Sorry to miss you all this week - I am at another conference on the east coast!
Emily
Dear Emily,
Great job. Everyone has been having trouble with this assignment. Please look at Adithya’s “general feedback post.” Briefly:
Impact indicators: Overall intervention/program goals (e.g., improved health, improved quality of life, and/or reduced healthcare costs).
Outcome indicators: Intervention/program objectives (e.g., behavior changes; program components you want to implement)
Process indicators: Whether activities you propose are done (e.g., if training is one of the activities, process indicators might include how many providers/patients attended the trainings and whether the training changed knowledge/attitudes/self-efficacy).
Q1: As we’ve discussed before, it’s always tricky with a screening and treatment proposal. You could consider making the outcome indicator the screening itself (currently a.i.). A secondary outcome could be whether those screened actually get MD cessation counseling (currently b.i.). Great idea re: the hand-off by MEA—though you need to think this through a bit depending on how you rework process and outcome indicators.
Q2: As you suggest, intermediate indicators are somewhere between process and outcome. So, while the surveys are great, I’d also see what the impact of some of your activities (e.g., processes) are. For example, if you held an education session and had # people attending an education session, you might have an intermediate outcome measure being proportion of people who know about how important smoking cessation counseling was
Q3: Rather than approaching the patients about the smoking cessation barriers, I’d actually be most interested in understanding the physician perceptions/thoughts about doing the smoking cessation counseling. You might want to hold individual interviews or do a focus group with the providers to understand this more. Smoking may just fall to the bottom of the (overfilled) problem list in this complex and vulnerable patient population.
Thanks Christina- I agree to focus on the provider behavior chagne target and have reoriented my processes and indicators. I think exploring patient experience/barriers coudl be an interesting project in the future, but probably too complicated here.
Hi Emily,
I think we might have talked about this before, but do you think it would be useful to focus on either the patient or the provider when developing your intervention (just for ease or to make things more manageable?)
Thanks Priya. Yes I think at least for the purposes of these assignments I will focus on the provider which is the primary behavior target. Will adapt my assignment accordingly!
Hi Emily--I agree with the suggestion to focus the intervention on one target, and the providers, as you say, makes the most sense. So if I've learned anything from the general feedback we've been getting for this assignment, your process indicators could be something like # of providers that attended the training you held (or completed the educational module), or providerss satisfaction of the training you provided, or the number of training sessions that were held (or # of emails discussing the intervention that were sent) while your outcome indicators could be something like the proportion of providers that screened their patients for smoking and recorded that in the EMR, or proportion of providers whost patients screened positive that provided counseling (or whatever is relevant to your target behavior).
Thanks Roya - yeah I totally misunderstood how to define the indicators. Fixing that now!