Basis for Study

This study is based on the following model depicting the public health intervention process.  This model is typically applied to individual at the patient level.  Since this work also involves measures of success at the provider and institutional/corporate levels, several changes were made in the classical terminology used for this flowchart to meet the needs for all three of the groups reviewed for this evaluation process.


The following stages of change can be defined for this activity.  These stages focus on the activities of the member or patient, and the provider and his health care system.  These stages overlap somewhat with certain parts of the Transtheoretical Model provided above.

The following table relies upon certain standards for measuring levels of progress and success.  This is typically used to define the progress and success of an intervention program, performed at the patient and/or provider level.  Since this table related to institutional and corporate reviews, it had to be modified by adding one more row or category to the levels in which personal, professional and population health related improvements take place.    This distinguishes the corporate pharmacal analyst approaches taken to reviewing population health from the general population health measurement methods employed by large federal agencies.  This is essentially stating that large corporations have the potential of serving as important connections between federal and local level population health monitoring and passive surveillance systems.

Notice that by engaging in preventive activities at the institutional and/or corporate level, another level of intervention can be defined (Level 7) that is typically not seen in most health programs currently underway.  Typically this corporate behavior is not engaged in so much due to expectations of corporate level involvement mostly at the service industry level.   It is therefore the responsibility of the clinicians and their institutions to develop whatever interventions are required for improvement in public health to ensue. 

This does not imply that the corporate activities that take place require corporate involvement in the development of interventions.  Instead, this implies that corporations involved with prescription drug distribution are capable of monitoring the public health that exists in a way not traditionally taken at the institutional and insurance agency level.  Taking such a step at the corporate level provides important insights into public health that no provider, institution, insurance or federal agency can provide.  The methodology employed is different, and is more focused on topics in need of extensive review that might otherwise be inadequately studies by any other means now underway.

The added advantage a corporate approach has to this aspect of public health pertains to its applicability across the board.  All health care insurance programs and institutional activities can be accessed via this method of research.  In particular, there are a number of types of programs and insurance agencies that can be reviewed, and should be analyzed separately.  Based upon typical outcomes found for identical programs carried out by distinctly different population groups, i.e. MCD vs. MC vs HMO etc.), there is a need to apply these findings of the institutions and agencies involved with such PIP and QIA activities to corporate level work as well. 

The following is an example of how much each of these types of service differ with regard to accreditation and outcomes.  In 2005, a study of childhood immunization documented a common finding in terms of outcomes. 

Results of a childhood immunization program study, four standard Medicaid programs, 2005 (including the MCP I produced)

Due to significant differences between PPOs, HMOs, MCDs, etc., significant differences exist in how to engage in a systematic review of their prescription data.  There will be different indicators for each of these groups due to age and income related features,  and there will be significant differences in how intervention programs should be developed and recommended to the insurance agencies and institutions such a review of services and public health outcomes might serve.  The way to successfully change an HMO population is very different from how we might react to a managed care (MCD) program’s success.  Those programs with the most potential for change are the PPOs and HMOs, with poorly behaved MCDs serving as the next group of programs to develop proposals of improvement for.

All of these would be summarized in the same report generated for each contracted agency, as follows.

The Report

The Following PIP/QIA format for producing such a report is recommended. 

I.   Executive Summary

II.  Introduction and Background/History

  • General Study Questions
  • How this research will be carried out

III.  Demographic Review of Program

IV.  Data Sources

  • Research Staff: Researchers/Analysts

V.  Methodology

  • Data Collection Methods
  • Analytic flowcharts
  • Statistical Methods put to use
  • Discussion of error, validity/reliability

VI.  Analysis Results (including charts/graphs)

VII.  Discussion (including Implications)

VIII.  Summary

IX.  Appendices


The steps taken to produce the final outcomes of a study that can be place in a report necessitate that the report have three sections for most chapters.  These sections detail results for:

  1. standard HEDIS related evaluations (ca 20-25),
  2. the results of HEDIS pharmacal measures (varied)
  3. the results of special non-HEDIS clinical measures designed specifically for the agency contracting this work (varied)

Like the PIP and QIA formats used, these three sections may each form major sections of each of the chapters, for example a Methodology Chapter can have Parts 1, 2 and 3 provided.  The Analysis section may require three well-defined sections, one for each type of analysis engaged in, some sections with more discussion of outcomes than the others.  The Discussions Chapter should describe the implications of each piece of work separately.  The Summary chapter would attempt to pull these findings together and close with some recommendations.  The Appendices to be included in this style of report would consist of additional flowcharts and figures, examples of implications, examples of recommended practice changes or interventions, etc.  An overall method of scoring the complete program report has not yet been defined.