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Improving
the Health in Dallas, One Patient at a Time
A critical element of Project Access is
accountability. Through a partnership with the University of Texas Southwestern
Medical School and University of Texas at Arlington, experts will continually
measure effectiveness. There will be two distinct evaluations that will
be performed to assess the progress of the program. A complete progress
report will be included in quarterly and annual reports completed by Project
Access.
First, there will
be a Process Evaluation that is designed to measure the
progress and quality of the project activities. This will be especially
important in the early stages of the project, as its focus will be on
the involvement of the various stakeholders necessary to make the program
a success.
Second, there will be a Program Evaluation
focused on outcome measurements. Each of the critical elements will be
measured in two ways: (1) regular surveys and interviews with Project
Access patients, staff, and care providers involved and (2) indicators
in health status and emergency room utilization. The primary measure of
health status will be the SF-12 Form (a twelve-item health survey). This
form will provide comparisons between the Project Access population and
other populations filling out the same form. Finally, by comparing the
proportion of network participants using the emergency room to the proportion
of network eligible (but not enrolled) emergency room users in the target
community, it will be possible to obtain an estimate of whether Project
Access participation and emergency room utilization are related.
The Outcomes
Work Group will develop additional evaluation approaches and tools in
two areas: Social Outcomes related to the presence of
Project Access in the original target community and a more rigorous evaluation
of the Community Health Worker Model.
In order to evaluate the social outcomes
related to Project Access, the OWG will examine the extent to which the
improvement of individual health in the community has an effect on their
behavior and community’s social environment. The OWG will develop
an index of community health in target communities where Project Access
is especially active. The index will consist of factors such as the amount
of crime in the neighborhood, number of teenage pregnancies, indicators
of substance abuse, and indicators of economic health related to employment
such as the turnover in employment and days of work missed due to illness.
The index will be designed to reflect changes in the community that are
related to improving the health of the community’s residents.
A more rigorous evaluation will be conducted of the CHW system. Part of
the success of Project Access depends on the ability of CHWs to help participants
develop the skills they need to participate in the maintenance of their
health. As enrollment increases, Project Access patients will be required
to step beyond their neighborhood clinics, and go to the private offices
of volunteer primary care or specialty physicians, a lab or x-ray provider,
and a pharmacy dispensing low-cost pharmaceuticals. A primary role of
the CHWs is to ensure that the patients can navigate the system effectively,
and provide health and wellness education on a broad range of health related
topics. Ultimately, this evaluation component is designed to determine
the likely contribution of the CHWs to patients’ autonomy related
to health maintenance.
Additionally, information on insurance status and
other relevant demographics will be available for comparison purposes
through the annual Dallas County Health Checkup
prepared by the Dallas/Fort Worth Hospital Council (DFWHC). These data
are collected and maintained for the council by the Population Medicine
Division of the Parkland Health & Hospital System (PHHS).
The Project Access plan also incorporates an interim and final program
report, features that are required as part of the National Program
Evaluation.
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