Figure 3. Washington State Heart Disease and Stroke Prevention Program (WaHDSPP) Logic Evaluation Plan, 2007–2008. (HDSPP indicates Heart Disease and Stroke Prevention Program; CDC, Centers for Disease Control and Prevention; EMS TAC, Emergency Medical Service Technical Advisory Committee; NCQA, National Committee for Quality Assurance; EPHS, essential public health services; MIS, management information system; HD&S, Heart Disease and Stroke; MI, myocardial infarction.)

The figure begins with a series of boxes organized into three columns. The three boxes arranged on top of each of the columns read 1) Inputs, 2) Activities, and 3) State Plan strategic improvement goals for the 10EPHS*. In the first column, entitled “Inputs,” are three boxes arranged from top to bottom. Inside the first box, entitled “HDSPP,” are the following bullet points: State Program Funding; Expertise of professional staff and infrastructure; Time Commitment; Internal Partners and Stakeholders; Communication; and Internal epidemiology support for surveillance and evaluation. Inside the second box, entitled “CDC,” are the following bullet points: Funding; Programmatic Guidance; Training; CDC Project Officer; Conference calls, listserv; and Technical Assistance. Inside the third box, entitled, “Steering Council Members,” is the following information: Invest staff time to implement strategies articulated in the State Plan, to meet State Plan Goals. All three boxes in the first column are connected with a right-pointing bracket to the boxes in the second column.

The second column, entitled “Activities,” contains one large box beneath the title box. The large box contains three major sections, each with information listed beneath. The three major sections are: 1) Primary Prevention, 2) Event, and 3) Secondary Prevention. Under the “Primary Prevention” section, three major areas are listed: 1) Worksite Health and Productivity, 2) Awareness of Signs and Symptoms, and 3) Washington State Collaborative. The “Worksite Health and Productivity” section lists the following two items: 1) External Healthy Worksite Summit, and 2) Grant and Internal Worksite Training. The “Awareness of Signs and Symptoms” section lists the following three items: 1) Outreach, African Americans; 2) Outreach, Native Americans; and 3) Activation of EMS-Acute Events. Under the “Event” major section, the following two items are listed: 1) Implement EMS TAC recommendations, and 2) Get with the Guidelines. Under the “Secondary Prevention” major section, six subheadings are listed: 1) Assess Rehabilitation Capacity, 2) NCQA Recognition, 3) Steering Council meetings, 4) Communication, 5) Epidemiology, and 6) Evaluation. Underneath the “Epidemiology” subheading, the following three items are listed: 1) Ongoing data analysis, 2) Disparities assessment, and 3) GIS analysis. Underneath the “Evaluation” subheading, the following four items are listed: 1) Steering Council evaluation, 2) Monitor performance measures, 3) Intervention evaluation, and 4) Awareness evaluation.

The third column, entitled “State Plan strategic improvement goals for the 10EPHS*,” contains one large box beneath the title box. The large box lists the following nine goals: 1) Comprehensive HD&S data to support the State Plan; 2) Surveillance used to identify persons who have, or at risk for HD&S; 3) WA residents know risk factors & warning signs of HD&S; 4) Convene Steering Council to implement State Plan Goals; 5) Action plan and policies empower consumers, result in improved health status and quality; 6) Establish process to assess and monitor State laws and regulations and identify opportunities to support the implementation of the state plan; 7) WA maintains and coordinated HD&S systems of prevention, screening, diagnosis, treatment and rehabilitation; 8) Education for HD&S prevention and management for licensed, registered, or certified HC providers; and 9) Evaluate Accessibility, Effectiveness and Quality of HD&S Prevention system.

To the right of column three are another series of three columns, each with a heading box above them. The first three columns already described are connected to the second series of three columns with a right-pointing bracket. The heading boxes above the second set of three columns read, “Supporting Outcomes (1-3 years),” “Medium-term Outcomes (3-5 years),” and “Long-term Outcomes (5 years +).” Underneath the column entitled “Supporting Outcomes (1-3 years)” is a box that contains the heading, “Primary Prevention,” followed by three bullet points: 1) Increased public awareness of the signs and symptoms of heart disease and stroke, knowledge to call 9-1-1 [noted as a CDC priority area]; 2) Worksite support for screening and control of risk factors AND for awareness of signs and symptoms of HD&S; and 3) Improved quality of primary care regarding control risk factors. The first column is connected to the second column with a right-pointing bracket.

Underneath the column entitled “Medium-term Outcomes (3-5 years),” is a box that contains three headings: 1) Primary Prevention, 2) Event, and 3) Secondary Prevention. Underneath the “Primary Prevention” heading are the following three bullet points: 1) Control of risk factors (blood pressure and cholesterol) achieved [noted as a CDC priority area]; 2) Increased recognition of symptoms; shorter time between recognizing symptoms and calling 911; and 3) Improved quality of care in primary care settings [noted as a CDC priority area]. Underneath the “Event” heading are the following two bullet points: 1) improved emergency response to acute events across the state [noted as a CDC priority area]; and 2) increased hospital compliance with protocols for optimal response to HD&S event. Underneath the “Secondary Prevention” heading is the following bullet point: improved rehabilitation and management of chronic condition following a heart attack or stroke. The second column is connected to the first two boxes of the third column with a right-pointing bracket and two arrows.

Underneath the column entitled “Long-term Outcomes (5 years +)” are four boxes arranged vertically. The first box contain the following information: Fewer first events; better survival rates following a heart attack or stroke; fewer repeat MI or stroke. The second box contains the following information: Decrease in disability associated with heart attack or stroke. The second box is connected to the third box with a downward-pointing arrow. The third box contains the following information: Reduce health disparities [noted as a CDC priority area] between general and priority populations. The third box is connected to the fourth box with a downward-pointing arrow. The fourth box contains the following information: Reduce deaths due to heart disease and stroke.

Underneath the six columns is the following text: “Rationale: by working towards reaching our state plan goals for improving the 10 EPHS, we enhance the capacity of HD&S public health system to achieve the short-term, intermediate, and long-term outcomes.”

Volume 5: No. 2, April 2008