USING PROCESS EVALUATION TO INFORM PROGRAM DESIGN. A CASE STUDY OF THE EBOLA RESPONSE IN THE U.S. HEALTHCARE SYSTEM Monica LaBelle, PhD

Transcription

1 USING PROCESS EVALUATION TO INFORM PROGRAM DESIGN A CASE STUDY OF THE EBOLA RESPONSE IN THE U.S. HEALTHCARE SYSTEM Monica LaBelle, PhD

2 Healthcare Associated Infections At any given time, about 1 in every 25 patients has an infection related to their hospital care CDC has identified eliminating HAIs as a Winnable Battle Antibiotic Resistance Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics Division of Healthcare Quality Promotion

3 Healthcare-Associated Infections (HAIs)

4 State HAI/AR Prevention Programs CDC supports HAI/AR Programs in every state through the Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Cooperative Agreement State health departments, along with some city and territorial health departments, work with state hospital associations, CMS-funded networks, and hospital networks to: Track infections in healthcare facilities Focus HAI prevention efforts using CDC s National Healthcare Safety Network (NHSN) data Implement prevention strategies across healthcare settings using CDC s tools and evidence-based guidelines

5 Ebola, a Healthcare-Associated Infection Ebola in the U.S brought vulnerabilities in infection control practices in the U.S. into the spotlight The event created opportunity to assess and build stateand local-level capacity to control infection in the U.S. healthcare system

6 Ebola Program Strategy Enhance Healthcare Associated Infection (HAI) Programs Create New and Strengthen Existing Partnerships Train and educate healthcare workers and their respective facilities

7 STATE EBOLA PROGRAM LOGIC MODEL RESOURCES ACTIVITIES OUTPUTS ELC Ebola Supplement Regular ELC Funds Regular EIP funds Existing state HAI and preparedness programs and plans Existing surveillance and other data collection initiatives CDC expertise Professional Associations Research Centers Enhance State HAI Programs Assess facility outbreak reporting, response, infection control capacity Develop state program infrastructure and capacity to identify and respond to Ebola and other outbreaks Develop guidelines and protocols Create New and Strengthen Existing Partnerships Hospital preparedness Hospital associations QIN/Os Accrediting/licensing Professional associations Train Healthcare Workers and Facilities Identify knowledge and practice gaps at facility level Develop and implement HCW training in infection control Conduct research, explore innovative approaches for infection control #, % of Ebola assessment hospitals where onsite assessment conducted #, % of hospitals Ebola-ready # healthcare facilities with complete info for inventory Updated HAI Advisory group Updated HAI action plan Completed outbreak detection and response activities assessment #,% of non-ebola assessment hospitals where infection control assessment conducted Gaps identified Gaps mitigated HAI Advisory Group partners added Meeting occurrence, attendance with preparedness and other partners Points of contact identified with partners Curricula developed # workers trained # facilities implementing competency-based training programs Projects completed #, type of publications #, type of presentations SHORT- TERM OUTCOMES Increase in state-level awareness of where facilities are and what they can do Increase and improvement in state-level data use Better coordination of outbreak identification, reporting and response among partners INTERMEDIATE AND LONG- TERM OUTCOMES Increase in outbreak reporting and response Increased knowledge of and adherence to infection control best practices in the healthcare setting IMPACT Control of healthcareassociated infections in the U.S. Program Purpose: Grow state capacity to identify, respond to, prevent, and control Ebola and other healthcare-associated infections

8 Program Evaluation as Part of an Ongoing Cycle

9 Evaluation Case Study Questions RESOURCES ACTIVITIES OUTPUTS ELC Ebola Supplement Regular ELC Funds Regular EIP funds Existing state HAI and preparedness programs and plans Existing surveillance and other data collection initiatives CDC expertise SMEs Training Team Professional Associations Research Centers NETEC HRET Enhance State HAI Programs Assess facility outbreak reporting, response, infection control capacity Increase understanding of regulatory oversight-who, where Develop state program infrastructure and capacity to identify and respond to Ebola and other outbreaks Create New and Strengthen Existing Partnerships Hospital preparedness Hospital associations QIN-QIOs Accrediting/licensing Professional associations Train Healthcare Workers and Facilities Identify knowledge and practice gaps at facility level Develop and implement HCW and facilities training in infection control Conduct research, explore innovative approaches for infection control #, % of Ebola assessment hospitals where onsite assessment conducted #, % of hospitals Ebola-ready # healthcare facilities with complete info for inventory Updated HAI Advisory group Updated HAI action plan Completed outbreak detection and response activities assessment #,% of non-ebola assessment hospitals where infection control assessment conducted Gaps identified Gaps mitigated HAI Advisory Group partners added Meeting occurrence, attendance with preparedness and other partners Points of contact identified with partners Gap identification and mitigation coordinated Curricula developed # workers trained # facilities implementing competency-based training programs Projects completed #, type of publications #, type of presentations Is the program being implemented as designed? Should the program design/logic model be modified? If so, how? To what extent and how did program participation increase/enhance current capacity to prevent and control HAIs? How do state staff describe the successes and challenges in implementing the ELC/ICAR activities? How can CDC improve its technical assistance efforts to support states HAI programs? To what extent and how did program participation strengthen partnerships? What is the extent and nature of the collaboration between/among partners? Did the partnerships enhance efficiency? If so, how? If not, why not?

10 Case Study Methodology Evidence to address the case study questions is being obtained using the following: Interviews with staff in two states Process measure data submitted to CDC Examination of state HAI plans

11 Next Steps 1. Collect, analyze, and summarize data and evidence 2. Meet with primary intended users of the evaluation (CDC staff) to review the evidence to determine whether and how to make changes in the program design (e.g., logic model) or to support improved program implementation? 3. Revise program and program design for program improvement

12 For more information, contact CDC CDC-INFO ( ) TTY: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.