Slide Number 1Health Policy and the Delivery of Health Care: Case Study Continuation and Placing Policy Analysis in ContextLecture ObjectivesLecture Objectives (Continued)Section ABeyond Bardach“U-Care” Case StudyOur Task Regarding Cardiovascular DiseaseTwo Policy Alternatives to Be ConsideredIndividual Exercise OK, Time’s Up—Let’s DebriefLet’s Review Outcome of ”Criteria” ExerciseLet’s Review Outcome of ”Criteria” ExerciseLet’s Review Outcome of ”Criteria” ExerciseCriteria (Continued)Criteria (Continued)Criteria (Continued) Estimating Impact of Policy AlternativesSection BEstimating Impact: A Brief Methodologic ReviewExamples of Quantitative Estimation ApproachesExamples of Quantitative Estimation ApproachesSample Decision TreeSample Decision TreeExamples of Economic Estimation ApproachesCEA: Diet Intervention and CV Risk FactorsQALYs of Diet InterventionsOK, Back to Our Case StudyEstimating Impact/OutcomesEstimating Impact/Outcomes (Continued)Estimating Impact/Outcomes (Continued)Making the Decision Making the DecisionSample Decision MatrixBefore Finishing Our Case StudySection CThe Continuum of Policy, Management, and EvaluationWhy This Broader Perspective Is Important to YouParadigms in PerspectivePH Problem Solving ParadigmQI ParadigmFocus of Health Services ManagementHealth Services Research/Evaluation FrameworkHealth Services Research/Evaluation FrameworkLet’s Finish the U-Care Case StudyThe Expanded Adaptation of BardachAdvocacy: Moving the Program Forward Advocacy: Moving the Program ForwardAdvocacy (Continued)The Continuum of Policy, Management, and EvaluationBeyond BardachA Word about Milestones/Measures Section DThe Continuum of Policy, Management, and EvaluationBeyond Bardach (Continued)Evaluation: Feedback Loop for Policy Makers, ManagersEvaluation: Feedback Loop for Policy Makers, ManagersThere Are Two Main Types of EvaluationHealth Services Research/Evaluation FrameworkFormative EvaluationHealth Services Research/Evaluation FrameworkSummative EvaluationEvaluation and Our Case StudyEvaluation and Our Case StudyAre You Prepared?Some Skills That Can Be Obtained from HPM CoursesSkills from HPM Courses (Continued)Some Relevant HPM CoursesRelevant HPM Courses (Continued)Copyright 2008, The Johns Hopkins University and Jonathan Weiner. 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Weiner, DrPHJohns Hopkins University3Lecture Objectives To continue our “U-Care” case study Per your homework assignment, we will have an individual exercise that focuses on− Decision criteria (#4 in expanded Bardach policy analysis framework)4Lecture Objectives (Continued) Close out our case study by discussing− Estimating impact (#5)− Decision-making process (#6)− Advocacy (#7)− Implementation, improvement, evaluation (#8) Place the Bardach policy analysis approach into broader contextSection AReview and Continuation of Case Study6Beyond Bardach Expanded Bardachframework1. Understand/define problem2. Obtain evidence/data3. Alternative solutions4. Develop “criteria” matrix5. Estimate impact (outcome) of policy6. Decision process (consider trade-offs)7. Advocate chosen policy8. Implement, improve, evaluate (“Beyond Bardach”) Standard eight-step Bardachpolicy framework1. Define the problem2. Assemble some evidence3. Construct the alternatives4. Select the criterion5. Project the outcomes6. Confront the trade-offs7. Decide8. Tell your story7“U-Care” Case Study The application of public health policy principles and methods within a private not-for-profit organization responsible for the health of 200,000 persons8Our Task Regarding Cardiovascular Disease Review of our task− To develop appropriate organizational policies that address key problems related to the treatment of persons with cardiovascular diseaseX Specifically, hypertension (high blood pressure) and hyperlipidemia (fatty arteries) Problems− Many among our population are not receiving adequate care for early-stage cardiovascular diseaseI. Majority or our members with early-stage disease are not under treatmentII. For about 50% of the patients under care, “process of care” standards not being met (e.g., lipid screening, recommended drug regimen)9Two Policy Alternatives to Be Considered1. Comprehensive “community” outreach program involving− Member education (not just patients)− Screening program for all members2. Aggressive “disease management” program focusing on− Improved administrative systems− Changing provider practices (using performance-based rewards and penalties)− Patient compliance interventions10Individual Exercise Developing decision criteria (turn to step #4 on handout)− For each of the five points (#4a–e on the handout), develop at least one practical criterion for possible inclusion in your final decision matrixX Remember, this criteria list is generic and should be applicable to both policy alternativesX Take 15 minutes for this exerciseX We will discuss the “correct” answers during the LiveTalk11OK, Time’s Up—Let’s Debrief I am the director of policy, planning, and evaluation at U-Care This is a meeting of senior staff from all units across our organization12Let’s Review Outcome of ”Criteria” Exercisea) Population benefit− End results/outcomes− Evidence-based care process standards− Access− Disparities13Let’s Review Outcome of ”Criteria” Exercisea) Population benefit− End results/outcomes− Evidence-based care process standards− Access− Disparities14Let’s Review Outcome of ”Criteria” Exercisea) Population benefit− End results/outcomes− Evidence-based care process standards− Access− Disparitiesb) Cost/economics− Cost benefit−