A conceptual framework for the evaluation of health improvements programs

The prevalence of chronic illness in the population over 65 years has been steadily growing in the United States over the past several decades. This is driving a financial crisis for Medicare that if left unchecked could ultimately mean bankruptcy for the program. While health improvement programs have become increasingly popular for controlling costs in employed and insured populations, rigorous evaluations in applied setting are often difficult. Also, findings from demonstration projects to evaluate health improvements programs in the Medicare population highlight the challenges for program evaluation in applied settings. Innovative methods for evaluating program effectiveness are badly needed.

We will present a conceptual outcomes framework developed by DMAA: The Care Continuum Alliance as part of an effort to generate consensus for outcomes guidelines for the health improvement industry. This framework provides recommended domains for health improvement outcomes, proposes causal relationships among domains, and depicts timeframes for expected impacts. When considered within a larger program model that includes the social, cultural and political context, the outcomes framework can help improve the design and evaluation of public and private sector health improvement programs. It provides a common framework that can be used to analyze and interpret a more full range of evaluation findings.

Our healthcare crisis demands that public and private healthcare stakeholders think, act, and collaborate in new and creative ways. It is imperative that program evaluations provide better insights into which programs components work, for whom, and under what circumstances, and that learnings be freely shared and broadly applied.