Find the Treasure! Putting the Scraps of Knowledge Together to Map Your Way to New Models of Care

Seeking New Models of Care “Treasures”This poster was inspired because a growing number of health care providers and payers are seeking to share of the “treasure” of health care savings by becoming part of new models of accountable, collaborative care. In a sense, we are all looking for the “treasure” of finding more effective models of care. The problem is that none of us has the complete “map” to the treasure. We recognize that each person has a “scrap” of that map—the difficulty has been in putting the scraps together to make a better map. In short, serious challenges make evaluating our models difficult.

IPA Is Not Just a Beer: Integrative Propositional Analysis Method

An emerging systems-based method, Integrative Propositional Analysis (IPA), provides a rigorous, easy to use way to quantitatively and qualitatively assess which maps are more likely to be effective in improving practice. Unlike previous methods, IPA analyzes models based on the internal logics of the model. You might think of IPA as an “x-ray view” into the structure of a map. IPA involves 6 steps:

1) Find the logical statements/propositions in a map (found in a publication) 2) Diagram the causal relationships between concepts/steps within the propositions3) Combine those smaller diagrams where they overlap to create a larger diagram4) Identify and count the concepts with 2+ causes (“Concatenated” concepts)5) Count the total number of concepts in the map (“Complexity”)6) Divide Concatenated concepts by total concepts to calculate “Robustness”

For this poster, we have evaluated three “maps” of ACO models in the literature. Complete models cannot be shown due to limitations of space—these serve as examples.

Bernadette Wright, PhD1; Ladel Lewis, PhD1; and Steven E. Wallis, PhD2

1Meaningful Evidence, LLC, 2Foundation for the Advancement of Social Theory

Which One Would You Choose?

* Chart shows results for specific concepts level maps only, due to space.

Sources 1Lewis, V.A., Larson, B.K., McClurg, A.B., Boswell, R.G., & Fisher, E.S. “The Promise and Peril of Accountable Care for Vulnerable Populations: A Framework for Overcoming Obstacles,” Exhibit 2: “Policy Levers Used to Overcome Obstacles for Patients and Health Systems on the Path to Accountable Care.” Health Affairs, 31, no. 8 (2012)1777-1785. 2Kroch, E. et al., Measuring Progress Toward Accountable Care, “Exhibit 1. ACO Model of Core Components and Related Capabilities.” Premier Research Institute for The Commonwealth Fund, Dec 2012, http://www.commonwealthfund.org/Publications/Fund-Reports/2012/Dec/Measuring-Accountable-Care.aspx3HHS, Agency for Healthcare Research and Quality, "Team-Developed Care Plan and Ongoing Care Management by Social Workers and Nurse Practitioners Result in Better Outcomes and Fewer Emergency Department Visits for Low-Income Seniors," AHRQ Healthcare Innovations Exchange, Service Delivery Innovation Profile (Original publication 1/14/09, Last updated 1/15/14, Accessed 2/11/14) http://www.innovations.ahrq.gov/content.aspx?id=2066&tab=1

Benefits for Research & Practice

If a strategy or goal has more roads leading to it, you have more options and more control. This can help you make strategic decisions with greater confidence that your plans will work.

Clarify which department or partnering organization is doing what, to coordinate efforts.

Identify what activities and outcomes might be important to track and measure.

Assess the terrain and what it means for your activities.

Find points of leverage to increase influence.

Visit the Next Poster to Integrate Maps and Make a Better Map!



For additional information please contact:Bernadette Wright, Ladel Lewis, and Steven E. WallisASK MATT ~ Accessing Strategic Knowledge – Meta Analysis Think Tankaskmatt@meaningfulevidence.com | www.askmattmaps.com

“Accountable Care for Vulnerable Populations: Framework For Overcoming

Obstacles” MAP

“ACO Model of Core Components and Related

Capabilities” MAP MapData / Empirical Evidence Used

Map 1: “Framework for Overcoming Obstacles” 1

Integrates insights from 26 studies in literature

Map 2: “Core Components & Related Capabilities”2

Team of 20 health care experts led by Premier, a member-owned health alliance

Map 3: GRACE3 Randomized controlled trial; analyses of implementation fidelity and cost outcomes

Geriatric Resources for Assessment and Care of Elders

(GRACE) MAP

FOUNDATION FOR THE ADVANCEMENT OF SOCIAL THEORY

Map 3

Map 2

Map 1

0 10 20 30 40 50 60

34

48

14

2

7

5

0.06

0.15

0.36

IPA Results: 3 Example Maps*

Systemicity Score (0-1 scale) # Strongly Explained Concepts # Concepts/Steps