Evaluating Medical Home constructs for children with special needs: integrating theory and logic models

Dance Your Heart Out: A Community's Approach to Addressing Cardiovascular Health by Using a Logic Model

Cardiovascular health has been identified as a prioritized community health need according to recent community health needs assessment data. While the Affordable Care Act mandates that nonprofit hospitals conduct a community health needs assessment, little guidance exists on how to address the identified needs. Logic models provide systematic structure and necessary direction in how communities can start to address their identified health needs. Completing logic models in a nonlinear fashion is encouraged to employ a strengths-based approach and verify the logic. This article provides an application of logic models as one strategy to generate a community-based program theory to improve cardiovascular health.

Evaluation of Diverse Community Asthma Interventions: Balancing Health Outcomes with Developing Community Capacity for Evidence-Based Program Measurement

The challenge of evaluating community asthma management programs is complicated by balancing the emphasis on health outcomes with the need to build community process capacity for conducting and monitoring evidence-based programs. The evaluation of a Georgia Childhood Asthma Management Program, a Healthcare Georgia Foundation-supported initiative for multiple diverse programs and settings, provides an example of an approach and the results that address this challenge. A "developmental evaluation" approach was applied, using mixed methods of quantitative and qualitative data collection and analysis, to assess the progress of community asthma prevention programs in building community within the context of: where the community is starting, community-level systems changes, and the community's progress toward becoming more outcome measurement oriented and evidence based. Initial evaluation efforts revealed extensive mobilization of community assets to manage childhood asthma. However, there were minimal planned efforts to assess health outcomes and systems changes, and the lack of a logic model-based program design linking evidence-based practices to outcomes. Following developmental technical assistance within evaluation efforts, all programs developed logic models, linking practices to outcomes with data collection processes to assess progress toward achieving the selected outcomes. This developmental approach across diverse projects and communities, along with a quality improvement benchmarking approach to outcomes, created a focus on health status outcome improvement. Specifically, this approach complemented an emphasis on an improved community process capacity to identify, implement, and monitor evidence-based asthma practices that could be used within each community setting.

Early intervention, IDEA Part C services, and the medical home: collaboration for best practice and best outcomes

The medical home and the Individuals With Disabilities Education Act Part C Early Intervention Program share many common purposes for infants and children ages 0 to 3 years, not the least of which is a family-centered focus. Professionals in pediatric medical home practices see substantial numbers of infants and toddlers with developmental delays and/or complex chronic conditions. Economic, health, and family-focused data each underscore the critical role of timely referral for relationship-based, individualized, accessible early intervention services and the need for collaborative partnerships in care. The medical home process and Individuals With Disabilities Education Act Part C policy both support nurturing relationships and family-centered care; both offer clear value in terms of economic and health outcomes. Best practice models for early intervention services incorporate learning in the natural environment and coaching models. Proactive medical homes provide strategies for effective developmental surveillance, family-centered resources, and tools to support high-risk groups, and comanagement of infants with special health care needs, including the monitoring of services provided and outcomes achieved.

A merged model of quality improvement and evaluation: maximizing return on investment

Quality improvement (QI) and evaluation are frequently considered to be alternative approaches for monitoring and assessing program implementation and impact. The emphasis on third-party evaluation, particularly associated with summative evaluation, and the grounding of evaluation in the social and behavioral science contrast with an emphasis on the integration of QI process within programs or organizations and its origins in management science and industrial engineering. Working with a major philanthropic organization in Georgia, we illustrate how a QI model is integrated with evaluation for five asthma prevention and control sites serving poor and underserved communities in rural and urban Georgia. A primary foundation of this merged model of QI and evaluation is a refocusing of the evaluation from an intimidating report card summative evaluation by external evaluators to an internally engaged program focus on developmental evaluation. The benefits of the merged model to both QI and evaluation are discussed. The use of evaluation based logic models can help anchor a QI program in evidence-based practice and provide linkage between process and outputs with the longer term distal outcomes. Merging the QI approach with evaluation has major advantages, particularly related to enhancing the funder's return on investment. We illustrate how a Plan-Do-Study-Act model of QI can (a) be integrated with evaluation based logic models, (b) help refocus emphasis from summative to developmental evaluation, (c) enhance program ownership and engagement in evaluation activities, and (d) increase the role of evaluators in providing technical assistance and support.

Receipt of transition services within a medical home: do racial and geographic disparities exist?

OBJECTIVES

(1) Rank states and southern region by racial disparity between black and white Youth with Special Health Care Needs (YSHCN) for Healthcare Transition receipt; (2) Determine if a racial and geographic disparity exists after control of characteristics.

METHODS

The 05/06 National Survey of Children with Special Health Care Needs data were used. A composite of Medical Home and Transition Outcome Measures captured Healthcare Transition. If both were met, Healthcare Transition was received; otherwise, if neither were met, it was not received. Race was grouped as Non-Hispanic black or white. Census Bureau regions defined geography. South was categorized as Deep South or remaining southern states. Characteristics included sex, age, health condition effect, education, poverty, adequate insurance, and metropolitan status. Observations were limited to YSHCN. Chi-square and logistic regression were conducted. Alpha was set to .05.

RESULTS

A national 42% healthcare transition rate, and 25% racial gap was calculated (higher rate among white YSHCN). White YSHCN had more than twice, and Midwestern had 44% higher Healthcare Transition odds in regression analysis; sex, health condition effect, insurance, and education remained significant. For the Southern region, the Healthcare Transition rate was 38% with a 26% racial gap. White YSHCN had about 2.6 higher odds, and southern geography was not associated in regression analysis. Education, poverty, adequate insurance, and health condition effect remained significant.

CONCLUSIONS

A low Healthcare Transition rate was found, and disparities are poignant. Culturally salient intervention programs to address racial and geographic disparities are needed for Healthcare Transition eligible YSHCN.

Applied social and behavioral science to address complex health problems

Complex and dynamic societal factors continue to challenge the capacity of the social and behavioral sciences in preventive medicine and public health to overcome the most seemingly intractable health problems. This paper proposes a fundamental shift from a research approach that presumes to identify (from highly controlled trials) universally applicable interventions expected to be implemented "with fidelity" by practitioners, to an applied social and behavioral science approach similar to that of engineering. Such a shift would build on and complement the recent recommendations of the NIH Office of Behavioral and Social Science Research and require reformulation of the research-practice dichotomy. It would also require disciplines now engaged in preventive medicine and public health practice to develop a better understanding of systems thinking and the science of application that is sensitive to the complexity, interactivity, and unique elements of community and practice settings. Also needed is a modification of health-related education to ensure that those entering the disciplines develop instincts and capacities as applied scientists.