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PubMed2003

[Costs and benefits of an education program for patients with ankylosing spondylitis as part of an inpatient rehabilitation programs-study design and first results].

The economic evaluation of a patient education program "ankylosing spondylitis"-based on a randomised controlled prospective multi-center study design-compares program costs and savings in direct and indirect follow-up costs. The collection of health services and cost data was conducted by questioning staff (education programme costs) and patients (follow-up costs). The present study results are: program costs per patient range between 117 euro (10 participants per course) and 186 euro (6 participants per course). Savings in indirect costs (unfitness to work) amount to 2500 euro and thus overcompensate program costs. Currently patient data are verified by sickness fund data and direct follow-up costs and qualitiy of life data are analysed.

Cost Savings↗
PubMed2004

Impact of a cardiac risk reduction program in vulnerable patients hospitalized with coronary artery disease.

STUDY OBJECTIVE: To increase the use of guideline-based pharmacotherapy in vulnerable patients (ethnic minorities and the poor) with coronary artery disease (CAD) through a nurse-based quality-improvement program. DESIGN: Retrospective program evaluation. SETTING: Inner-city hospital in Denver, Colorado. PATIENTS: One hundred fifty-one consecutive patients hospitalized with a CAD-related diagnosis. INTERVENTION: A nurse-management program was initiated for patients with angiographically documented CAD, and rates of guideline-based care were compared with rates for historic controls. The intervention consisted of two key elements: patient counseling with language-appropriate education materials and direct physician education regarding the importance of cardioprotective drugs. The 151 patients in the intervention group were compared with 125 historic control patients hospitalized before the program was begun. Multivariable logistic regression analysis was used to assess differences in care with regard to ethnicity, education level, and insurance status, and to adjust for different baseline characteristics. MEASUREMENTS AND MAIN RESULTS: At hospital discharge, patients in the intervention group were more likely to receive statins (71% vs 52%, p=0.001) and angiotensin-converting enzyme inhibitors (79% vs 51%, p<0.001) compared with controls. These differences remained after adjusting for ethnicity, education level, insurance status, and baseline clinical characteristics. Also, a trend was noted toward greater use of aspirin (92% vs 86%, p=0.13) and beta-blockers (79% vs 73%, p=0.24) in the intervention group compared with controls. Patients in the intervention group were more likely to receive counseling for smoking cessation. CONCLUSION: An inpatient nurse-management program improved the quality of care for patients with CAD regardless of sociodemographic status. Properly designed disease-management initiatives can be effective for disadvantaged patients, who often obtain health care through emergency and inpatient services.

Colorado↗
PubMed2002

Neighborhood and physical activity outcomes in women: regional comparisons.

The environment a person lives in can play a large role in determining whether they exercise. This study examined the physical activity level of women living in either a northern or a southern region of the United States. Sedentary women were recruited to be part of a program designed to increase walking. Women were measured on the time it took to walk 1 mile, lung capacity, BMI, percent body fat, and mood. We found significant regional differences at baseline and change on outcomes over time. Awareness of the relationship between community/neighborhood and physical activity can be useful for designing fitness programs that are sensitive to environmental differences in women's lives.

Adult↗
PubMedDate not supplied

Modified therapeutic community for homeless mentally ill chemical abusers. Sociodemographic and psychological profiles.

This paper, the first in a series of reports from a field study on the efficacy of modified therapeutic community (TC) treatment for homeless mentally ill chemical abusers, presents sociodemographic profiles, psychiatric diagnosis, and psychological symptom data on 342 homeless mentally ill chemical abusing clients seeking treatment in mental health community residence settings. The findings reflect the multidimensional deficits, social dysfunctionality, and severity of psychopathology of the study sample. The paper discusses the implications of these findings for program design and program planning, with special reference to modified TC programs.

Adult↗
PubMed2003

Cancer screening practices and attitudes: comparison of low-income women in three ethnic groups.

OBJECTIVE: Based on the Health Belief Model, this study investigates differences among ethnically diverse, low-income women in the USA to inform better outreach strategies to encourage participation in the Centers for Disease Control & Prevention (CDC)- sponsored breast and cervical cancer early detection program. DESIGN: Program-eligible, low-income, Hispanic, Vietnamese and Cambodian American women who were over the age of 40 volunteered to be interviewed in their first language for the study. A total of 78 women completed the interviews. RESULTS: All three samples of women were more likely to perceive barriers to having a mammogram performed compared to the non-minority normative group. Hispanic and Vietnamese women were more similar in their health beliefs and behaviors than Vietnamese and Cambodian women. CONCLUSION: This study supports other research on the barriers and health belief differences found among ethnic minority women in the USA. Further, these findings suggest that it is not advisable to collapse ethnic groups into general categories such as 'Asian' when planning cancer control strategies, as differences were found by country of origin.

Adult↗
PubMed1982

Problems associated with establishing a clinic for the elderly.

Actual use of a newly established geriatric clinic in a low-cost housing unit was appreciably below projected numbers, even though cost and transportation were removed as barriers to care. In a survey of building occupants, 20% were unaware of the clinic's existence. More than 90% of the occupants did not know clinic hours but a third could identify clinic staff. About half of the occupants had used the clinic, often for minor services. The major reason for lack of use of the clinic was an established pattern of receiving medical care which occupants were reluctant to risk or abandon. Needs must be appropriately assessed before service programs are designed for the elderly. Assumptions may at times be incorrect. A thorough understanding of needs and existing methods of meeting them leads to more appropriately designed programs.

Aged↗
PubMed1999

Motivating the well elderly to exercise.

Most older adults hope to remain independent until death, but their inactivity, poor nutrition, and disabling diseases contribute to the loss of functions that are necessary for independence. Although exercise has been shown to improve a person's functioning and decrease health care costs, two thirds of persons over age 65 do not exercise regularly. The purpose of this article is to describe intervention strategies and evaluate their usefulness in motivating adherence to an exercise program designed specifically for well-elderly community dwellers. Attendance records were reviewed and informal discussions were held to determine the usefulness of the selected intervention strategies. Fifty-seven percent of the group's members attended at least one half of the 52 sessions indicating that our strategies were effective. Information about the exercise strategies that we used can help community health providers to promote health by designing exercise programs that will entice the elderly to attend on a regular basis.

Activities of Daily Living↗
PubMed2004

Reduction of amputation rates among Alaska Natives with diabetes following the development of a high-risk foot program.

OBJECTIVE: The prevalence of diabetes is increasing rapidly among Alaska's Indian, Eskimo and Aleut populations. Approximately half the Native people with diabetes have no road access to hospitals or physicians, presenting a challenge in the attempt to prevent lower extremity amputation as a complication. In late 1998 funding became available for diabetes prevention and treatment among Native Americans. The tribal health corporations in Alaska decided to use a portion of this funding to implement a high-risk foot program to decrease the amputation rate. PROGRAM DESIGN: The program initially involved a surgical podiatrist who provided training to local staff and performed preventive and reconstructive surgery on several patients with impending amputations. The program then provided training for a physical therapist to become a certified pedorthist. This individual established the long-term maintenance phase of the program by conducting diabetic foot clinics routinely at the Alaska Native Medical Center, a referral center in Anchorage. He also travels to other regions of the state to provide training for village and hospital-based health care providers and to conduct field clinics. A system was established in a common database management program to track the patients' foot conditions. Patient education is emphasized. RESULTS: The overall amputation incidence among all Alaska Native patients with diabetes decreased from 7.6/1,000 in the pre-program period (1996 to 1998) to 2.7/1,000 in the post-program period (1999-2001) (p<.001). The rate among Aleuts, who previously had the highest amputation incidence, decreased from 17.4/1,000 to 3.1/1,000 over the same time periods (p<.001). Among people who had had diabetes at least 10 years, the overall amputation incidence decreased from 16.4/1,000 to 6.8/1,000 (p=.021); among Aleuts the rate fell from 24.5/1,000 to 2.6/1,000 (p=.01). CONCLUSIONS: Though longer follow-up is needed, these data suggest that even in populations living in isolated regions, diabetic amputations can be prevented by a coordinated system to identify high-risk feet and provide preventive treatment and education in the context of a comprehensive diabetes management program in an integrated health system.

Alaska↗
PubMedDate not supplied

The Pyramid Model: an integrated approach for evaluating continuing education programs and outcomes.

Recent mergers and downsizing of health care agencies have made resources for continuing education (CE) increasingly scarce. Nurse educators must demonstrate the effectiveness and sustainability of CE programs and establish the link between nursing professionalism and positive patient outcomes. The Pyramid Evaluation Model expands and enhances previous evaluation frameworks. Simple steps are outlined to evaluate CE programs and outcomes systematically and comprehensively through an impact model that examines goals, reviews program design, monitors program implementation, assesses outcomes and impact, and analyzes efficiency.

Cost-Benefit Analysis↗
PubMed2005

Library outreach: overcoming health literacy challenges.

OBJECTIVE: This paper examines the powerful influences of consumer health literacy on access to and use of relevant health information. METHOD: The paper describes how widespread problems with health literacy significantly limit effective dissemination of relevant health information in society, especially to many vulnerable populations where health literacy challenges are especially pervasive. RESULTS: The paper examines strengths and weaknesses of different programs for addressing health literacy problems, including educational programs, message design programs, and strategic communication training and intervention programs. IMPLICATIONS: The paper evaluates strategies that can be implemented throughout the modern health care system to address problems of health literacy by improving health information access, processing, and understanding. It concludes by examining several strategies that libraries can adopt to overcome many health literacy challenges.

Community-Institutional Relations↗
PubMed1997

End-user searching: impetus for an expanding information management and technology role for the hospital librarian.

Using the results of the 1993 Medical Library Association (MLA) Hospital Libraries Section survey of hospital-based end-user search services, this article describes how end-user search services can become an impetus for an expanded information management and technology role for the hospital librarian. An end-user services implementation plan is presented that focuses on software, hardware, finances, policies, staff allocations and responsibilities, educational program design, and program evaluation. Possibilities for extending end-user search services into information technology and informatics, specialized end-user search systems, and Internet access are described. Future opportunities are identified for expanding the hospital librarian's role in the face of changing health care management, advances in information technology, and increasing end-user expectations.

Computer Communication Networks↗
PubMed1994

Designated-driver programs: college students' experiences and opinions.

We investigated the experiences and opinions of college students regarding the use of designated drivers. Although using designated drivers appeared to be common, results indicated that in many instances the designated driver did not abstain from drinking alcoholic beverages. The opinions of the participants indicated that the nondrivers in a drinking group may in fact drink more when there is a designated driver. Our findings lead us to question the overall value of currently practiced designated-driver programs for college student drinkers. Developing programs on how to be a designated driver are among our recommendations.

Adult↗
PubMed2003

Designing an HIV counseling and testing program for bathhouses: the Seattle experience with strategies to improve acceptability.

Bathhouses are important venues for providing HIV counseling and testing to high-risk men who have sex with men (MSM), yet relatively few bathhouses routinely provide this service, and few data are available to guide program design. We examine numerous logistic considerations that had been identified in the HIV Alternative Testing Strategies study and that influenced the initiation, effectiveness, and maintenance of HIV testing programs in bathhouses for MSM. Key programmatic considerations in the design of a bathhouse HIV counseling and testing program included building alliances with community agencies, hiring and training staff, developing techniques for offering testing, and providing options for counseling, testing, and disclosure of results. The design included ways to provide client support and follow-up for partner notification and treatment counseling and to maintain relationships with bathhouse management for support of prevention activities. Early detection of HIV infection and HIV prevention can be achieved for some high-risk MSM through an accessible and acceptable HIV counseling and testing program in bathhouses. Keys to success include establishing community prevention collaborations between bathhouse personnel and testing agencies, ensuring that testing staff are supported in their work, and offering anonymous rapid HIV testing. Use of FDA approved, new rapid tests that do not require venipuncture, centrifugation, or laboratory oversight will further decrease barriers to testing and facilitate implementation of bathhouse testing programs in other communities.

AIDS Serodiagnosis↗
PubMed1979

The Mayo Three-Community Hypertension Control Program. I. Design and initial screening results.

The Mayo Three-Community Hypertension Control Program implemented graduated programs for the control of high blood pressure in three rural southeastern Minnesota communities, beginning in 1974. Prevalence of hypertension (when defined as diastolic blood pressure, at initial screening, of 95 mm Hg or more) was similar to that found for comparable groups by age and sex in the United States generally, but an atypically high frequency of known but untreated hypertension was found. Programs of public and professional information, systematic household screening, continuing professional education (two communities), and a new community hypertension clinic (one community) were initiated, and plans were made to evaluate the programs simultaneously by means of total rescreening of persons found to be hypertensive initially. The present report describes in detail the design of the program and the results of initial screening in relation to findings in other populations at the time. Subsequent reports assess the impact of each program on its target community and of a community hypertension clinic within the one setting where this component of a model program was established.

Adult↗
PubMed1996

[The practical theory of occupational health planning: Part Two--The theoretical background from the priority setting procedure to the post project appraisal making procedure (OPST research report 3)].

This report focuses on the final six procedures of the 8-stage OPSS. The first two procedures were covered in an earlier report. This paper examines the theoretical underpinnings of these six procedures. In the Priority Setting procedure, three factors are compared (TCP; Time/timing, cost, and population) for the OPSS in the general community, and also those in industry. These sometimes differ, especially with respect to responsibility and implementation. TCP allows the appropriate factors to be considered for a more objective prioritization of the various factors. As discussed earlier, the first TCP is used for prioritizing occupational health problems through the Needs assessment procedure. The second TCP prioritizes the countermeasures of those problems selected in the first TCP. In the Program Design procedure, we discuss the MIO (Merit, Impact, Outcome). Merit is defined as the effectiveness of a program as viewed by the company, taking into account the managerial and social merits. Impact refers to the behavioral effectiveness and behavioral change from the viewpoint of the program designer. Outcome refers to the effectiveness of the program from the traditional medical and epidemiological view-point. The study goes on to discuss the relationship amongst participation level, program development, and the subject's compliance, as a means to ensure that subjects participate indirectly through both steps of OHQ. In the Presentation procedure, we summarize the flow of effective presentations in the company setting. This covers initial understanding of the target audience wants, together with what the planner wants to focus on. In this way common issues and themes can be developed. Further assistance is given with strategy formation, presentation aids, time category presentations, evaluation and feedback. In the Process and Final Evaluation procedures, we discuss the objectives, and their significance to the overall process. In the Post Project Appraisal Making procedures, the previous three procedures are strongly affected by each proceeding procedure. In OPSS, we did not include the program development step in the Program Design procedure because the development skills can be referred from behavioral sciences methodologies. In the final part of this paper, we discuss the merits of the underlying theories of behavioral sciences, which have potential to apply to the occupational health settings.

Health Planning↗
PubMed2003

MFDTool: a software program for designing optimal multifunction displays.

This paper describes a software program called MFDTool. MFDTool is used to design multifunction displays (MFDs), which enable people to interact with computer information systems. MFDTool characterizes the problem of MFD design as the identification of how people interact with the system and what types of constraints should be imposed by the designer to shape the properties of the MFD. Once this information is provided, MFDTool uses an optimization procedure to build a variety of candidate MFD designs and to identify the MFD design that best satisfies the constraints. An example of MFD design is discussed.

Algorithms↗
PubMed1993

A computer program for designing clinical trials with arbitrary survival curves and group sequential testing.

We present a program, mhghseq, for designing a clinical trial to compare two treatments. For a user-specified hypothesis and a user-specified alternative, mhghseq finds the number of subjects required to achieve a given size and power. It permits each treatment to have an arbitrary survival curve and it allows for group sequential testing. It provides solutions for small samples as well as for large samples. There may be a follow-up period after accrual is completed. Tests may be one or two-sided, either the log-rank or the Gehan test may be used, and either of two commonly used boundary forms--the O'Brien-Fleming or Pocock boundary forms--may be specified. Although mhghseq relies primarily on simulation to produce results, the large sample sequential boundary for the log-rank test optionally may be computed with an algorithm given here that is different from ones used in the past for this purpose.

Computer Simulation↗