PROGRAM EVALUATION OVERVIEW
Evaluation is a critical component of your diabetes management program. In setting up this part of the program, what you are really doing is developing a mechanism to measure whether you have been able to reach the goals established at the onset of the program. Typically, employers strive to achieve positive changes in the following three areas:
- Changes in process outcomes. This refers to an improvement in the efficiency of the administration of services. For example, if employers decide to send out notices reminding people with diabetes to have a yearly eye exam, is there an increase in the number of people doing so? If so, then there has been an improvement in process outcomes.
- Changes in health outcomes. This refers to an improvement in the health of individuals involved in a program. In this case, a person with diabetes participating in a diabetes management program is expected to have improved his or her blood sugar as a result of the diabetes management program.
- Changes in financial outcomes. This refers to a savings in either direct or indirect costs, as well as improvement in absenteeism (number of days missed), presenteeism (better quality of work while present and on the job), and overall productivity. These changes can be measured by looking at absenteeism records over the course of a year, analyzing their relationship to the program, and determining whether they have improved.13
PROGRAM EVALUATION: NEXT STEPS
After deciding which of these or other outcomes you want to measure, the next step is to figure out how you are going to measure them. Ideally, the way to proceed next would be to set up a controlled study with two well matched, randomized groups. Employers might find it useful to have the control group located at a plant in one city, while the experimental group is located at a site in another city. In the case of a diabetes program, the control, located in County A, for example, would be comprised of people with diabetes. They would not be invited to participate in the program or would only be given the basic health care information packet. The second group, the experimental or intervention group, perhaps located in County B, would also be comprised of people with diabetes. This group, however, would receive the full benefits of the diabetes management program. For this study, you could compare improvements in blood sugar (a health outcome), improvements in absenteeism (a financial outcome), and improvements in hospital stays (a financial outcome). At the end of six months or a year, you can compare the two groups to see whether there is an improvement in both the designated health outcome and the designated financial outcomes. Using other forms of analyses, you can determine if these improvements are a result of or related to your program intervention.
This kind of study, though ideal, is usually very difficult to implement in the workplace setting. As a result, what employers usually do is develop “before and after studies.” For these studies, employers begin with baseline data of what they want to measure. Having these data is essential because without this information, you have nothing against which to compare the progress of your program. From a practical standpoint, without hard numbers it will be very hard to prove the effectiveness of the program for at least one to two years.14