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PubMed1984

Effects of a physician-led home care team on terminal care.

Inconsistent results in studies of cost-effectiveness of home health care have led to the need for identification of target populations for whom cost-savings can be anticipated if expanded home care programs are introduced. This analysis of results of a randomized controlled study of efficacy of a physician/geriatric nurse practitioner/social worker home care team identifies such a potential target population. The team provides round-the-clock on-call medical services in the home when needed, in addition to usual nursing and other home care services, to home-bound chronically or terminally ill elderly patients. Overall health services utilization and estimated costs were not substantially different for the patients who did not die while in the study; however, for those who did die, team patients had considerably lower rates of hospitalization and overall cost than controls, and more frequently died at home. Of 21 team and 12 control patients who died but had at least two weeks of utilization experience in the study, team patients had about half the number of hospital days compared with controls during the terminal two weeks, and although they had more home care services, had only 69 per cent of the estimated total health care costs of the controls. Satisfaction with care received was significantly greater among the total group of team patients, and especially among their family caretakers, than among controls. This model is effective in providing appropriate medical care for seriously ill and terminal patients, and in enabling them to die at home if they so wish, while at the same time reducing costs of care during the terminal period.

Aged↗
PubMed2006

A community-based organization's integration of HIV and substance abuse treatment services for ex-offenders.

This paper explores the point of intersection of the substance abuse treatment and HIV services industries with the criminal justice system. Section I reviews the literature and "best practices" that have integrated substance abuse treatment and HIV care and prevention services for ex-offenders and which informed the development of a community- based organization's initiative, the VIP STRIVE Project. Section II presents a brief history of VIP in the context of its ability to adapt to its environment and to the changing needs of its target population,with specific reference to the development of HIV and substance abuse treatment services for members of the criminal justice population. The concluding section brings the two previous sections together by explaining how the VIP STRIVE Project can assist VIP in enhancing its capacity to integrate its substance abuse treatment and HIV services in order to improve services for this target population.

Acquired Immunodeficiency Syndrome↗
PubMed2002

HIV prevention among people with developmental disabilities.

This investigation sought to determine the effect of HIV/AIDS on people with developmental disabilities. Inquiries about contributing factors and HIV prevention needs also were made. In this qualitative descriptive study, two focus groups were conducted with individuals from the target population, as well as service providers. Each focus group was held in a conference room of a community-based organization located in Philadelphia on a weekday evening. Sixteen adults participated in the focus groups. Seven were members of the target population, and 9 were services providers. Focused topics were developed to guide the group discussion. Participants identified several contributing factors and barriers associated with risk behavior and HIV risk in this population. Recommendations for HIV prevention needs and strategies also were generated. The results of this formative inquiry indicated there is a need for development of specific HIV intervention strategies for this vulnerable and often overlooked population. Clinical and research implications are proposed.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Evaluating injury prevention programs: the Oklahoma City Smoke Alarm Project.

Evaluation of injury prevention programs is critical for measuring program effects on reducing injury-related morbidity and mortality or on increasing the adoption of safety practices. During the planning and implementation of injury prevention programs, evaluation data also can be used to test program strategies and to measure the program's penetration among the target population. The availability of this early data enables program managers to refine a program, increasing the likelihood of successful outcomes. The Oklahoma City Smoke Alarm Project illustrates how an evaluation was designed to inform program decisions by providing methodologically sound data on program processes and outcomes. This community intervention trial was instituted to reduce residential fire-related injuries and deaths in a geographic area of Oklahoma City that was disproportionately affected by this problem. The distribution of free smoke alarms in targeted neighborhoods was accompanied by written educational pamphlets and home-based follow-up to test whether the alarms were functioning correctly. Early evaluation during the planning and implementation phases of the program allowed for midcourse corrections that increased the program's impact on desired outcomes. During the six years following the project, the residential fire-related injury rate decreased 81% in the target population but only 7% in the rest of Oklahoma City. This dramatic decline in fire-related injuries in the target area is largely attributed to the free smoke alarm distribution as well as to educational efforts promoting awareness about residential fires and their prevention.

Adolescent↗
PubMed2005

Health and economic impacts of an HIV intervention in out of treatment substance abusers: evidence from a dynamic model.

INTRODUCTION: A community-based intervention program found that the high-risk target population interacts with its surrounding community as a source of drugs and prostitution, creating a measure of co-dependence in the health status of each group. METHODOLOGY: The intervention collected extensive data on sexual and drug use practices in the target population. A dynamic compartment model estimates the epidemiological impact of the intervention, which serves as the basis for the economic assessment comparing intervention costs and lifetime HIV treatment costs. RESULTS: Approximately 2/3 of the new infections arise in the surrounding community. Intervention spillover benefits in the surrounding community are sufficient to make the intervention cost-saving in the first year--a savings of approximately 534,000 dollars. CONCLUSIONS: Conducting the intervention results in health benefits and cost-savings not only for the risk group, but for the entire community in which it resides. Quantifying the spillovers is vital to policymakers attempting to allocate scarce public health resources.

Adolescent↗
PubMed1975

Fertility reduction in an MCH/family planning program: a model for projection.

One of the important questions in an integrated maternal and child health/family planning program is the likely effects on fertility rates if given proportions of a stated target population can be reached and provided with family planning services. The question is easy, but the process of obtaining viable estimates of potential fertility decline from this type of program is complicated. First of all, the number of women in the target population must be estimated. Next, it is necessary to make various assumptions and estimates concering the types of contraceptives accepted, the age distribution of acceptors, the sets of continuation rates that go with each age/method specific group of women, and a variety of other factors. This article describes and illustrates a procedure for estimating potential fertility declines with an integrated maternal and child health/family planning program.

Age Factors↗
PubMed1999

Essential strategies for achieving durable population-based maternal and child health services.

Increased competition for dwindling financial resources places funding and provision of public health services at risk in all countries of the world. Maternal and Child Health (MCH) clients--often poor, mostly women, their children, and families--are at extraordinary risk of receiving poor or no health care. Not considered a voting constituency, and therefore exercising little leverage over elected officials, specific assurances are necessary to ensure that essential health services are available to MCH target population. Therefore, it is critical that all MCH stakeholders leverage their capacity by networking and by developing common strategies for survival and relevance within the health care system in their jurisdiction. Identifying and working with every segment of the population at risk is a crucial first step. Becoming familiar with the history of the population at risk, and defining their geographic boundaries are essential secondary steps. Developing baseline information on their general health and MCH risk status according to available demographic, socioeconomic and environmental data are important next steps. Then, working with the target population, we propose that MCH advocates adopt the 18 MCH strategies discussed in this article. These strategies will strengthen the ability of programs and initiatives that deal with women, their children and families, to survive the current financial and management struggles of the public health services in developed and developing countries.

Adolescent↗
PubMed1987

Control of epidemic group A meningococcal meningitis in Nepal.

During the first six months of 1983, an epidemic of serogroup A meningococcal meningitis occurred in the Kathmandu valley of Nepal, resulting in 875 cases and 95 deaths. The annual attack rate was 103 cases per 100,000 population, with a peak attack rate occurring in April. Epidemic meningococcal disease had not been recognized previously in Nepal. Early in 1984, a review of hospital-based data on pyogenic meningitis in Kathmandu showed three times as many cases per month compared with the same period the previous year, suggesting that a recurrent epidemic was unfolding. Beginning in February 1984, a vaccination campaign directed at a high-risk target population of people aged 1-24 years was launched; over 329,000 doses of bivalent A/C meningococcal vaccine were given, achieving approximately 64% coverage of the target population. A dramatic decline in the number of new meningitis cases occurred coincident with the initiation of the mass vaccination campaign. This experience demonstrates that it is possible, with appropriate surveillance efforts, to detect an evolving epidemic of meningococcal disease early in its course and to institute control measures in advance of the expected epidemic peak.

Adolescent↗
PubMed2000

Prevention validation and accounting platform: a framework for establishing accountability and performance measures of substance abuse prevention programs.

The field of substance abuse prevention has neither an overarching conceptual framework nor a set of shared terminologies for establishing the accountability and performance outcome measures of substance abuse prevention services rendered. Hence, there is a wide gap between what we currently have as data on one hand and information that are required to meet the performance goals and accountability measures set by the Government Performance and Results Act of 1993 on the other. The task before us is: How can we establish the accountability and performance measures of substance abuse prevention programs and transform the field of prevention into prevention science? The intent of this volume is to serve that purpose and accelerate the processes of this transformation by identifying the requisite components of the transformation (i.e., theory, methodology, convention on terms, and data) and by introducing an open forum called, Prevention Validation and Accounting (PREVA) Platform. The entire PREVA Platform (for short, the Platform) is designed as an analytic framework, which is formulated by a collectivity of common concepts, terminologies, accounting units, protocols for counting the units, data elements, and operationalizations of various constructs, and other summary measures intended to bring about an efficient and effective measurement of process input, program capacity, process output, performance outcome, and societal impact of substance abuse prevention programs. The measurement units and summary data elements are designed to be measured across time and across jurisdictions, i.e., from local to regional to state to national levels. In the Platform, the process input is captured by two dimensions of time and capital. Time is conceptualized in terms of service delivery time and time spent for research and development. Capital is measured by the monies expended for the delivery of program activities during a fiscal or reporting period. Program capacity is captured by fourteen measurement units, tapping into the dimensions of staff resources and community assets. Staff resources are, in turn, operationalized in terms of staff size, staff certification status, staff turnover rate, and the accreditation status of a provider agency. Community assets are operationalized by the number of community centers accessible to the funded agency, number of formalized teams or antidrug coalitions active in the catchment area, and other social/human services providers with whom the prevention agency has formalized networks. The totality of process output from all sources of program activities is reduced to eighteen classes of measures. These are operationalized by thirty-three summary measures. Some of these include: total count of events facilitated; total number of clients served; average number of clients served per event; clients served by single and multiple program sessions; classification of target population in terms of the severity of risk as defined by the Institute of Medicine; age groups and race/ethnicity of clients served; number of program participants retained by recurring programs; number of clients who have completed the program; penetration rates to the target population; client attrition rates; average referral rates per provider per time interval; referral success rates; and so on. All process output measures specified in the Platform are derived from two broad classes of events classified as either products or services. The collectivity of these measures is expected to present a cost-effective, parsimonious, yet comprehensive picture of the entire spectrum of the process output, i.e., "what came out of the program as program activities". For the measurement of performance outcomes, two types of data are incorporated into the Platform: outcome data from individuals and the behavior (or performance) of social indicators from aggregated data bases. Individual data are used to evaluate the outcome of substance abuse programs

Accounting↗
PubMed1991

Who enrolls in prevention trials? Discordance in perception of risk by professionals and participants.

Internal and external validity problems permeate all intervention studies but are accentuated in primary preventive intervention research, particularly when studies target or recruit individuals based on their risk for psychopathology. Since many people who are at risk do not yet experience distress, they may not perceive the need for intervention. Recruitment tactics based on explaining extent of risk are unlikely to be persuasive and may have negative consequences. If respondents are not motivated to participate, a small or biased subset of the target population will participate in the intervention. Bias is of special concern when those enrolled represent only part of the continuum of risk. Selective enrollment may compromise both internal validity (the interpretation of the research results) and external validity (the generalizability of the findings) of intervention trials in primary prevention. This article discusses the effects of partial enrollment and the resultant bias. It suggests several strategies for increasing the enrollment of the target population and examines some of their ethical ramifications. It also stresses the importance of collecting systematic data documenting how the participants in the intervention differ from the target group as a whole.

Bias↗
PubMed2004

Culture-independent identification of periodontitis-associated Porphyromonas and Tannerella populations by targeted molecular analysis.

Periodontitis is the commonest bacterial disease of humans and is the major cause of adult tooth loss. About half of the oral microflora is unculturable; and 16S rRNA PCR, cloning, and sequencing techniques have demonstrated the high level of species richness of the oral microflora. In the present study, a PCR primer set specific for the genera Porphyromonas and Tannerella was designed and used to analyze the bacterial populations in subgingival plaque samples from inflamed shallow and deep sites in subjects with periodontitis and shallow sites in age- and sex-matched controls. A total of 308 clones were sequenced and found to belong to one of six Porphyromonas or Tannerella species or phylotypes, one of which, Porphyromonas P3, was novel. Tannerella forsythensis was found in significantly higher proportions in patients than in controls. Porphyromonas catoniae and Tannerella phylotype BU063 appeared to be associated with shallow sites. Targeted culture-independent molecular ecology studies have a valuable role to play in the identification of bacterial targets for further investigations of the pathogenesis of bacterial infections.

Adult↗
PubMed2005

Community actions against alcohol drinking in Slovenia--a Delphi study.

AIM: To define the national strategy and public actions to reduce alcohol related harm, based on societal consensus. BACKGROUND: Alcohol abuse is an avoidable behaviour that can threaten health. In Slovenia, only a few public campaigns against drinking alcohol are under way. It is important to establish which community measures are acceptable to society in Slovenia in order to reduce alcohol-related risks. METHODS: A Delphi study with 45 professionals from different disciplines was conducted. Participants offered many suggestions to improve the current situation. After three rounds of questionnaires, 86 participant statements were accepted as a consensus. RESULTS: Actions such as: state monopolies, alcohol taxation, legislative restrictions on availability and purchase of alcohol, age-related restriction on sales, drink-driving laws, school-based alcohol education and media information campaigns are most likely to be achieved by consensus. The main target populations for implementation of alcohol-related educational programs are children, young people and employees. CONCLUSIONS: As a result of the study, a number of community actions against drinking alcohol that could be acceptable for society can now be suggested. They vary across different target populations, change agents (individuals, organizations and institutions) and methods of implementation.

Adolescent↗
PubMed2006

How to write health dialog for a talking computer.

Automated dialogue systems delivered over the telephone offer a promising approach to delivering health-related interventions to populations of individuals at low-cost. Over the past two decades, an automated telephone system called Telephone-Linked Care or TLC has been successfully designed and evaluated by the authors and their colleagues. This work has resulted in over twenty systems for various health-related conditions and lifestyle behaviors. This paper describes our approach to developing and writing dialogue for these automated telephone systems, including determining the program objectives, defining the target population, and selecting a theory of behavior change to guide the intervention. Both macro and micro issues are considered in constructing dialogue systems that are engaging for the target population, easy to use, and effective at promoting positive health behaviors and outcomes.

Communication↗
PubMed2004

Strategies for enrolling diverse older women in an osteoporosis trial.

OBJECTIVES: This study reviewed a consumer-oriented process for recruiting research volunteers age 65 or older for an osteoporosis clinical trial. METHODS: Odds ratios were used to estimate the relative importance of methods to enroll research volunteers from three racial or ethnic groups. RESULTS: Nine hundred and four women were screened; 168 African American, White, and Hispanic women enrolled. Mailings and media were effective when the target population was large and knowledgeable about the disease and treatment being investigated. Efficiency of mailings was increased when individuals in the mailing list were familiar with research and the research center. An interpersonal approach was more effective than a media-based approach when the target population was small, unaware of their personal risk of the disease, and unfamiliar with research and research center. DISCUSSION: Information on the characteristics of potential volunteers and their communities will enable readers to evaluate the applicability of recruitment methods used.

Aged↗
PubMed2003

Identification of children with special health care needs within a managed care setting.

OBJECTIVE: To assess 2 established methods of identifying children with special health care needs (CSHCN) within a health plan population for intensified service coordination. METHODS: The tools tested were the Questionnaire for Identifying Children With Chronic Conditions (QuICCC) and the Clinical Risk Grouper (CRG) software. The QuICCC was administered by telephone to the parents of 517 children. The CRG software tool was then applied to the health plan database. The accuracy of identifying the target population was assessed by a single trained reviewer by comparison with the comprehensive medical record. RESULTS: According to the QuICCC, 37.1% of the parents surveyed had CSHCN. According to the CRG, 11% of the health plan's pediatric population was categorized as CSHCN. The medical record review agreed with overall QuICCC findings in 53% to 61% of cases and overall CRG findings in 66% to 73% of cases. CONCLUSIONS: Administering the QuICCC was a time- and labor-intensive endeavor with a relatively low overall level of sensitivity. The CRG was less labor intensive with slightly higher sensitivity. Identifying the target population in an effective and efficient manner remains a challenge for health plans.

Child↗
PubMed1983

The Pennsylvania domiciliary care experiment: I. Impact on quality of life.

This paper reports findings concerning the impact on quality of life of a case management focused program of small board and care facilities serving aging, mental health, and mental retardation adult target populations--the Pennsylvania Domiciliary Care Program. Program participants from the counties in which the Domiciliary Care Program was initiated were matched with persons residing in similar counties without the program who were comparable on a large array of characteristics prior to program initiation. Conducted separately by target group, 10-month follow-up assessments provided the basis for determining impact. In general, the effects were positive, particularly with respect to meeting program quality of life goals (providing needed services, improving living conditions, increasing community integration, and reducing institutional days); the effects were more positive for the aging and mental health than for the mentally retarded target populations.

Aged↗
PubMed1990

A clinician's guide to cost-effectiveness analysis.

Cost-effectiveness analysis can be used to help set priorities for funding health care programs. For each intervention, the costs and clinical outcomes associated with that strategy must be compared with an alternate strategy for treating the same patients. If an intervention results in improved outcomes but also costs more, the incremental cost per incremental unit of clinical outcome should be calculated. The incremental cost-effectiveness ratios for various programs can be ranked to set funding priorities. By using this list, the person responsible for allocating resources can maximize the net health benefit for a target population derived from a fixed budget. Clinicians may not share this objective because, individually, they are appropriately concerned solely with the effectiveness of a specific intervention for their patients and are not concerned with the benefit derived from spending those resources on other patients in the target population. In addition, allocation may be driven by distributional and political objectives. Nevertheless, cost-effectiveness analysis demonstrates the consequences of allocation decisions. Because clinicians should participate in policy making, they must understand d the role of this technique in setting funding priorities.

Cost-Benefit Analysis↗
PubMed1984

Obstetric and gynecological care for Third World women.

The particular characteristics which women's health care in the Third World should have as compared with the situation in developed countries is discussed. Women in the Third World present a different prevalence of specific pathologies, give less attention to symptoms and to preventive measures, and the health system is usually not well adapted to respond to those characteristics. Examples of the difference between the needs of health care of Third World women compared to developed countries are taken from pre-natal care, prevention of cancer of the cervix and family planning. A critical analysis of the prevalent characteristics of present women's care in the Third World was done. Accordingly, some basic points to be considered in the implementation of women's health care for the Third World were proposed: avoid the uncritical replication of developed country's models to solve developing countries' health problems; application of a larger proportion of the resources to primary health care; a more aggressive attitude to increase preventive behavior, trying to maintain a continuous and not sporadic contact between the health system and the target population; great attention to reference and contra-reference to improve the integration of the various levels of the health system; delegation of functions from physicians to paramedical personnel; emphasis on health education, both formal and in the day-to-day contact between health agents and target population.

Delivery of Health Care↗