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Chronic Kidney Disease: the Evaluation Plan

Introduction

Chronic kidney disease is one of the most burning issues of the modern society, and the program to fight its occurrences and eliminate the disease as such is vital. Such a program is especially important today when the incidence of the chronic kidney disease is on the dramatic rise according to the data by the National Institute of Health. This program should include the comprehensive analysis of all the diseases causes, its effects, and the major ways to fight chronic kidney disease. However, after the program is put into practice it is important to timely evaluate its results on the regular basis. The evaluation plan for this purpose should include the clearly developed methodology for assessing the program results with special emphasis on evaluation of short-term, intermediate, and long-term outcomes of the program.

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Evaluation Plan

Background

But before starting the evaluation process, it is necessary to inquire about the evaluation such and answer the questions about the essence of evaluation and its main goals. Thus, in the broadest sense of the notion, evaluation of the program is the consideration of the latter in order to find out the data about the performance of the whole program or any element of the latter (Cwikel, 2006, p. 15). Scholars like Cwikel (2006), Bash, Coresh, Köttgen, Parekh, Fulop, Wang, and Astor (2009) distinguish over 35 various evaluation directions that include the assessment of the program’s needs, cost/benefit considerations, evaluation of the efficiency and effectiveness of the program, and the assessment of the goals and their outcomes for a certain period of time (Bash, Coresh, Köttgen, Parekh, Fulop, Wang, and Astor, 2009, p. 414).

Singh, Szczech, Tang, Barnhart, Sapp, Wolfson, and Reddan (2009) also considers the so called “20 – 80” rule for evaluation process, which implies that not all the people involved in the project or a program are to be involved into evaluation process (p. 2087). In other words, 20% of the effort made for evaluation provides about 80% of the desired results. Accordingly, evaluation of the program of handling the chronic kidney disease should have the clear focus on one of the evaluation directions and have the established methodology for reaching the aim of the evaluation.

Basic Techniques

The basic techniques used for program evaluation purposes also depends the above mentioned factors, as well as on the type of information the researcher needs to obtain and the area of the program he/she wants top study and evaluate. Patterson (2001) and Cwikel (2006) argue that evaluation might focus on the very procedures that are taken according to the program (Patterson, 2001, p. 23), on their effectiveness, on meeting the program’s goals, on assessing the future needs of the program in respect of funding, planning, improvement, etc (Cwikel, 2006, p. 47). Drawing from these considerations, Cwikel (2006), Bash, Coresh, Köttgen, Parekh, Fulop, Wang, and Astor (2009), and Patterson (2001) single out three main types of evaluation that include goal-based, process-based, and outcome-based evaluations.

The major techniques of evaluation, as Bash, Coresh, Köttgen, Parekh, Fulop, Wang, and Astor (2009) and Patterson (2001) argue, include the use of questionnaires and surveys among the program workers, interviews with the workers and people in charge of the program, documentation reviews of the program files, observations of the program developments, conduct of case studies and meetings in the focus groups (Patterson, 2001, p. 132). As the program of the chronic kidney disease handling involves collection of mixed, qualitative and quantitative, data, only the combination of all the above techniques can ensure the success of the evaluation.

Outcomes Evaluation

Short-Term Outcomes

The type of evaluation that fits the program of handling the chronic kidney disease the most is determined by the major focus of epidemiology. As the latter is focused on helping people deal with illnesses and their consequences, the evaluation of the program outcomes, as Cwikel (2006) notes, is the most important part of the program (p. 49). In other words, epidemiology is concerned with finding effective ways to treat diseases or help people in treating them. Thus, outcomes, i. e. those effective treatment ways and health improvements, are the most valuable phenomena for epidemiological programs. Accordingly, the efficiency of the epidemiological program in question can be best measured by evaluating its outcomes. The latter are divided into short-term, intermediate, and long-term outcomes.

The evaluation of the short-term program outcomes should be carried out with the help of questionnaires, surveys, and direct face-to-face interviews carried out with the workers of the program (NIH, 2009). These techniques will provide the evaluators with the instant information about what effect the program implementation had on handing the chronic kidney disease, how the program was perceived by the public, and what its intermediate outcomes are. The evaluation of the short-term outcomes is of crucial significance for the whole program as it allows tracing the program progress and make necessary improvements timely.

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Intermediate Outcomes

Intermediate outcomes of the chronic kidney disease handling program are also important to the program evaluation as these outcomes allow the researcher to monitor the effectiveness of the short-term outcomes and establish the long-term goals according to which the long-term outcomes can be first predicted and than evaluated (Bash, Coresh, Köttgen, Parekh, Fulop, Wang, and Astor, 2009, p. 416). Therefore, the intermediate goals for the program under consideration include the processing of literature review results and establishing the long-term goals for the further research on the program (Cwikel, 2006, 57). Accordingly, the methodology for evaluating the intermediate outcomes of the program in question will include the following points:

  • Synthesize, on the basis of literature review, the intermediate goals of the program;
  • Carry out the interviews and questionnaire surveys to determine the attitudes of program participants towards the program and its intermediate outcomes;
  • Conduct the documentation overview to consider the program progress on the way to reaching its intermediate goals;
  • Inquire about the reasons, if any, for failing to achieve intermediate goals and for the presence of insufficient intermediate outcomes;
  • Assess the possibilities of the program and make the necessary improvements to it in order to facilitate the intermediate outcomes (Patterson, 2001, pp. 12 – 14);

Thus, the combination of the preliminary research work, interviews and questionnaire surveys, preemptive measures to avoid failures and steps to eliminate their consequences can form the effective tool for evaluating the intermediate outcomes of the chronic kidney disease handling program.

Long-Term Outcomes

Needless to say, the long-term outcomes of the program are the most important results of the whole work of a number of people to create the program to handle the chronic kidney disease. As Fos and Fine (2000) note, long-term outcomes manifest the proper structure of the program, its effectiveness, and actual ability to help people in handling the chronic kidney disease (pp. 12 – 13). Thus, the methodology to evaluate the long-term outcomes of the program will include the following points:

  • Use interviews and questionnaire surveys on a regular basis during two years after the program implementation to monitor the intermediate outcomes and trace their development towards a positive long-term outcome, i. e. increase in people’s awareness in handling the chronic kidney disease given that 20% of answers reporting such an increase mean success;
  • Carry out the final survey two years after the program implementation to see the actual effect of the program upon people’s perception of the disease and the ways to fight it given that the 20% decrease of death conditioned by the disease means success;
  • Monitor the NIH data on the chronic kidney disease incidence in the USA after the implementation of the program given that the 15% decrease in the incidence will mean the success of the program;

Conclusions

To conclude, the main purpose of the epidemiology as a science is to help people fight the diseases that constitute the main threat to human health at a certain time period. Therefore, evaluating the epidemiology program one should evaluate outcomes of the latter at the first hand. The program of handling the chronic kidney disease, thus, requires its short-term, intermediate, and long-term outcomes to be evaluated so that the effectiveness of the whole program could be seen. Among the whole variety of evaluation techniques, only the combination of personal activities and research work in documentation overview and statistical results’ tracking can provide success for program evaluation in chronic kidney disease area.

References

Bash, L. D., Coresh, J., Köttgen, A., Parekh, R. S., Fulop, T., Wang, Y. and Astor, B. C. (2009). Defining Incident Chronic Kidney Disease in the Research Setting. American Journal of Epidemiology, 170(4):414-424.

Cwikel, J. (2006). Social epidemiology: strategies for public health activism. Columbia University Press.

Fos, P. and Fine D.J. (2000). Designing Healthcare for Populations: Applied Epidemiology in healthcare administration, San Francisco, Jossey-Bass.

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NIH. (2009). Chronic Kidney Disease and Kidney Failure. National Institute of Health Fact Sheet.

Patterson, R. (ed) (2001). Changing patient behavior: improving outcomes in health and disease management. San Francisco: Jossey-Bass.

Singh, A. K., Szczech, L., Tang, K. L., Barnhart, H., Sapp, S., Wolfson, M., and Reddan, D. (2009). Correction of Anemia with Epoetin Alfa in Chronic Kidney Disease. The New England Journal of Medicine, 355(20): 2085 – 2098.

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