MMHA 6475 Week 10 Proposal Alignment Crosswalk Example

Does Every Objective Have a Path, a Budget and a Measure? An Alignment Crosswalk for the Tamarack Hospital at Home Proposal

Student Name

Walden University

MMHA 6475: Program Planning, Implementation, and Evaluation

Instructor Name

Month Day, Year

Does Every Objective Have a Path, a Budget and a Measure? An Alignment Crosswalk for the Tamarack Hospital at Home Proposal

Purpose

This crosswalk checks that each objective in the Tamarack Health hospital-at-home proposal is connected to every earlier piece of the plan: the gap it answers, the logic diagram boxes it runs through, the launch tasks that deliver it, the budget lines that fund it, the fidelity measure that watches it and the indicator that judges it. Assembling the proposal from separately written pieces often leaves gaps, such as an objective that no budget line funds or a measure that no objective needs. The crosswalk makes those gaps visible before leadership reads the proposal. Page references point to the revised draft that accompanies this crosswalk.

The Crosswalk

Table 1 shows one row for each of the seven objectives from Week 3. Cells marked with an asterisk were empty when the pieces were first assembled; the notes below explain how each was filled.

Table 1

Alignment Crosswalk (Page References to the Revised Draft)

How the Empty Cells Were Filled

Objective 2, launch tasks. The first assembly had no task supporting patient acceptance; the launch plan assumed patients would agree if offered. Since acceptance depends on how the program is explained, a task was added to the build phase: written and spoken patient education materials, developed with the Patient and Family Advisory Council and tested with five former inpatients before launch. The task is owned by the patient experience manager.

Objective 7, gap answered. The needs case described the bed gap but said nothing about sustainability, so the maintenance objective had no grounding in the original problem statement. A paragraph was added to the needs case explaining that a capacity solution funded only by launch money would leave the gap unaddressed after the funding ended, which is why maintenance is part of the problem definition rather than an afterthought.

Fidelity measure for objective 6. The first draft linked readmission to nurse visit timeliness alone. The revision adds video round completion, since the daily physician round is where discharge readiness and follow-up planning are decided, both of which bear on readmission.

What the Crosswalk Revealed Beyond the Empty Cells

The crosswalk also showed that one element of the plan had no objective attached. The Week 8 fidelity plan measured whether first medication doses arrived before their scheduled time, but no objective concerned medication delivery. Rather than delete the measure, which protects patients, the revision ties it to objective 5, since late medication is a common reason for escalation. The logic diagram already linked timely delivery to low escalation through arrow 6, so the change made an existing claim explicit. A logic model is meant to show these connections (W. K. Kellogg Foundation, 2004), and the crosswalk is the check that the written plan honors them.

Revision Log

Table 2 lists every change made to earlier pieces during alignment.

Table 2

Revision Log

Glossary

Three terms are fixed for the draft that follows, because earlier pieces used them inconsistently. Episode: one period of acute care at home, from transfer home to discharge from the program or escalation to the hospital. Eligible patient: an adult admitted through the flagship campus emergency department with one of the five pilot conditions, meeting the clinical criteria in the protocol, living within 20 miles and with a safe home setting. Escalation: any transfer from home back to a hospital bed during an episode, whether planned or urgent. Each term carries one meaning throughout the proposal. Earlier drafts had used episode sometimes to mean a patient and sometimes a day of care, which would have made the budget's per-episode figures and the evaluation's indicators impossible to compare.

Readiness for the Final Draft

With the revisions above, every objective now has a gap, a path through the logic diagram, launch tasks, budget lines, a fidelity measure and an outcome indicator, and every fidelity measure supports at least one objective. The revised draft carries page references matching the crosswalk. The remaining risk is not alignment but evidence: several objectives rest on targets marked illustrative, and Tamarack's own baseline data, once pulled, may show that some targets need to change. The proposal will note this and commit to resetting targets after the baseline review, with the steering group's approval (Glasgow et al., 1999). The comparison design in Week 9 depends on those baselines too, since the difference-in-differences estimate is only as good as the pre-launch data for both campuses (Dimick & Ryan, 2014).

References

Dimick, J. B., & Ryan, A. M. (2014). Methods for evaluating changes in health care policy: The difference-in-differences approach. JAMA, 312(22), 2401-2402. https://doi.org/10.1001/jama.2014.16153

Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322-1327. https://doi.org/10.2105/AJPH.89.9.1322

W. K. Kellogg Foundation. (2004). Logic model development guide. W. K. Kellogg Foundation.