weight infant and a normal
  infant?

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Priority setting and cost effectiveness

• Why prioritize when there isn't enough money?
  byDaniel Wikler Department of Population and
  International Health, Harvard School of Public
  Health, Boston MA 02115, USACost Effectiveness
  and Resource Allocation 2003, 15The electronic
  version of this article is the complete one and
  can be found online at http//www.resource-alloca
  tion.com/content/1/1/5

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• Bring to class examples of cost effectiveness and
  dietetic practice.
• We will collect and discuss
• (Not in 04