if you’d like to practice a bit after the logical framework lecture, this is an activity for you. Please develop a logical framework for the CDSS PSA project with 4 levels of objectives, critical assumptions, verifiable indicators, and means of verification and post it here! This is another student’s post to help you start the work Verifiable IndicatorsMeans of verificationCritical assumptionsGoalDecrease harm associated with over-screening of PSA testingDecreased rate of prostate biopsiesEMR dataPatients agree with the risk/benefit analysis that recommends against PSA screening in all populations regardless of evidence based practicesOutcomeDecrease rate of PSA screening in men with low and moderate life expectancyRate of PSA testingEMR dataOver-screening in vulnerable populations leads to greater risk of side effects from unnecessary testing and procedures without a substantial increase in benefit derived.OutputAll JHCP providers use the education and CDSS tools to inform decision making re: screeningProvider compliance with CDSS recommendationsChart review of randomly selected patients across all 10 JHCP sitesIndividual patient characteristics unaccounted for in the CDSS development process do not unduly impact provider compliance with the recommendations for testing.InputDevelop curriculum for shared decision making and PSA screening for providersDevelop CDSS to guide providers through the screening decision making processPilot test the CDSS with “super users” and a select focus group of patientsExpand implementationCompletion of web-based training modules by providersQuarterly meetings of “super users”Monitor completion rates of modules by individual providersReview attendance of quarterly meetings (observation)Providers are amenable to changing their practiceImplementation of the CDSS does not add significant time or administrative burden to the primary care encounterDon’t copy and past do your own work !!I have attached the powerpoint of the lecture.
eqipsp_lec4__1_.pdf
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Using A Logical Framework in Evaluation
Yea-Jen Hsu, PhD, MHA
Johns Hopkins University
Logical Framework
A logical framework is used to strengthen project design, implementation, and
evaluation, and helps to
Relate actions to expected results
Set performance indicators
Allocate responsibilities
Communicate information on the project concisely and unambiguously
The first logical framework was developed for USAID at the end of 1960s
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Section A
Vertical Logic
The material in this video is subject to the copyright of the owners of the material and is being provided for educational purposes under
rules of fair use for registered students in this course only. No additional copies of the copyrighted work may be made or distributed.
Logical Framework
Verifiable indicators
Means of verification
Critical assumptions
Goal
Outcome
(purpose)
Output
Input
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Logical Framework: Vertical Logic
Goal
The higher-order objective that you are seeking to achieve
through the project
Outcome
The effect which is expected to be achieved as the result of
the project
Output
The results that the project management should be able to
produce
Input
The actions that have to be undertaken by the project in
order to produce output
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Vertical Logic: ICU Example
Goal
Reduce mortality and length of stay for ICU patients
Outcome
Improve patient safety culture
Reduce central line-associated bloodstream infections
Output
The CUSP (Comprehensive Unit-based Safety Program) is fully implemented
ICU staff use evidence-based infection prevention practices
Input
ICU CUSP team is formed
CUSP team members are trained on how to implement CUSP
CUSP team meets monthly at minimum for CUSP implementation
ICU staff get education on and use checklist for infection prevention
practices
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Logical Framework: Vertical Logic
Goal
Outcome
Output
Input
Then
If
Then
If
Then
If
The higher-order objective that you are seeking to achieve
through the project
The effect which is expected to be achieved as the result of
the project
The results that the project management should be able to
produce
The actions that have to be undertaken by the project in
order to produce output
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Vertical Logic: ICU Example
Goal
Outcome
Output
Then
If
Then
If
Then
If
Input
Reduce mortality and length of stay for ICU patients
Improve patient safety culture
Reduce central line-associated bloodstream infections
The CUSP (Comprehensive Unit-based Safety Program) is fully
implemented
ICU staff use evidence-based infection prevention practices
ICU CUSP team is formed
CUSP team members are trained on how to implement CUSP
CUSP team meets monthly at minimum for CUSP implementation
ICU staff get education on and use checklist for infection
prevention practices
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Critical Assumptions
Assumptions are important events, conditions, and decisions outside the control of the
program that may affect the link between each level of objectives
Verifiable
indicators
Means of
verification
Critical assumptions
Goal
How goals contribute to a broader
purpose
Outcome
(purpose)
Factors needed for outcomes to
contribute to goals
Output
Factors needed to convert outputs to
outcomes
Input
Factors needed to translate inputs to
outputs
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Critical Assumptions: ICU Example
Verifiable
indicators
Means of
verification
Critical assumptions
Goal: reduce mortality and
length of stay for ICU patients
Mortality and length of stay are
important issues of quality of
care
Outcome: improve patient safety
culture, reduce CLABSIs
CLABSIs in the ICU sometimes
cause death
CLABSIs in the ICU sometimes
extend ICU length of stay
Output: CUSP, infection
prevention practices
New interventions fit the
context and culture of the unit
Input: CUSP team, training,
meeting, checklist
No unexpected distractions for
key members or champion in
the unit
No large staff turnover
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Critical Assumptions: ICU Example
Verifiable
indicators
Means of
verification
Goal: reduce mortality and length
of stay for ICU patients
Mortality and length of stay are
important issues of quality of care
Then
Outcome: improve patient
If
safety culture, reduce CLABSIs
Output: CUSP, infection
prevention practices
Input: CUSP team, training,
meeting, checklist
If
And
Then
And
Then
If
Critical assumptions
And
CLABSIs in the ICU sometimes cause
death
CLABSIs in the ICU sometimes
extend ICU length of stay
New interventions fit the context and
culture of the unit
No unexpected distractions for key
members or champion in the unit
No large staff turnover
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An
Interdisciplinary
Conceptual
Framework of
Provider Behavior
Change
Sources: Gurses, A.P., Marsteller, J.A., Ozok, A.A.,
Xiao, Y., Owens, S. & Pronovost, P. J. (2010). Using
an interdisciplinary approach to identify factors
that affect clinicians’ compliance with evidencebased guidelines. Crit Care Med, 38, [Suppl.]: S282S291. Marsteller, Gurses, et al. forthcoming.
“Effecting Behavior Change among Clinicians,” In S.
Kahan, A. Gielen, & P. Fagan, (Eds.), Changing
Health Behaviors In Populations. Baltimore: Johns
Hopkins University Press.
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Assumptions
Assess conditions according to importance and probability
Need to be monitored
Especially “killer assumptions”
Putting indicators on assumptions may help
13
Section B
Indicators
The material in this video is subject to the copyright of the owners of the material and is being provided for educational purposes under
rules of fair use for registered students in this course only. No additional copies of the copyrighted work may be made or distributed.
Logical Framework
Verifiable
indicators
Goal
Outcome
(purpose)
Output
Input
Means of
verification
Critical
assumptions
Verifiable Indicators
Indicators demonstrate results
The fewer the better—use only the number of indicators required to clarify what must
be accomplished to satisfy the objective
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Means of Verification
Sources of information used to track the verifiable indicators
Important concerns
Availability from normal sources (e.g., statistics)
Reliability of sources
Availability in time series
Clarity and understandability to users
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Critical Assumptions: ICU Example
Verifiable indicators
Means of
verification
Goal: reduce mortality and
length of stay for ICU
patients
Mean ICU mortality per quarter
Mean ICU length of stay per quarter
Hospital
surveillance
system
Outcome: improve patient
safety culture, reduce
CLABSIs
Hospital Survey on Patient Safety Culture
(HSOPS)
Mean and median of CLABSIs per 1000 central
line days
Hospital
surveillance
system
Output: CUSP, infection
prevention practices
Whether each CUSP steps/activities is
undertaken
Staff’s compliance of infection prevention
practices
Survey
Checklist
Input: CUSP team, training,
meeting, checklist
Whether CUSP team meets monthly
% of staff receive training
% of staff use checklist
Survey
Checklist
Observation
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Who Should Be
Involved and
What Else to
Consider?
Who should be involved?
Project planning and management should always be
considered a team task—this requires giving key
stakeholders the opportunity to provide inputs
What else to consider?
To ensure that all elements for the successful
implementation of a project are adequately considered
in the planning phase, the logical framework can be
supplemented with:
• An assessment of the implementing organization(s),
(for example, capacity, competence, interests,
division of labor)
• An assessment of the institutional context (for
example, role, policies and strategies of relevant
stakeholders in the private and the public sector)
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Logical Framework for Evaluation
Verifiable
indicators
Expectations
Observations
Explanations for differences
between expectations and
observations
Goal
Outcome
(purpose)
Output
Input
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Advantages
Easy to learn and use
Bring together in one place all key components of a project or program
Reduce time or effort to project management
Set up a framework for monitoring and evaluation where planned and actual results
can be compared
Assists communications between project donors and implementers
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Limitations
Not a substitute for other technical, economic, social, and environmental analyses
It requires a team process with good leadership and facilitation skills to be most
effective
The whole culture of the logical framework can be alien
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Lecture Evaluation
Your feedback is very
important and will be used
for future revisions.
The Evaluation link is
available on the lecture
page.
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