Chapter
54
Evaluating Individual and Program Outcomes
Lynn B. Gerald and Joan M. Mangan
Clinical Pearls
l The evaluation of individual or program outcomes deter-
mines the value or worth of an intervention provided to
persons with asthma and their families.
l An evaluation may examine the process of delivering an
intervention and/or the impact an intervention has on a
person with asthma and their families.
l The ability to detect changes brought about by a program
will depend on (1) the operational definition of a physi-
ologic marker, behavior, or event to be evaluated; (2) the
precision of the measure used; (3) effect size; and (4) the
sample size.
l The goals of asthma therapy provide a basis for what is
evaluated when assessing individual patient and program
outcomes.
l The strategies used to gather data for an evaluation are
guided by the resources available to conduct the evaluation
and the nature of the evaluation’s goals.
Advances in medical technology as well as the drive to ensure
access to quality health care for all citizens have led, in part,
to the escalating costs of health care. In turn, these costs have
highlighted the need for evidence-based medicine, generated
calls for greater accountability for the dollars spent on patient
care and health promotion programs, and have raised con-
cerns for documenting the worth of program expenditures in
relation to their costs. Accordingly, the evaluation of individ-
ual and program outcomes has become paramount.
Entire textbooks have been dedicated to the topic of eval-
uation; the challenge is to present key issues related to the
evaluation of individual and program outcomes in one chap-
ter. In an attempt to meet this challenge the first portion
of this chapter highlights approaches for evaluating outcomes
and detecting changes brought about by an intervention. The
second half of the chapter presents a synopsized discussion
of clinical measures of asthma, asthma events, and behavioral
measures that might be incorporated into the evaluation of
patient or program outcomes, as well as a discussion of data
collection.
Evaluation
A Definition of Evaluation
At its core, the term evaluation speaks to the value or quality
of a program for people with asthma, or the care and services
provided to individual patients. In order to establish value
or judge the level of quality, a systematic assessment of an
asthma program or patient outcomes is compared to a set of
explicit or implicit standards.1
Explicit standards may be found in clinical practice guide-
lines or case management protocols, while the explicit stan-
dards for a program or research study are usually developed
by program/study leaders and set forth in the program’s/
study’s objectives. Examples of explicit standards include:
the change expected in spirometry measures before and after
a patient inhales a short-acting bronchodilator; an average
2-point change in overall score on a questionnaire measuring
depressive symptoms; the reduction in days per week a per-
son experiences asthma symptoms; or the number of missed
doses per month of daily inhaled corticosteroids.
Implicit standards are generally understood and can be
harder to define because they may vary by people or groups
based on personal interests, or overlap based upon shared
aims. Examples of implicit standards include: the expecta-
tions a patient brings to a clinical encounter; a health care
team’s aspiration to help their patients attain a better quality
of life; or a health organization’s goal to motivate patients to
engage in healthy behavior changes.
Why Evaluate?
The underlying reasons why an evaluation is conducted can
vary. Generally, an evaluation of an individual patient may be
conducted in order to:
l Monitor the clinical progress of individual patients.
l Identify factors impacting the clinical progress of patients.
l Determine the effectiveness of an intervention.
An evaluation of an entire program may focus on the same
issues, as well as:
l Explore ways to increase efficiency in the delivery of a
program.
l Determine the effectiveness of attempts to improve an
existing program.
l Satisfy accountability requirements of a sponsor or
stakeholder.
l Examine the allocation of resources.
l Justify the expansion, reduction or abandonment of a
program or services.
l Determine approaches to decrease the costs associated
with the provision of services.2,3
As this list illustrates, the evaluation of program outcomes
is often a political activity. Unless programs have a demon-
strable effect, it is difficult to garner the support needed to
maintain them. Knowledge of a program’s effect may still
be insufficient to justify its continuation. Decisions related
to a program are often made based on the program’s ben-
efits in relation to its costs. However, estimating costs can be
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