Assignment: Assessing A Healthcare Program/Policy Evaluation
Review the healthcare program or policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.Assessing A Healthcare Program Policy Evaluation Essay
The Assignment: (2–3 pages)Assessing A Healthcare Program Policy Evaluation Essay

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Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:

Describe the healthcare program or policy outcomes.
How was the success of the program or policy measured?
How many people were reached by the program or policy selected?
How much of an impact was realized with the program or policy selected?
At what point in program implementation was the program or policy evaluation conducted?
What data was used to conduct the program or policy evaluation?
What specific information on unintended consequences was identified?
What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
Did the program or policy meet the original intent and objectives? Why or why not?
Would you recommend implementing this program or policy in your place of work? Why or why not?
Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation.Assessing A Healthcare Program Policy Evaluation Essay

Over the past decade the private and public sectors have made large community-based investments in improving population health. Many of these investments have been made in multisector coalitions that seek to improve specific communitywide health outcomes, such as reductions in obesity or smoking. Through their programs, these coalitions develop consensus on targeted health outcomes, potential metrics, and programs for implementation; align existing resources in community-based organizations; and implement evidence-based interventions to fill programmatic gaps. Despite often substantial financial investment, little is known about the relationship between the implementation of a health improvement program and the subsequent health status of the community.

Previous studies of community-based health improvement programs have found that they are influential in changing individual behavior and health-related community policies1,2 but do not produce significant changes in health outcomes, even after ten years.3–8 Much of the earlier literature that demonstrated positive changes in attributable health outcomes was limited to smaller, health care–oriented interventions, specific racial or ethnic groups, or highly specific health conditions.9–12 A more recent study investigating self-reported public health coalition activity found that greater planning activity was associated with reductions in mortality.13

These previous reports highlight the challenges inherent in evaluating community-based health improvement programs. Communities that implement these programs might not have sufficient resources to collect data or measure health outcomes. Evaluations of these programs typically rely on easily collectible data and pre-post designs without comparison or control communities. And because these evaluations do not adjust for secular trends, it is difficult to link program implementation to changes in health behavior, attitudes, or outcomes. Nevertheless, the economic and human capital investments being made in health improvement programs warrant the use of more rigorous research designs.Assessing A Healthcare Program Policy Evaluation Essay

This study used a pre-post design with county-level health status comparisons to evaluate community-based health improvement programs implemented in the period 2007–12. By combining multiple programs into a single analysis, examining changes in specific health outcomes, and using a more rigorous design, this study provides insight into such programs’ potential to make positive changes in population health outcomes. Our analysis also demonstrates important threats to the validity of commonly used evaluation designs.Assessing A Healthcare Program Policy Evaluation Essay

STUDY DATA AND METHODS
Because many of the communities in our data set implemented programs at the county level, we focused on the association between these programs and county-level health outcomes. We used multiple sources of publicly available data to create an inverse propensity-weighted set of controls for conducting multiple regression analyses.

DATA
We conducted extensive internet searches for relevant community-based health improvement programs and contacted leaders at national foundations and governmental agencies engaged in population health efforts to identify an initial set of programs to examine. Through snowball-sampled conversations with these leaders and, subsequently, with leaders of the programs, we attempted to define the universe of programs that met our program criteria. (For the programs included in our analysis, see online appendix exhibit 1.)15 We shared this list with major foundations and agencies operating in this area to ensure that we identified all relevant programs, and we iterated our identification strategy based on their feedback.

We then defined the geographical areas (or program sites) covered by each implemented program. Most program sites involved only a single county, or a large metropolitan area within a county, but others encompassed multicounty regions. The majority of the programs were implemented at the county level, and programs serving areas larger than a county could be disaggregated to the county level, which suggested that county-level analysis was most appropriate for this study.Assessing A Healthcare Program Policy Evaluation Essay

We included communities that implemented a program in the period 2007–12 if their program included multiple sectors, such as private industry, health care organizations, and public health departments; were externally funded; or received guidance, oversight, or technical assistance from a national coordinating agency. These selection criteria intentionally omitted many programs implemented by county or city health departments using federal or state grant money. Identifying programs in a less restrictive way would have introduced greater variability in the kind, intensity, and duration of the programs, which would have decreased the precision of the estimated effects and would have made it difficult to generalize findings to programs with specific characteristics.

We identified four programs implemented at fifty-two sites that collectively encompassed 396 counties (appendix exhibit 1 lists organization names and overall characteristics of the four programs included in our study).15 We classified each site by its foci (sites within programs could have different foci, and sites could also have multiple foci). Sites were classified as focusing either on overall health and well-being (two) or on specific health outcomes—namely, child health (six), tobacco control (twenty-three), diabetes (eight), obesity (thirty-eight), or other health outcomes (nineteen). Additionally, we identified each program’s year of implementation, as well as the year of its termination (if applicable).Assessing A Healthcare Program Policy Evaluation Essay

The outcome variables were county-level health outcomes obtained from the Selected Metropolitan/Micropolitan Area Risk Trends (SMART) data for the period 2002–12 from the Behavioral Risk Factor Surveillance System (BRFSS). BRFSS county-level SMART estimates are derived from metropolitan and micropolitan statistical areas (MMSAs) that have at least 500 respondents in a given year and 19 sample members in each MMSA-level stratification category (such as race, sex, or age groups).16 County-level estimates are weighted by procedures that employ known population demographics produced by the decennial census and American Community Survey.16 Over our study period, an average of 7.36 percent of US counties were included in the SMART data. The units of analysis for our study are county-year dyads.

We linked the SMART data and program data to county-level estimates of poverty and demographic and employment characteristics. Poverty data, including median household income and percentage living in poverty, were obtained from the Small Area Income and Poverty Estimates, produced annually by the Census Bureau.17 County-level age composition was obtained from Surveillance, Epidemiology, and End Results Program data, produced annually by the National Cancer Institute.18 Employment data were obtained from the Local Area Unemployment Statistics program of the Bureau of Labor Statistics.Assessing A Healthcare Program Policy Evaluation Essay

ANALYSES
Descriptive statistics of the number and type of community-based programs over time were produced. We then used inverse propensity score treatment weighting to reweight treatment and control counties. Regression analyses were conducted using a difference-in-differences design and an event study.Assessing A Healthcare Program Policy Evaluation Essay

Our goal was to evaluate the implementation of any program, a tobacco-focused program, and an obesity-focused program. We examined programs that focused on tobacco and obesity separately because of the direct link between the implementation of these programs and changes in specific health outcomes captured in the SMART data. Additionally, we chose to focus on tobacco and obesity programs because of their growth in numbers over the study period. This growth was attributable, in part, to funding provided by the American Recovery and Reinvestment Act of 2009, which required a focus on tobacco control or obesity.

For each type of program, we were interested in the association between implementation and three county-level self-reported health outcomes: whether respondents reported being in poor or fair health, smoking status, and obesity status. We chose overall health because of the potential of any program to improve this outcome, and we chose smoking and obesity status because of our emphasis on tobacco- and obesity-focused programs. Programs that focused on other health priorities, such as diabetes and hypertension, may also improve smoking and obesity status, making the latter two outcomes relevant to a broader set of programs.Assessing A Healthcare Program Policy Evaluation Essay

INVERSE PROPENSITY SCORE TREATMENT WEIGHTING
We employed inverse propensity score treatment weighting, using changes in pre-implementation covariates to reweight untreated counties to achieve greater balance on observed covariates and create a more appropriate control group.20 We assessed the balance of observed covariates using standardized differences.21 These inverse propensity weights were then used in all subsequent regression analyses. (For details on the methodology, see the appendix.)15

DIFFERENCE-IN-DIFFERENCES ANALYSIS
We used difference-in-differences regression analysis to evaluate the association between the implementation of a health improvement program and county-level health outcomes.22 Because some of the counties in our data set were included in both the treatment and control groups, depending on the year of implementation, we also employed a difference-in-differences design in which only counties that did not implement a program during the study period were included in the control set. All regression models included county and year fixed effects. We clustered standard errors at the county level to address autocorrelation.

EVENT STUDY
To examine possible pretreatment trends in the study counties, we also used an “event study” design, which compared annual average outcomes for treated counties in each year leading up to and after the county implemented a health improvement program.23,24 Each of these models also included county and year fixed effects, the same covariates that were included in our difference-in-differences analysis, and clustered standard errors at the county level.

SENSITIVITY ANALYSES
Communities that implemented a population health improvement program may be intrinsically different from communities that did not. This endogeneity presents a problem in the regression analyses above. One way to mitigate the potential biases attributed to endogeneity is to parse out programs where selection is less of an issue. Our data set included counties that were selected for the Communities Putting Prevention to Work program,25 which was funded by the Centers for Disease Control and Prevention under the American Recovery and Reinvestment Act. Funding for this program was competitive, and communities that received funding had to demonstrate in their applications that they were “shovel ready” (that is, had developed the necessary coalition, infrastructure, or capacity to begin implementing evidence-based programs as soon as funding was obtained).

Additionally, there may be countercyclical effects on health resulting from the Great Recession (2007–09).26 To address this concern, we excluded counties that received a Communities Putting Prevention to Work grant. These programs were implemented as a direct result of the recession, and counties that received these grants may have been more susceptible than other counties were to the countercyclical effects of the economic downturn.Assessing A Healthcare Program Policy Evaluation Essay

All analyses were conducted using Stata, version 15. The Vanderbilt University Institutional Review Board considered this study exempt from review, based on its use of publicly available data.

LIMITATIONS
This study, like many quasi-experimental studies, had several limitations. First, counties with a health improvement program have economic and demographic characteristics that differ significantly from those of counties without such a program. Because these differences could be related to both the health outcomes of interest and the probability of treatment, our estimates could be biased. However, when we limited our analyses to programs that had received funding through the American Recovery and Reinvestment Act, a group arguably less subject to selection bias than the group of programs that was not competitively selected, we found that programs funded through the act were not associated with significantly different changes in county-level health or smoking status or obesity when compared to programs that had not received funding through the act.

Second, although the list of programs, their foci, and their years of implementation have been validated by the program staff of funders in this area, including large nonprofit organizations and governmental agencies, there is still a possibility that some unpublicized programs were excluded from this analysis. Additionally, we did not measure the intensity (that is, the number of interventions implemented or the number of people reached) of the implemented programs or the amount of financial resources invested. Failure to capture variations in these programs could also mask the true effects of larger, more resourced, or better-administered programs.

Third, programs could have different effects depending on the baseline levels of health conditions or behaviors. For example, we found some evidence to suggest that among counties with higher baseline rates of people who reported poor or fair health, implementation of a health improvement program was associated with significant decreases in the proportion of residents reporting such health. This type of analysis was beyond the scope of this study, but it merits further investigation.Assessing A Healthcare Program Policy Evaluation Essay

Fourth, while our identification and classification strategy included the stated health outcome foci of these programs, we did not necessarily capture the full range of intended outcomes. For some communities, the intended outcome of the health improvement program could be changes to policies or procedures; for others, the goal could have been improvements in health education and knowledge or changes in health behaviors and outcomes. While all of these policies and programs may eventually lead to changes in health outcomes, such changes might not be the only or best source of measurement for all programs. Despite the validation of our selection criteria and the use of small-area estimates for health outcomes, obtaining adequate data for the evaluation of programs was difficult.

Finally, small-area estimates from the BRFSS SMART data are known to have measurement error, which could result in inflated standard errors. Thus, relying on existing sources of aggregate data would be problematic even for communities that may conduct more rigorous evaluations of their programs in the future. Additional data gathering for evaluation from both implementation and non-implementation counties may be necessary and could prove to be a challenge, in terms of both the quality of the data and the time and resources required. Despite these limitations, this study used the best data and most rigorous methods available to estimate the relationship between health program implementation and county-level health outcomes.

STUDY RESULTS
The number of health improvement program sites grew substantially over the study period, from fourteen in 2007 to fifty-two in 2012. The number of counties with a health improvement program also grew, from 319 in 2007 to 396 in 2012. Before 2010, most of the programmatic sites were focused on child health or other health priorities. With the start of funding through the American Recovery and Reinvestment Act in 2010, the number of tobacco- and obesity-focused sites grew substantially, from one each in 2007 to twenty-four and thirty-seven, respectively, in 2012 (exhibit 1). While the relative share of programs that focused on hypertension, child health, and other health priorities decreased after 2009, the absolute number of these programs either remained the same or grew.Assessing A Healthcare Program Policy Evaluation Essay

Exhibit 1 Numbers of community-based health improvement programs and their health outcome foci, 2007–12

Exhibit 1
SOURCE Authors’ analysis of selected community-based health improvement program data. NOTES The number of programs is cumulative over time. Programs with more than one focus are counted in each of their foci. Over this period, four programs were implemented at fifty-two sites that collectively contained 396 counties. The first program was implemented in 2007.
Before the implementation of any health improvement program (that is, in 2002–06), there were significant differences between counties that did and did not implement a program in the period 2007–12. Compared to non-implementing counties, the counties with a health improvement program had a larger share of young adults (ages 20–39) but a smaller proportion of nonelderly adults (ages 40–64) (exhibit 2). Additionally, counties with a program had significantly higher proportions of their populations living in poverty and higher rates of unemployment. Our inverse propensity treatment reweighting, however, achieved balance among observable covariates in the pre-implementation period (appendix exhibit 3)

Nurses can play a very important role assessing program/policy evaluation for the same reasons that they can be so important to program/policy design. Nurses bring expertise and patient advocacy that can add significant insight and impact. In this Assignment, you will practice applying this expertise and insight by selecting an existing healthcare program or policy evaluation and reflecting on the criteria used to measure the effectiveness of the program/policy.Assessing A Healthcare Program Policy Evaluation Essay

NOW

To Prepare:

· Review the Healthcare Program/Policy Evaluation Analysis Template provided in the Resources.

· Select an existing healthcare program or policy evaluation or choose one of interest to you.

· Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.

The Assignment: (2–3 pages)

Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:

· Describe the healthcare program or policy outcomes.

· How was the success of the program or policy measured?

· How many people were reached by the program or policy selected?

· How much of an impact was realized with the program or policy selected?

· At what point in program implementation was the program or policy evaluation conducted?

· What data was used to conduct the program or policy evaluation?

· What specific information on unintended consequences was identified?

· What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.

· Did the program or policy meet the original intent and objectives? Why or why not?

· Would you recommend implementing this program or policy in your place of work? Why or why not?

· Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation

Required Readings

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.

Chapter 7, “Health Policy and Social Program Evaluation” (pp. 116–124 only)
Glasgow, R. E., Lichtenstein, E., & Marcus, A. C. (2003). Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. American Journal of Public Health, 93(8), 1261–1267.Assessing A Healthcare Program Policy Evaluation Essay

Note: You will access this article from the Walden Library databases.

Shiramizu, B., Shambaugh, V., Petrovich, H., Seto, T. B., Ho, T., Mokuau, N., & Hedges, J. R. (2016). Leading by success: Impact of a clinical and translational research infrastructure program to address health inequities. Journal of Racial and Ethnic Health Disparities, 4(5), 983–991. doi:10.1007/s40615-016-0302-4

Williams, J. K., & Anderson, C. M. (2018). Omics research ethics considerations. Nursing Outlook, 66(4), 386–393. doi:10.1016/j.outlook.2018.05.003

Note: You will access this article from the Walden Library databases.

RUBRIC

Excellent

Good

Fair

Poor

Program/Policy Evaluation

Based on the program or policy evaluation you seelcted, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:

· Describe the healthcare program or policy outcomes.
· How was the success of the program or policy measured?
· How many people were reached by the program or policy selected? How much of an impact was realized with the program or policy selected?
· At what point in time in program implementation was the program or policy evaluation conducted?Assessing A Healthcare Program Policy Evaluation Essay

32 (32%) – 35 (35%)

Response clearly and accurately describes in detail the healthcare program or policy outcomes.

Response accurately and thoroughly explains in detail how the success of the program or policy was measured.

Response clearly and accurately describes in detail how many people were reached by the program or policy and fully describes the impact of the program or policy.

Response clearly and accurately indicates the point at which time the program or policy evaluation was conducted.

28 (28%) – 31 (31%)

Response accurately describes the healthcare program or policy outcomes.

Response accurately explains how the success of the program or policy was measured.

Response accurately describes how many people were reached by the program or policy and accurately describes the impact of the program or policy.

Response accurately indicates the point at which time the program or policy evaluation was conducted.

25 (25%) – 27 (27%)

Description of the healthcare program or policy outcomes is inaccurate or incomplete.

Explanation of how the success of the program or policy was measured is inaccurate or incomplete.

Description of how many people were reached by the program or policy and the impact is vague or inaccurate.

Response vaguely describes the point at which the program or policy evaluation was conducted.

0 (0%) – 24 (24%)

Description of the healthcare program or policy outcomes is inaccurate and incomplete, or is missing.

Explanation of how the success of the program or policy was measured is inaccurate and incomplete, or is missing.

Description of how many people were reached by the program or policy and the associated impacts is vague and inaccurate, or is missing.Assessing A Healthcare Program Policy Evaluation Essay

Response of the point at which time the program or policy was conducted is missing.

Reporting of Program/Policy Evaluations

· What data was used to conduct the program or policy evaluation?
· What specific information on unintended consequences was identified?
· What stakeholders were identified in the evaluation of the program or policy? Who would benefit the most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
· Did the program or policy meet the original intent and objectives? Why or why not?
· Would you recommend implementing this program or policy in your place of work? Why or why not?
· Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation.

45 (45%) – 50 (50%)

Response clearly and accurately identifies the data used to conduct the program or policy evaluation.

Response clearly and thoroughly explains in detail specific information on outcomes and unintended consequences identified through the program or policy evaluation.

Response clearly and accurately explains in detail the stakeholders involved in the program or policy evaluation.

Response clearly and accurately explains in detail who would benefit most from the results and reporting of the program or policy evaluation.

Response includes a thorough and accurate explanation of whether the program met the original intent and outcomes, including an accurate and detailed explanation of the reasons supporting why or why not.

Response includes a thorough and accurate explanation of whether the program should be implemented, including an accurate and detailed explanation of the reasons supporting why or why not.Assessing A Healthcare Program Policy Evaluation Essay

40 (40%) – 44 (44%)

Response accurately identifies the data used to conduct the program or policy evaluation.

Response explains in detail specific information on outcomes and unintended consequences identified through the program or policy evaluation.

Response explains in detail the stakeholders involved in the program or policy evaluation.

Response explains who would benefit most from the results and reporting of the program or policy evaluation.

Response includes an accurate explanation of whether the program met the original intent and outcomes, including an accurate explanation of the reasons supporting why or why not.

Response includes an accurate explanation of whether the program should be implemented, including an accurate explanation of the reasons supporting why or why not.

35 (35%) – 39 (39%)

Response vaguely or inaccurately identifies the data used to conduct the program or policy evaluation.

Explanation of specific information on outcomes and unintended consequences identified through the program or policy evaluation is vague or incomplete.

Explanation of the stakeholders involved in the program or policy evaluation is vague or inaccurate.

Explanation of who would benefit most from the results and reporting of the program or policy evaluation is vague or inaccurate.

Explanation of whether the program/policy met the original intent and outcomes and the reasons why or why not is incomplete or inaccurate.

Explanation of whether the program or policy should be implemented, and the reasons why or why not, is incomplete or inaccurate.Assessing A Healthcare Program Policy Evaluation Essay

0 (0%) – 34 (34%)

Identification of the data used to conduct the program or policy evaluation is vague and inaccurate, or is missing.

Explanation of specific information on outcomes and unitended consequences identified through the program or policy evaluation is vague and incomplete, or is missing.

Explanation of the stakeholders involved in the program or policy evaluation is vague and inaccurate, or is missing.

Explanation of who would benefit most from the results and reporting of the program or policy evaluation is vague and inaccurate, or is missing.

Explanation of whether the program or policy met the original intent and outcomes and the reasons why or why not is incomplete and inaccurate, or is missing.

Explanation of whether the program or policy should be implemented, and the reasons why or why not, is incomplete and inaccurate, or is missing.

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.

5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.Assessing A Healthcare Program Policy Evaluation Essay

4 (4%) – 4 (4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive.

3.5 (3.5%) – 3.5 (3.5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%- 79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic.

0 (0%) – 3 (3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion was provided.

Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation

5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors.

4 (4%) – 4 (4%)

Contains a few (1-2) grammar, spelling, and punctuation errors.

3.5 (3.5%) – 3.5 (3.5%)

Contains several (3-4) grammar, spelling, and punctuation errors.

0 (0%) – 3 (3%)

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. Assessing A Healthcare Program Policy Evaluation Essay

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