OSMAN AYTAR NHCRP2013
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This document presents the program theory for evaluating a Swedish national project called "Learning Project - Care on Equal Conditions". The project aims to identify and develop methods to facilitate more equitable care in primary care units. The evaluation will assess the process, outcomes and health economics of the project from the perspectives of patients, caregivers and healthcare payers. It will examine activities, outputs, and short and long-term outcomes. The program theory provides a framework for the different types of evaluations and can be used as inspiration for the participating care units.
OSMAN AYTAR NHCRP2013
- 1. Using program theory-driven evaluation in primary care units An integrated evaluation perspective on a learning project providing equitable care in Sweden The 7th Nordic Research Conference in Health Promotion Promoting Health in Everyday Settings: Opportunities and Challenges, 17-19 June 2013, Vestfold University College in Norway Osman Aytar, Sharareh Akhavan, Marianne Granath, Hanna Wallin, Lennart Bogg, Anne Söderlund and Per Tillgren
- 2. School of Health, Care and Social Welfare School of Health, Care and Social Welfare ● To present the program theory for evaluation of Lärandeprojekt - Vård på lika villkor (Learning Project - Care on equal conditions) which is a national project from the Swedish Association of Local Authorities and Regions (SALAR) in cooperation with the Swedish Government. ●In this project SALAR will, together nine primary care units and the research group from MDH, identify and develop methods and procedures that facilitate a more setting based equitable care. ● The evaluation is conducted by a research group at Mälardalen University (MDH). 2 Purpose of the presentation
- 3. School of Health, Care and Social Welfare Costs Perspective: - Patients - Caregivers - Healthcare payers Financial and non- financial Focus on caregivers Short-, medium- and long-term Direct and indirect Intended and unintended Identifying and testing practices and methods for a more setting based equitable care Identified and tested practices and methods are available to all counties and regions Initiation, coordination and research support Learning seminars Teamwork at care units Agreements between: - The government and SALAR - SALAR and care units - SALAR and MDH Resources (personnel, budget etc.) Goals and resources OutcomesOutputsActivities External factors Central, regional and local Stakeholders Patients, caregivers, healthcare payers, SALAR, the goverment, MDH Program theory for Learning Project - Care on equal conditions (Lärandeprojekt - Vård på lika villkor) © MDH and SALAR (Revised version, 2013-04-29)
- 4. School of Health, Care and Social Welfare School of Health, Care and Social Welfare ● The program theory model which has been developed early in the project includes three types of evaluation: ● process evaluation ● performance evaluation ● health economic evaluation ● Focus on stakeholders and external factors. ● Focus on outcomes from different perspectives. ● This model is developed for the project at the national level, but can be used as a source of inspiration even by the care units involved in the project. 4 The aims of using program theory
- 5. School of Health, Care and Social Welfare School of Health, Care and Social Welfare ● Initiation, coordination and research support: ● Invitation from SALAR to care units ● Applications of interest from care units ● Meeting notes ● Interviews with some selected persons ● A self-assessment by the research team at MDH ● Learning seminars: ● Activities at seminars ● Participant surveys ● Teamwork at care units ● Team surveys ● Interviews with some selected tutors and participants 5 Process evaluation
- 6. School of Health, Care and Social Welfare School of Health, Care and Social Welfare ● A web Questionnaire in the beginning and in the end of the project Results shows responses to close-ended questions regarding; ● Factors that are important for access to health care on equal terms ● Organizational / structural criteria to provide care on equal terms ● Operations-factors to provide care on equal terms ● Factors affecting improvement and change ● Three important resources to effect change Results from the open-ended questions shows responses to issues as; ● The meaning of "care on equal terms” ● Patient/client groups who find it difficult to be heard ● Patient /client groups that are more likely to get attention ● Factors (in addition to those as already mentioned in close-ended questions) that affect clients/patients access to care on equal terms ● Factors which may influence health care facilities to offer health care on equal terms 6 Performance evaluation
- 7. School of Health, Care and Social Welfare School of Health, Care and Social Welfare ● The health economic evaluation involves collecting data on the time used by participants for learning and for developing and implementing interventions to improve equity in access and utilization of first line care ● Data is also collected on the provider payment systems which are in place in the respective county councils in order to assess the financial incentives and support for equity oriented initiatives 7 Health economic evaluation
- 8. School of Health, Care and Social Welfare School of Health, Care and Social Welfare ● Cultural and historical descriptions ● Socio-economic background: ● Sickness ● Financial help ● Income distribution ● Lifestyles and health: ● Smoking ● Alcohol consumption ● Exercise habits ● Organizational activities ● Mental illness and insomnia ● Self-perceived health ● Overweight ● Care consumption ● Drug consumption 8 Area descriptions of care units ● Descriptions of participant care units: ● Economy ● Staff ● Quality indicators ● Listed patients
- 9. School of Health, Care and Social Welfare School of Health, Care and Social Welfare ● Based on the process and the results so far: ● Program theory is a fruitful perspective for improvement and development of the learning project. ● Program theory gives structure to different types of evaluation in relation to each other. ● Opportunity to revise the model during the project is also another important possibility about ability to respond to the emerging problems and/or needs on the way. 9 Usefulness of program theory
- 10. School of Health, Care and Social Welfare School of Health, Care and Social Welfare For more information: ●Osman Aytar: osman.aytar@mdh.se ●Sharareh Akhavan: sharareh.akhavan@mdh.se Thanks for your attention! 10