1. The Alameda County Care Alliance
Evaluation Research to Assess ACCA Outcomes:
Challenges, Dead Ends, and Ways Forward
November 29, 2017
Jill G. Joseph, MD, PhD
Betty Irene Moore SON, UC Davis
Cynthia Carter Perrilliat, Executive Director, ACCA

2. Alameda County Care Alliance
A faith-based community advanced illness care navigation program that helps persons needing advanced illness care and their caregivers
In 2014, five denominationally diverse African-American Pastors in Alameda County recognized increasing problems with serious health concerns among their congregants and poor integration of spiritual concerns into health care. In response, they created the Alameda County Care Alliance Advanced Illness Care Program™ (ACCA-AICP) a faith-based, person-centered, lay care navigation intervention serving predominantly African American adults with advanced illness and their caregivers in alignment with their spiritual and religious values.
(FYI) Advanced Illness occurs when one or more conditions become serious enough that:
general health and functioning decline, and “Health gets worse over time” “unable to function independently”
treatments begin to lose their impact – “treatment is less helpful

3. Multiple Programmatic Accomplishments
Trust building
Program planning and partnership building
Staff recruitment and training
Funding support
Broad inclusion beyond faith community
Expansion of participating churches
Fidelity to faith-based roots

4. The ACCA Path to Sustainability
Sustainable, replicable program
Build trusting relationships
Confirm need & commitment
Attract funders
Aligned policy and funding
Standardized training
Standardized intervention
Inclusion
New partners and funders
Evaluation Activities
Program Planning
Local Successful Program
National Program Model

5. Outcome Evaluation History: Challenges
Randomized trial approach advocated
Quasi-experimental pre/post longitudinal design
Now what?
Not acceptable
Not feasible
Acceptable +/-
Remarkable progress
Limited progress

6. Now What? Clearly Define Program
Program community-based and developed, NOT community-engaged
Program with multiple domains, NOT just care navigation intervention

7. Evaluation activities
Community expectations
Church culture
Not enrolled
Personal contact
Enrolled
Partial visits
Enrolled receive
10 visits
Evaluation activities

8. Two “Dead End” Alternatives
DEMAND
PROVIDE
Rigorous design
Large N representative samples
Longitudinal data
Faith and community-based novel programs
Enthusiasm
Limited support
Intriguing model for policymakers

9. Evaluation: A Collective Way Forward?
1. Recognize merits of methodologic rigor
2. Recognize limits of methodologic rigor WRT bias, generalizability and relevance (Ioannidis JP (2005) Why most research findings are false. PLoS Medicine 2: ;)
3. “Triangulate” outcome evaluation across multiple domains
Track church culture, community expectations
Track change in clinical outcomes with clinical partners
Consider consortium to provide real time “replication”
4. Think historically and incrementally. Act collectively.