March 2018

March 2018

Hello Flex Coordinators,

I’m sure the progress report for your fiscal year (FY) 2018 funding extension request is top of mind for everyone right now. If you missed the Flex Grant Extension Technical Assistance Webinar, please watch the recording. I also expect you will have questions as you start working on your report—please post those questions in the Flex Program Forum so we can all learn from them! I regularly monitor the Forum and so does the TASC team, and we will make sure you get timely answers. See the Flex Grant Guidance page for additional materials, including instructions from prior years and the FY 2015 Notice of Funding Opportunity which is our governing document for this project period.

In the context of the progress report I’ll revisit the question, What do we mean by impact and outcomes?

Impact refers to the overall effects produced by a program or intervention. What are the positive and negative effects of the project? Another way to say this is to ask, “What is different because we implemented this project?”

Outcomes are concepts and tools to help us demonstrate impact. Outcome measures are specific, well-defined questions that use data to track specific changes. Outcome measures help us meet the challenge, “Prove it.”

Outcome measures may assess a variety of changes from short- to long-term. Short-term outcome measures often track changes in participants’ knowledge, medium-term measures monitor changes in behaviors or policies, and long-term measures look for changes in conditions and health status (such as population health status for rural communities or financial health for rural hospitals).

In contrast to outcome measures, output measures help us understand the scale and scope of program activities. For example, the number of people participating in quality improvement workshops and the number of critical access hospital (CAH) site visits completed in a year are both output measures. Output measures are important for describing what the Flex Program is doing, but they cannot show the impact of the program by themselves. For the previous output examples, did the 100 workshop participants learn anything or change any behaviors? Did the 15 site visits lead to improved communication and more engagement with CAHs? Are those changes associated with better quality of care for rural people? These are outcomes and impact.

The Flex Program Logic Model shows graphically how Flex activities, outputs and outcomes relate to one another. This model was presented at the 2017 Flex Program Reverse Site Visit, and I encourage you to look at it as you plan the next grant year.

I have also been working with Katy Lloyd, program coordinator for the Small Health Care Provider Quality Improvement Program. The Quality program is a Federal Office of Rural Health Policy (FORHP) Community-Based Division grant that provides support to mature networks of rural health care providers engaged in quality improvement initiatives to improve patient care and chronic disease outcomes. Approximately 70 grantees from the Quality program will be joining us July 17-18 in the same hotel as the Flex Program Reverse Site Visit. Both groups will have program-specific sessions, but will come together for several of the plenary speakers and for networking with our fellow rural health professionals. I’m really looking forward to learning from you and from the Quality grantees at this joint meeting. You can see a directory of Quality grantees and more information about their projects on the Rural Health Information Hub.

Until next time, happy spring! Our peak cherry blossom forecast in DC shifted two weeks later due to all of the cold weather we’ve had in March. (Thanks a lot, Punxsutawney Phil.) I will appreciate the cherries whenever they bloom though!

Sarah Young

Flex Program Coordinator

This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $1,100,000 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.