Assignment: NURS 6050 Assessing a Healthcare Program/Policy Evaluation

Healthcare Program/Policy Evaluation

The Racial and Ethnic Approaches to Community Health (REACH) program evaluation

Description

The REACH program started in 1999 to reduce racial and ethnic health disparities (Centers for Disease Control and Prevention, 2020). It is a national program administered by the Centers for Disease Control and Prevention (CDC). Generally, the program’s recipients carry out extensive local and culturally appropriate programs to address a wide range of issues faced by racial and ethnic minorities such as African Americans, Hispanics, and American Indians. The primary objective is to promote health disparities related to chronic illnesses, mental health, preventive health, and overall health coverage (Carratala & Maxwell, 2020). The program also seeks to improve healthy behaviors.

How was the success of the program or policy measured?

After a decade, the REACH had significant success as far as its targets are concerned. However, instead of evaluating the program generally, REACH uses data to evaluate the change in the health status of its target communities. For instance, it used data between 2014 and 2018 to assess the number of people it has helped access healthy foods, access to chronic health programs, and opportunities for physical activity. A progressive increase in the population it serves is the primary success indicator.

How many people were reached by the program or policy selected? How much of an impact was realized with the program or policy selected?

The evaluation between 2014 and 2018 showed that millions of people have benefitted in various ways under the REACH program. According to the Centers for Disease Control and Prevention (2020), over 2.9 million people had better access to healthy foods and beverages, while over 322,000 people benefitted directly from tobacco-free interventions. CDC further reported that about 1.4 million people got opportunities for physical activity, as over 830,000 people got access to chronic disease programs (Centers for Disease Control and Prevention, 2020). Using these reflection points, there is no denying that the impact of the REACH program cannot be underestimated.

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

The REACH program is continuous, where evaluation is done at different implementation points. In most cases, evaluation happens after the completion of a project at the community level. As illustrated in the various CDC reports, evaluation can be after a decade or after some years, depending on the element being assessed.

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

Change in health behaviors was the reference data for the evaluation between 2001 and 2009. For instance, Hispanic taking medication for hypertension increased from less than half to more than two-thirds of the affected population. In the same period, vaccination rates for pneumonia increased from 50.5% to 60.5% in black communities (Centers for Disease Control and Prevention, 2020). The other data is the impact across REACH communities through a 2009-2012 evaluation. The data examined reduction in smoking and obesity rates in REACH communities.

What specific information on unintended consequences was identified?

The program’s impact is huge as far as disparities’ reduction is concerned. However, impact evaluation showed that ethnic gaps continue being affected by societies, culture, and the environment (Centers for Disease Control and Prevention, 2021). As a result, REACH must use many strategies to address health gaps to ensure that health performance in ethnic and racial minorities reaches the desired state.

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.

REACH partners with local health departments, community-based organizations, universities, and tribes. Respective partners were consulted during program evaluation to determine success and areas of improvement. On who would benefit from results and reporting of the program evaluation, the Centers for Disease Control and Prevention would be the primary beneficiary. CDC would use the report to examine the health performance in the minority groups as the basis of improving outcomes or using other interventions to supplement outcomes.

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

To a huge extent, REACH achieved the original intent using the data from the different evaluations. CDC reports reveal significant community successes, including reducing chronic illnesses and unhealthy behaviors such as smoking as access to healthy food and beverages and physical health activities increases.

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

I would recommend the program in my place of work. Firstly, health care organizations should partners with national and community-based organizations to reduce health disparities. Carratala and Maxwell (2020) reported that ethnic and racial minorities continue to be burdened by chronic illnesses and mental health problems. Since such illness burden at the communities has a domino effect in health care organizations, it is crucial to implement the REACH program to improve health outcomes in underserved populations.

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

One way I could be involved in evaluating a program after one year of implementation is by being part of the evaluation committee. Here, I can share my knowledge on the reference points to consider when determining whether a program was a success or not. The other way is to avail information concerning the program by performing individual research. My information would guide on how to conduct a summative evaluation of the program.

General Notes/Comments

Evaluation reliably indicates whether a program achieved the desired outcomes. Healthcare programs can be at the state, community, or organizational levels, and their evaluation can be yearly, terminal, or progressive, as considered appropriate. Nurses should advocate for program evaluation to determine their success and provide the basis for continuous improvement.

Healthcare Program/Policy Evaluation

New York State Medicaid program’s Children’s Design

Description

The program is an amendment to the existing 1115 waiver program. It was implemented on August 2, 2019. It simplified care for kids and teens below age 21 who need home- and community-based physical and behavioral health treatments. The state could move services covered by the consolidated Children’s Waiver from fee-for-service to Medicaid managed care (MMC) and target eligibility to medically needy family-of-one children who meet clinical criteria and are enrolled in the waiver but do not qualify for Medicaid due to family income (Harry et al., 2021).

How was the success of the program or policy measured?

The success of the program was measured through an ongoing evaluation process. It assessed how well special needs children could access primary care practitioners who understood them and the magnitude to which enrollees were accessing home- and community-based services (HCBS) promptly resulting in improved health care outcomes (Harry et al., 2021).

How many people were reached by the program or policy selected? How much of an impact was realized with the program or policy selected?

The program was aimed at providing health insurance for children without insurance who were ineligible for Medicaid. The interim review revealed that parents of children with chronic diseases exhibited considerable satisfaction with their primary care providers. However, they expressed lower levels of satisfaction with their ability to obtain specialized equipment and therapies, as well as coordination efforts across numerous healthcare providers. Initially, the levels of quality indicators for children were relatively stable, except for certain primary care indicators for small children, which showed improvement. Improvements were also shown in various indicators, such as the frequency of preventive visits, rates of immunization, utilization of the medical home for healthcare, adherence to preventative instructions, and the parent-reported health status of the child.

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

Evaluation is still ongoing but, the interim evaluation was conducted after the program’s implementation (Rand.org, n.d).

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

Data on quality indicators for children, satisfaction levels of parents of children with chronic conditions, and perceptions of stakeholders were used to conduct the policy evaluation

What specific information on unintended consequences were identified?

Stakeholders found the transition to the Children’s Design to be difficult and expressed specific concerns around the impact on children’s families in terms of accessing care and the potential decrease in service availability. This implies that although the program has achieved certain favorable effects, there might still be room for enhancement to fully achieve its planned results. Subsequent assessments will yield more extensive understanding of the program’s influence (Harry et al., 2021).

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.

Stakeholders identified in the evaluation include providers, advocates, Medicaid Managed Care plan representatives, and government partners. The stakeholders, as well as the families and children who are recipients of the program, would derive the most advantages from the outcomes and documentation of the program evaluation. The evaluation results can inform improvements to the program that directly impact their health outcomes. For example, the evaluation identified specific areas where service accessibility or quality is lacking, the program can be adjusted to address these issues, leading to better health outcomes for the children and youth involved.

In addition, healthcare providers and the New York State government can also benefit significantly from the evaluation results. The providers can use the results to improve their practices and workflows, while the government can use the results to make informed decisions about funding and policy directions.

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

Based on the interim findings from the independent evaluation, the program met its original intent of streamlining care for kids and teens who are below the age of 21. However, there were challenges in the transition to the Children’s Design, particularly concerning the burden of accessing care on children’s families and reductions in service availability.

These findings suggest that while the program has made some progress towards its objectives, there are areas where it has not fully met its original intent. The challenges in transitioning to the new design and the concerns about access to care and service availability indicate that there is room for improvement in the program’s implementation. However, the improvement in some primary care indicators for young children is a positive sign that the program is having some impact.

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

Yes, I would recommend this program in my place of work. The program’s focus on early intervention and prevention aligns with the goals of many healthcare facilities to provide comprehensive and proactive care. The program has potential benefits in streamlining care for children in need. Yet, it’s important to consider the challenges identified in the evaluation and develop mitigation strategies.

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

As a nurse advocate, I could contribute to the policy evaluation by:

1. Assisting in the collecting of data that might be used to analyze the policy’s efficiency and effectiveness.
2. Conduct surveys or interviews with patients and families to gather feedback on the program.
3. Analyze patient outcomes and service usage data to assess the effectiveness of the program
4. Providing feedback on the program’s effectiveness based on my observations and experiences.
5. Volunteering to partake in policy review meetings after I have identified the legislators involved (Milstead and short, 2019).

General Notes/Comments

The initiative aimed to enhance clinical and recovery health outcomes for children and teenagers who require behavioral health and Home and Community Based Services (HCBS). Additionally, its objective is to enhance prompt availability of programs that cater to early childhood requirements, preventing them from escalating into more expensive and intricate issues in maturity. Despite some challenges, the program has the potential to make a positive impact on the health outcomes of these individuals. However, its success depends on careful implementation, ongoing evaluation, and the commitment and involvement of healthcare providers. As a nurse advocate, I would play a key role in this process by providing feedback on the program’s effectiveness based on my observations and experiences, and by advocating for the needs of the children and youth involved in the program.

Healthcare Program/Policy Evaluation 

Better Choices Better Health Diabetes (BCBH-D) Self-Management Program. 

Description 

• BCBH-D program is an all-online workshop.  
• Participants of the program logged on at their convenience to learn about:  
• Healthy eating and menu planning. 
• Managing blood glucose (Turner et al., 2018).  
• Strategies to address problems such as frustration, fatigue, and isolation.  
• Appropriate exercise for controlling blood glucose and maintaining and improving strength, flexibility, and endurance (Turner et al., 2018). 
• Appropriate use of Diabetes medications. 
• Communicating effectively with family, friends, and health professionals (Turner et al., 2018). 
• Goal-setting. 
• Disease-related problem-solving. 
• The program ran for six weeks, with new lessons being posted every week. The participants logged on 2-3 times per week for a total of 1-2 hours (Turner et al., 2018). 

How was the success of the program or policy measured? 

• The success of the BCBH-D program was measured by its impact on comorbid illness attributed to DM, Health care utilization, and Health care costs within 12 months after establishing the program (Turner et al., 2018).  
• The impact was compared with a propensity score-matched control cohort of DM patients who were provided usual care but did not participate in the BCBH-D program. 

How many people were reached by the program or policy selected? How much of an impact was realized with the program or policy selected? 

• The BCBH-D program reached 558 persons with Diabetes Mellitus. 
• The health program had a significant impact since the participants had a reduced all-cause health care utilization and medical costs (Turner et al., 2018).  
• The impact realized with the BCBH-D program include: 
• Decreased all-cause utilization. 
• Reduced ED visits and outpatient visits (Turner et al., 2018). 
• Decreased unadjusted total all-cause medical cost by $2207 (Turner et al., 2018). 
• Direct cost savings of the BCBH-D were $815. 

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

• Outcome evaluation data included pre-and post-intervention all-cause and diabetes-specific utilization and costs. 
• Diabetes-specific utilization referred to hospitalizations and ED visits with a primary diagnosis of Diabetes (Turner et al., 2018). 
• It also includes outpatient services such as office visits, laboratory tests, imaging, and procedures with any diabetes diagnosis on the claim.  
• All-cause utilization referred to any claims-based health care utilization inclusive of Diabetes and any other diagnosis on the claim (Turner et al., 2018).  
• All-cause and Diabetes specific utilization data for the 12-month pre-and post-intervention periods included ED visits, hospitalizations, and outpatient services, reported as visits per 1000 participants (Turner et al., 2018). 

What specific information on unintended consequences were identified? 

Some participants did not attend all the program’s sessions and, as a result, did not complete the program’s entire course (Turner et al., 2018). 

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. 

• Stakeholders identified in the evaluation of the BCBH-D program include persons diagnosed with Diabetes mellitus (Turner et al., 2018).  
• Patients with Diabetes would benefit the most from the results and reporting of the BCBH-D program (Turner et al., 2018). 
• The program’s impact would influence the development of other Diabetes self-management programs, which would help reduce healthcare utilization and costs for diabetic patients. 
• DM patients would also benefit from improved health outcomes such as controlled glycemic levels, reduced DM comorbidities, and reduced DM-related complications. 

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

• The original goal of the BCBH-D self-management program was to reduce healthcare utilization and healthcare costs attributed to the management of Diabetes (Turner et al., 2018). 
• The program adequately met its goal, as evidenced by results showing that participants in the peer-facilitated BCBH-D program experienced decreased all-cause health care utilization and medical costs (Turner et al., 2018).  
• Based on the results, there was a significant decrease in all-cause utilization and costs for the participants for ED, inpatient, and outpatient services. 
• There was also a decrease in total all-cause medical and pharmacy costs (Turner et al., 2018).  
• There was a decreased utilization in the participants for DM comorbid chronic conditions. 
• Notably, there were reduced claims for hyperlipidemia, hypertension, and depression among participants in the BCBH-D program during the follow-up period (Turner et al., 2018). 

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

• I would highly recommend implementing a health program similar to the BCBH-D Self-Management Program in my current healthcare organization.  
• Implementation of the program would significantly reduce healthcare costs used in the management of DM, which has the highest expenditures (Adam et al., 2018). 
• It would also reduce ED visits and hospitalizations of patients and thus enable the organization to channel the resources to manage other conditions. 
• I recommend the program because it would significantly improve health outcomes for persons with DM, who have one of the worst morbidity and mortality rates in our healthcare setting and other healthcare systems (Adam et al., 2018). 

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

A nurse advocate can become involved in a program’s evaluation after implementation by: 

• Disseminating a program evaluation, particularly a program that extends over to the public health pyramid, to interdisciplinary health care audiences interested in the health problem or interventions used to address the health problem (Issel, 2016).  
• Nurse advocates can also submit a health program’s evaluation reports to a myriad of health journals. This can inform other health providers and organizations of the program’s impact in improving health outcomes and efficiencies in patient care, influencing them to implement similar programs (Issel, 2016).  

General Notes/Comments 

• The BCBH-D Self-Management Program is an ideal healthcare program that should be implemented in all healthcare organizations providing care to diabetes patients. 
• Similar programs can also be established to include patients with other chronic or lifestyle conditions such as hypertension, heart failure, hyperlipidemia, and obesity. 
• The State governments should facilitate health care organizations to establish such programs through funding and mobilization to help improve health outcomes in the population and lower health care costs.  

Healthcare Program/Policy Evaluation

The COVID-19 Vaccination Program

Description

The COVID-19 Vaccination Program, launched in late 2020, involved a collaborative effort to distribute and administer vaccines, effectively curbing the virus’s spread and reducing severe cases and deaths (Steele et al., 2022). However, ongoing challenges like vaccine hesitancy, global distribution, and emerging variants impact its overall effectiveness (Ali & Perera, 2023).

How was the success of the program or policy measured?

Vaccination coverage: The program’s success was assessed by tracking the percentage of the population that received the vaccine (Rosen et al., 2023). This included monitoring the number of doses administered and the number of individuals who were fully vaccinated.

Reduction in COVID-19 cases, hospitalizations, and deaths: Success was measured by comparing COVID-19 case rates, hospitalization rates, and death rates before and after the implementation of the vaccination program. A downward trend in these metrics indicated the program’s effectiveness in controlling the pandemic.

How many people were reached by the program or policy selected? How much of an impact was realized with the program or policy selected?

The COVID-19 Vaccination Program had administered over 380 million doses in the United States and 5.7 billion doses globally (Gostin & Hodge, 2020). The program reduced COVID-19 cases, hospitalizations, and deaths, particularly in areas with high vaccination rates. It also effectively protected vulnerable populations such as the elderly and individuals with underlying health conditions.

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

The COVID-19 Vaccination Program was evaluated continuously throughout its implementation, allowing for adaptations and responses to changing circumstances and challenges. Evaluations began with the initial rollout, focusing on distribution and coverage, identifying logistical challenges, and reaching target populations. As the program progressed, evaluations assessed vaccine effectiveness, safety, and impact on COVID-19 cases, hospitalizations, and deaths (Rosen et al., 2023). Later evaluations concentrated on addressing vaccine hesitancy, equitable distribution, and effectiveness against emerging variants.

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

Vaccination records: Data on the number of doses administered, as well as the demographic information of vaccine recipients, were collected to assess coverage and equitable distribution among various population groups.

COVID-19 case, hospitalization, and death data: Public health authorities collected and analyzed data on the number of COVID-19 cases, hospitalizations, and deaths to assess the impact of the vaccination program on reducing the virus’s spread and its overall burden on the healthcare system (Steele et al., 2022).

What specific information on unintended consequences were identified?

Vaccine hesitancy and misinformation: Misinformation and misconceptions about vaccines have contributed to vaccine hesitancy, leading to slower uptake, prolonged pandemic, and increased risk of new variants emerging (Ali & Perera, 2023). Inequitable distribution: The global vaccine distribution has been uneven, with high-income countries receiving a disproportionately higher share of doses. This has resulted in slower vaccination progress in less-developed regions, exacerbating global health disparities and prolonging the pandemic (Rosen et al., 2023).

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.

Government agencies: Entities like the CDC would benefit from evaluation results to make informed decisions, allocate resources efficiently, and improve future vaccination campaigns.

Healthcare providers: Hospitals, clinics, and healthcare professionals would use the results to optimize vaccine distribution, address logistical challenges, and enhance patient education.

Public health organizations: Organizations such as the WHO and Gavi would benefit from evaluation results to improve their efforts in addressing health disparities and promoting vaccine equity.

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

The COVID-19 Vaccination Program has effectively lowered the number of cases, hospitalizations, and fatalities while prioritizing high-risk individuals. However, ongoing challenges such as vaccine hesitancy caused by misinformation and unequal global vaccine distribution continue to influence the program’s overall success in controlling the pandemic (Ali & Perera, 2023).

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

The COVID-19 Vaccination Program has been successful in reducing virus spread, protecting vulnerable populations, and enabling a return to normalcy. Implementing it in your workplace is generally recommended for health and safety, as well as maintaining business continuity. Before implementation, consider legal and ethical aspects, and ensure effective employee communication and education. The decision to implement the program depends on your organization’s specific context, public health situation, and legal framework (Gostin & Hodge, 2020).

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

Participate in data collection and analysis: Nurses can provide valuable insights and data for evaluation. Contributing by collecting data on patient outcomes, program adherence, and patient satisfaction, as well as monitoring challenges during implementation, ensures a comprehensive and accurate evaluation process.

Advocate for continuous improvement: Nurse advocates can promote program or policy improvements based on evaluation results. Sharing results with stakeholders, raising awareness of successes and areas needing improvement, and providing recommendations for modifications ensures healthcare programs and policies remain effective, efficient, and patient-centered.

General Notes/Comments

In summary, program/policy evaluation in healthcare is crucial for assessing effectiveness and guiding improvements. Nurses play a vital role in this process. The COVID-19 Vaccination Program has seen successes and challenges, with ongoing efforts needed to address issues like vaccine hesitancy and inequitable distribution. Nurse advocates can contribute by participating in data collection, analysis, and advocating for continuous improvement to ensure better outcomes for the targeted populations.