Approach for conducting the longitudinal program evaluation of the US Department of Health and Human Services National Action Plan to prevent healthcare-associated infections: roadmap to elimination.

BACKGROUND: In response to mounting evidence about skyrocketing morbidity, mortality, and costs associated with healthcare-associated infections (HAIs), in 2009, the US Department of Health and Human Services (HHS) issued the HHS HAI Action Plan to enhance collaboration and coordination and to strengthen the impact of national efforts to address HAIs. To optimize timely understanding of the Action Plan's approach and outcomes, as well as improve the likely success of this effort, HHS requested an independent longitudinal and formative program evaluation. OBJECTIVES: This article describes the evaluation approach to assessing HHS's progress and the challenges encountered as HHS attempted to transform the national strategy to HAI elimination. RESEARCH DESIGN: The Context-Input-Process-Product (CIPP) model, a structured-yet-flexible formative and summative evaluation tool, supported the assessment of: (1) the Context in which the Action Plan developed, (2) the Inputs and decisions made about selecting activities for implementation, (3) Processes or implementation of selected activities, and (4) Products and outcomes. MEASURES: A system framework consisting of 4 system functions and 5 system properties. RESULTS: The CIPP evaluation model provides a structure for tracking the components of the program, the relationship between components, and the way in which components change with time. The system framework allows the evaluation team to understand what the Action Plan is doing and how it aims to facilitate change in the healthcare system to address the problem of HAIs. CONCLUSIONS: With coordination and alignment becoming increasingly important among large programs within healthcare and other fields, program evaluations like this can inform the policy community about what works and why, and how future complex large-scale programs should be evaluated.