TNDMS - The National Diabetes Management Strategy
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Research Studies ...

DEFINE Program - The Framework

  • Five Step Evaluation Framework
  • Determinants of Health Schematic
  • Priority Multi-level Indicator Set
  • All Inclusive Multi-level Inidcator Set
  • Table of Associated Measurement Tools

What is DEFINE?

What is the difference between other performance/evaluation frameworks and DEFINE?

How was the framework developed?

Who was DEFINE created for?

What is the DEFINE user-guide?

Why and how to use the DEFINE user-guide?

 

What is DEFINE?

The Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE) is a framework to guide the comprehensive evaluation of diabetes prevention and management initiatives, strategies and programs, and to facilitate policy innovations in order to improve diabetes care and reduce the clinical and financial burden of diabetes. To help attain its overarching goal, the DEFINE Package includes: a Five Step Evaluation Framework, a Determinants of Health Schematic, a Priority Multi-level Indicator Set, an All-inclusive Multi-level Indicator Set, and a Table of Associated  Measurement Tools.

Three main goals of DEFINE:
  • To guide comprehensive evaluation
  • To build a balanced and robust body of evidence
  • To facilitate knowledge translation

DEFINE was designed to be broad and system-focused to encourage everyone to move beyond performance measurement to a more systematic and comprehensive evaluation approach. Thus, it is inclusive in nature with an emphasis on all the factors that play a role in a patient’s wellbeing rather than just clinical process and outcome measures. DEFINE has built-in flexibility to allow its application irrespective of the type of diabetes program or evaluation question of interest. This user-guide is available here here to walk you through the Five Step Evaluation Framework, to highlight the relationships that influence a patient’s wellbeing, specifically the relationships among the medical and non-medical determinants of health, and to provide you with a number of multi-level indicators and measurement tools to consider when planning an evaluation.  

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The DEFINE Package - Brief Overview

Five Step Evaluation Framework


A pictorial representation of the three main goals and the five step approach of DEFINE. For more detail about each of the five steps of the framework, click here.

 

 

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Determinants of Health Schematic

 

A pictorial representation of the relationship among medical and non-medical (e.g. social, economic, cultural) determinants of health that influence a patient’s wellbeing. The determinants in this schematic are categorized into four levels: Patient, Healthcare Delivery, Organization of Healthcare, and Environment. Click here for a video describing the schematic.

 

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Priority Multi-level Indicator Set

 

A list of critical indicators that should be captured as part of most comprehensive evaluations. These indicators provide important information about the impact of your program of interest and evidence-based information to inform policy and system performance.
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All-inclusive Multi-level Indicator Set

 

All-inclusive Multi-level Indicator Set related to diabetes to consider as you seek to gain a better understanding of the impact of your program. Some of these indicators can be selected to help answer your specific evaluation question(s), goals and context.

Full Indicator Table

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Table of Associated  Measurement Tools

 

A list of existing measurements tools or instruments (up to January, 2013) that could be considered when developing your evaluation plan. Remember that there are other important methodologies to think about that are not captured in this table (i.e. qualitative data, administrative data and patient chart data) and that new measurement tools are constantly under development. We encourage you to conduct your own search before making the final selection of measurement tools for your evaluation. View the Table of Associated Measurement Tools.

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What is the difference between DEFINE and other evaluation frameworks?


As described in the Canadian Journal of Program Evaluation:"Time to Evaluate Diabetes and Guide Health Research and Policy Innovation: The Diabetes Evaluation Framework (DEFINE)"(Paquette-Warren et al., 2014), the main focus worldwide has been on performance measurement. However, until DEFINE, no single framework existed to systematically guide the comprehensive evaluation of diabetes care (Borgermans et al., 2008) , or to study the causal relationships between programs and outcomes (Blalock, 1999).

General health-related frameworks exist and provide the wider context for disease specific frameworks such as The Health Indicators Framework by the Canadian Institute for Health Information (Canadian Institute for Health Information, 2011a; Canadian Institute for Health Information, 2011b; Hogg, Rowan, Russell, Geneau, & Muldoon, 2008; McLoughlin, Leatherman, Fletcher, & Owen, 2001; World Health Organization, 2010). Diabetes specific systems/frameworks are also in place in many countries around the world. Of particular note are the Organization for Economic Co-operation and Development Healthcare Quality Indicators Project for Diabetes (Kelley, Arispe, & Holmes, 2006; OECD, 2011)  and work by the International Diabetes Federation (International Diabetes Federation, 2011).


Overall, current frameworks are limited because they:

  • Focus on clinical data for surveillance (Khan, Mincemoyer, & Gabbay, 2009)
  • Rely on only one source of data: administrative or self-reported or chart audit
  • Do not include system and environmental indicators (Chaudoir, Dugan, & Barr, 2013)

Before DEFINE, health-related frameworks did not seek enough breadth of information (Canadian Institute for Health Information, 2011b) to truly determine the impact of programs on targeted outcomes (Canadian Institute for Health Information, 2011b)  or the impact of investments and policy on diabetes care.

DEFINE was devleoped to move beyond system performance to explore the relationship between investments/programs and outcomes.

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How was the evaluation framework developed?


DEFINE was developed through an iterative process, including:
  • A comprehensive literature review of published and grey literature (published prior to January 31, 2012).
  • A series of five National Diabetes Management Strategy (TNDMS) Advisory Council (experts in diabetes, policy, evaluation, medicine, and research) committee meetings to conceptualize and refine the framework between 2009 and 2012.

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Who was DEFINE created for?

DEFINE has been designed for you!

  • Clinicians
  • Evaluators
  • Policy makers
  • Program planners
  • Researchers

DEFINE was created as a resource for anyone involved in diabetes program planning, implementation, evaluation, and policy. Regardless of your background or experience, DEFINE will guide and assist you in designing a comprehensive evaluation approach to assess your particular diabetes program, strategy or initiative. For more information or additional support, please do not hesitate to contact us. We would be happy to hear from you.


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What is the DEFINE user-guide?


The DEFINE user-guide is a tool to support comprehensive evaluation of diabetes initiatives, strategies and programs. The user-guide walks you through the step-by-step framework, highlights the important concepts to reflect on as you progress in an evaluation, and provides a series of tips, examples, resources, and worksheets to assist you as you go along. View the user-guide.


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Why use the DEFINE user-guide?


Conducting an evaluation can be overwhelming, and the user-guide can help you apply DEFINE in your work. It will walk you through each step of the framework, and explain how the tools included in the DEFINE Package can be used to facilitate the planning and implementation of your evaluation. The user-guide can facilitate the process of conducting an evaluation with confidence that it is comprehensive and able to inform future program planning and policy. To get started view the user-guide.

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