A: Implementation / Process evaluation KEQ 1: How well was the Checks health target implemented? Criteria Poor Almost adequate Adequate Excellent Achievement of coverage target ≤82% 83 – 84% 85 - 89% ≥90% Achievement of coverage target (equity) Coverage for at-risk populations (by ethnicity and deprivation) is less than for populations with lower risk, and this ‘gap’ has not meaningfully reduced since 2012. A reduction in the relative coverage gap between ethnicity groups that are at higher risk than with relatively lower risk; or a reduction in the relative gap in coverage between Quintile 5 and Quintile 1. A reduction in the relative coverage gap between ethnicity groups that are at higher risk than with relatively lower risk; and a reduction in the relative gap in coverage between Quintile 5 and Quintile 1. Coverage for ethnicities at relatively higher risk is the same or better than for other ethnicities; and coverage for those living in Quintile 5 areas is the same or better than for those living in Quintile 1 areas. Quality of service delivery Checks were only delivered opportunistically. Purpose of check may not have been communicated to patient. Follow-up (where indicated) was not a routine aspect of the risk assessment process (possibly stalling until the patient initiated a further consultation). Checks were mostly delivered opportunistically. Purpose of check may not have been communicated to patient. Follow-up (where indicated) was initiated by the health provider when assessment suggested the patient to be ‘at risk’, with those people encouraged to initiate a consultation. Checks were delivered both opportunistically and Purpose of check and result were communicated to patient. Follow-up (where indicated) was initiated by the health provider, with those who were assessed as ‘at risk’ encouraged to initiate consultation, and this was Checks were delivered both opportunistically and Purpose of check and result were communicated to patient. Everyone whose risk was assessed was followed up, whether or not their risk was elevated. Those who were assessed as ‘at risk’ were encouraged to initiate a
followed up if no appointment was requested. consultation, and this was followed up if no appointment was requested. Influence of national initiatives (Target Champion) Sector was unaware of the role of the Target Champion. Many in the sector of the Target Champion role but did not recognise its value. Majority of the sector aware of the Target Champion role and reflected positively on their experiences with the Target Champion. Majority of the sector aware of the Target Champion role and reflected positively on their experiences with the Target Champion. Regions or providers with poorer performance perceived the Target Champion to have provided useful support. Influence of national initiatives (performance information) Providers were unaware of performance. Providers were of their performance (but not how they compared to similar others). Providers were aware of their performance (including compared to similar others). Providers were aware of their performance (including compared to similar others). This knowledge was used to drive performance. Influence of national initiatives (promotion and awareness) Target population was not aware of social marketing campaign. HPA promotional material was not displayed and information leaflets were not available. Target population was aware of social marketing campaign but not motivated by it. HPA promotional material was displayed or information leaflets were available but were not actively promoted. Target population was aware of and motivated by social marketing campaign. HPA promotional material was displayed and information leaflets were available but were not actively promoted. Target population was aware of social marketing campaign and hard-to-reach and high-risk populations were motivated to seek risk assessment. HPA promotional material was displayed and information
Consumer understanding and management of CVD risk People did not generally understand the meaning of the assessments and their CVD risk, or how to manage risks where elevated. People understood the meaning of the assessments and their CVD risk (i.e. result) but were not confident in how to manage risks where elevated. People understood the meaning of the assessments and their CVD risk (i.e. result), and were confident in how to manage risks where elevated. People understood the meaning of the assessments and their CVD risk (i.e. result), and were confident in how to manage risks where elevated, and had taken active steps to do so. Improved processes and systems There has been no impact on providers’ processes and systems for CVD risk assessment, nor for the ongoing treatment and management of patients with an elevated risk. Providers have improved processes and systems for CVD risk assessment, and for the ongoing treatment and management of patients with an elevated risk, but further improvements are needed. Providers have improved their processes and systems for CVD risk assessment, and for the ongoing treatment and management of patients with an elevated risk. Providers have significantly improved their processes and systems for CVD risk assessment, and for the ongoing treatment and management of patients with an elevated risk. Economic KEQ 3: What have been the economic implications of the Checks health target and is it likely the programme provides good value for money? Criteria Poor Almost adequate Adequate Excellent Efficiency Some evidence of wastage of funding. Compliance/ administration costs associated Minimal evidence of wastage of funding. Compliance/ administration costs associated No evidence of wastage of funding. Compliance/ administration costs associated Proactively sought efficiencies in implementation. Compliance/ administration costs associated
with the Checks target were high. with the Checks target were not insignificant. with the Checks target were minimal. with the Checks target were minimal. Impact of financial incentive Bonuses and incentives had minimal impact on implementation, and probably have achieved the same result for lower cost. Bonuses and incentives had some impact on implementation, but may have achieved same result for lower cost. Bonuses and incentives had an impact on implementation, and not have achieved the same result for less. Bonuses and incentives had a significant impact on implementation, and would not have achieved the same result for less.
Sustainability KEQ 4: To what extent are any gains made through the Checks health target likely to continue? Criteria Poor Almost adequate Adequate Excellent Sustainability CVD risk assessment is only embedded in some primary care practices and the positive benefits of the Checks target are likely to reverse in many areas. CVD risk assessment is embedded in most primary care practices but the positive benefits of the Checks target are likely to reverse in some areas. CVD risk assessment is widely embedded in primary care practice and the positive benefits of the Checks target are likely to continue. CVD risk assessment is widely embedded in primary care practice and the positive benefits of the Checks target are likely to continue to improve, including for hard-to-reach groups.