Performance Improvement

Clinical Preventive Services and Screenings—Intervention Module

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Diabetes Control Intervention Module

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Intervention Planning Worksheet

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Getting to Impact: An Evaluation Framework for Performance Improvement

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Sample Tracking and Intervention Evaluation Forms

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Welcome to Performance Improvement.  You have surveyed your clients on the risks to healthy aging.  You’ve analyzed your data and selected a health issue on which to focus.  Now what?  

It is time for an action plan!

The Performance Improvement section of Health Indicators is designed to help senior serving organizations use the results from their survey to plan and implement services (interventions) that can demonstrably make a difference in the health of their clients (impact).  

To help you choose an intervention to implement, review the Standards of Practice for management of diabetes, heart disease, and falls risk, three common health conditions in older adults.

Performance improvement, simply put, requires change.  To demonstrate that what you are doing to improve the health of clients, you will need to do some things differently (targeting, engagement, tracking, and measurement) to get your clients to change what they are doing to improve their health and well-being (health seeking behaviors). 

About This Section

This section contains two health risk intervention modules (Diabetes Control, and Clinical Prevention and Medicare Screenings) to help get you started.  Each module includes a brief description of the health issue, a range of interventions for service providers of varying capacities, brief descriptions of the interventions, the activities involved, the resources needed, sample tracking forms, and suggested measures to evaluate the success of the intervention.  

These health risk intervention modules reflect best practices and clinical guidelines that community agencies and seniors can do to reduce the risks to healthy aging.  Some interventions build on activities you are already doing and can be completed with modest staff and little or no additional resources.  Several interventions draw on the seniors themselves as peer supporters to help with blood pressure control.  Other interventions, such as Stanford’s Diabetes Self-Management Program, Tomando (DMSP in Spanish), A Matter of Balance, and others, are Tier III Evidence-based interventions and require significant staff time and or resources. Local health care providers or other external players may have some of the resources and expertise you need. There is a wide range of interventions from which to choose, some of which may be opportunities for partnership with a health care provider.

Diabetes Control and Clinical Prevention and Medicare Screenings are two examples of the many different health interventions and resources that exist.  They are by no means the only things you can do.  

Visit the U.S. Community Preventive Services Task Force’s Guide to Community Preventive Services (The Community Guide) or NCOA’s Center for Healthy Aging to learn more about the range of interventions available.


Making a Difference

Shifting from an activity for all, to a focused impact-oriented intervention for a specific set of clients, will mean doing some things differently. With a health risk issue selected, it is time to choose an intervention, decide what you are trying to accomplish and how you will know if you have succeeded.

Use the Intervention Planning Worksheet to help you develop an action plan.   Make sure you have:

  • A TEAM LEADER—Someone needs to be in charge to manage the intervention process. Performance improvement Interventions usually have a number of moving parts and involve more than one person.   The Team Leader makes sure that everyone understands his or her role and assigned tasks, intervention activities and tasks are happening, the right group of clients is reached, tracking information is gathered and correctly entered, and pre and post measurement is conducted.
  • A REGISTRY—This is the list of clients you will target for the intervention, which was developed using the Registry Generator.   On this list are the clients who have the selected health issue risk(s) you have decided to focus on.  This is your target population.  These are the individuals who you want to connect to the intervention.  
    • For example: If you have decided to focus on clients with diabetes who have not had an annual flu shot (a known risk factor for people with diabetes), then the people on your registry are all the clients who said YES on the survey that they have diabetes and NO on the survey to having had an annual flu shot. 
  • AN ENGAGEMENT STRATEGY—With your focus now on clients with a specific health risk, how will you connect to them?  Posting flyers on bulletin boards or making an announcement at lunchtime in the senior center, will not necessarily reach the clients on your registry, nor will they know that what you are offering (the intervention) was developed with them in mind.
    • New strategies will be needed.  Consider:
      • What will help maintain clients’ participation over time—Most interventions involve activities that happen over time (such as, weekly blood pressure monitoring, an 8-week education and support program).    The key is to keep clients’ interest and excitement going.  Some things that work are a buddy system pairing clients together, weekly reminder calls, token incentives.
      • How to encourage clients on your registry to participate—Your message is important.  Is this about a problem the client is having or is it about simple things older adults can do to stay or feel well?  Perhaps it is about your senior center winning a competition to have the highest rate of flu shots in the city!  What will motivate your clients?
      • How best to reach the clients on your registry—The personal touch—either by phone or in    person—is often what is needed.
  • RESOURCES AND MATERIALS—Beyond the space and staff needed to conduct the intervention activities, some interventions may require expertise, materials, or help from outside of your organization.  Is there a compelling argument that can be made?  How does the conversation change with a local health care provider (or places with a needed resource) now that you have quantifiable data (40% of our seniors have diabetes and 2/3 of them have not had an annual flu shot) and have a system in place to demonstrate results?  
  • AN EVALUATION PLAN—Evaluation need not be onerous or complicated.  But, you need to have one before you start an intervention.  Your evaluation plan must be structured and built into what you do so that you can manage your intervention along the way.  Without a plan that has process, progress, and impact measures that you are correctly capturing, you will not be able to show impact. Has your intervention made a difference for the seniors? Have you increased the number of seniors with diabetes getting flu shots?  Getting to Impact describes the Performance Improvement evaluation framework of Health Indicators.
  • TRACKING WHAT YOU DO-o demonstrate that what you are doing makes a difference in the health of your clients, you will need to document (track) what you are doing (process), how it is going (progress), and what difference it is making (impact).  There are many ways to track these things.  Sample tracking forms can help you get ideas for what, and how, to track. You may already have some of the information needed by what you are already doing.  The key is to have a system in place to know:
    • What data you need to track
    • How it will be collected
    • How often
    • Who will collect it
    • Where it will be recorded
    • If the data are collected the same way every time so that you can compare apples to apples

Use the Intervention Planning Worksheet to develop a clear picture of your tracking strategy and the data to be collected (such as engagement calls to clients on your registry, weekly attendance at exercise class, blood pressure readings, etc), who will collect it, how frequently it will be done, and what will be used to keep track of the data. 

Checking the things you are tracking as the intervention is happening helps you see if there are some things that need to be adjusted.  Are clients consistently participating?  Are the tracking forms being completed clearly and accurately?)  Spotting a problem and addressing it early in your intervention could make the difference in your having the information you will need to see the impact of your intervention.  Make tracking part of your intervention at the outset.

Getting to Impact provides more informatino about process, progress, and impact measurement.






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