The Value of Providing Smoking Cessation Clinics for Employees on Company Time

The purpose of this paper is to select a health care delivery or education program in the workplace or community. The chosen program for this part of the assignment is the “Chronic Disease Management Program” (CDM). The CDM was implemented to education to patients and their families about living with congested heart failure (CHF). This is part one of a three part assignment. This assignment will include a description of the program, its objectives, goals, and the evaluation process. Chronic Disease Management Program

The chronic disease management program is designed to educate patients and their families about congestive heart failure. The program is to empower the patient by education regarding medication compliance, daily weight, activity, low sodium diet, and following up with his or her doctor once they have been discharged. CHF means that the heart is weak and cannot pump blood as well as a healthy heart. The CDM was implemented one year ago as the result of the “Centers for Medicare and Medicaid” (CMS) along with The “Joint Commission” (TJC) partnered and created the heart failure (HF) core measures. This standard set determines if hospitals caring for this population will receive full reimbursement. The goal of this program is to prevent a 30-day readmission by empowering and educating these patients. Program Goals, Objectives, and Evaluation Process

The intermediate goal is 100% identification of CHF patients admitted and provide education to patients and their families in the hospital. “Intermediate goals are expected to occur as a result of the proper implementation of the program, but that do not constitute the final goals
intended for the program” (Posavac & Carey, 2007, p. 54). The second goal is patients are empowered after education and commit to lifestyle changes, and the third goal is the patient makes his or her follow-up appointment after discharge to prevent a CHF exacerbation from re-occurring. The objectives the stakeholders developed for measurement are to identify patients who have CHF as a primary admission diagnosis in the hospital. The second objective is providing bedside education regarding CHF management (daily weight, medication compliance, low sodium diet, report worsening signs and symptoms, activity). The third objective is to schedule a follow up doctor appointment before they are discharged.

The objectives and goals will play a significant role in the evaluation process. To evaluate the success of these objectives and goals (outcomes) staff involved in the program will first assess the identification process through Medical Records because they can track patients coded with the CHF diagnosis and match against the daily identification process. This will provide proof that the identification process is accurate and if any changes need to be made. Evaluating the patient and family for increased knowledge about CHF management is monitored by return demonstration of staff directly involved in the teaching process and reporting back to the doctors and director. The teaching method is examined thoroughly to ensure that staff is properly trained to provide education in an effective manner. The follow up appoints will provide an understanding of the effectiveness of the empowerment of the patient to participate in his or her care. This process is monitored by calling the doctor’s office and patient to monitor compliance. Steps and Phases of Program

The first step the organization performed was a needs analysis in response to the high readmission rates of CHF patients and CMS initiatives. An evaluation examined patient needs, program feasibility, and its marketability. The organization examined its internal and an external resource (human, financial, and external partners) after the needs analysis was completed. “If the evaluator looks at the needs analysis, she can determine the actual need for or marketability of the program to the clients, internal or external, before any resources are committed” (Boulmetis & Dutwin, 2005, p. 40). A proposal for funding was completed and presented to the philanthropy and funds were allocated toward the program. The program was implemented and staff was selected from within the organization. A program committee was formed with all the stakeholders, their roles were identified and deliverables were established that matched the needs of the patients.

Those needs were identified as providing education about CHF, designing education material, navigating the patient from admission to discharge, and providing scheduled follow up appointments. The deliverables are metrics that could be evaluated to provide outcome data.”You [sic] are looking at performance, both the clients’ progress toward attaining goals and the staff’s effectiveness in performing activities. You are assessing the staff’s ability to achieve its goals and objectives” (Boulmetis & Dutwin, 2005, p. 47). “Formative evaluation findings are usually reported to the program director and program staff and are typically released throughout the course of the evaluation” (Boulmetis & Dutwin, 2005, p. 48). The committee meets monthly, and this is the time when daily operations are discussed by the staff within the program. The director of the program provides information regarding funding, other stakeholder feedback, and changes to the program if required based on performance data. Indentified Stakeholders

“Everyone involved in the program, from those who fund it, to those who lead it, to those who receive its services or products, has a stake in the decision making” (Boulmetis & Dutwin, 2005, p. 38). The stakeholders assigned to the CDM program are the philanthropy group, hospital, director of Quality Management (QM), doctors, cardiovascular nurse navigator, social worker navigators, and patients. The director oversees the daily operation of the program and reports data to the board of directors and the philanthropy group. The director also communicates any problems or changes in the process to the program staff.

The doctor’s role is to meet with the nurse navigator and discuss his or her patient’s education needs before discharge and provide a bridge to the follow up appointment. The cardiovascular nurse navigator is the core of the program. The navigator identifies the CHF patients throughout the hospital, provides bedside education to patients and family members, schedules a follow up appointment before the patient is discharged, and collects data. The social workers receive the hand off from the nurse navigator and support the patients after discharge. Their primary responsibility is to collect data and place a phone call to the patient to ensure that the follow up doctor appointment has been made by the patient. Tracking Data

The process for data collection is currently tracked manually by the QM abstractors, cardiovascular navigator, and the social worker navigators. The hospital is currently implementing a new administrative and clinical system house wide; the newer system will provide automated data tracking at a click of the mouse making it easier for data collection. Data collection is assigned to the staff, according to their role in the program. The following data is collected; patient demographics, date education was provided, scheduled appointments made or not made, and reason for patient’s readmission. The hospital also receives tracking data from outside agencies, such as CMS so it can compare its performance outcomes against other programs providing the same services. Conclusion

This assignment examined the process of a selected education program developed to meet the needs of the hospital, preventing CHF readmissions, an intuitive driven by CMS. The Chronic Disease Management program provides education to CHF patients empowering them to participate in their care and commit to lifestyle changes. The stakeholders within the program work in sync to provide a handoff at every step of the process maximizing the objectives to meet their goals (outcomes). Evaluation will always be part of its existence, monitoring for any gaps in the process while tracking data on its performance and developing new methods improving its efficiency, effectiveness, and outcome.

Reference

Boulmetis, J., & Dutwin, P. (2005). Decision making: Whom to involve, how, and why. In The abcs of evaluation; Timeless techniques for program and project managers (2nd ed., pp. 36-56). San Francisco, CA: Jossey-Bass. Posavac, E. J., & Carey, R. G. (2007). Evaluation Criteria and evaluation questions. In Program evaluation; Methods and case studios (7th ed., pp. 55-69). Upper Saddle River, NJ: Prentice Hall.