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PubMed1989

Issues in evaluation: evaluating assessments of elderly people using a combination of methods.

In evaluating a health service, individuals will give differing accounts of its performance, according to their experiences of the service, and the evaluative perspective they adopt. The value of a service may also change through time, and according to the particular part of the service studied. Traditional health care evaluations have generally not accounted for this variability because of the approaches used. Studies evaluating screening or assessment programmes for the elderly have focused on programme effectiveness and efficiency, using relatively inflexible quantitative methods. Evaluative approaches must reflect the complexity of health service provision, and methods must vary to suit the particular research objective. Under these circumstances, this paper presents the case for the use of multiple triangulation in evaluative research, where differing methods and perspectives are combined in one study. Emphasis is placed on the applications and benefits of subjectivist approaches in evaluation. An example of combined methods is provided in the form of an evaluation of the Newcastle Care Plan for the Elderly.

Aged↗
PubMed2006

Evaluation of curricula in higher education: challenges for evaluators.

Evaluation of teaching at universities is traditionally realized in terms of student ratings. Curriculum evaluation is rarely done in a systematic manner. More often, the emphasis is placed on a particular aspect, which is only of little help in terms of modifying education. A very prominent example is that of medical education. Here, evaluations of curricula primarily focus on new curricula by contrasting them to traditional ones. The article at hand deals with a different evaluation approach, in which five phases have to be considered and contrasting results to other teaching formats are not the main focus. In this article, the authors concentrate on the first phase (baseline evaluation) of the systematic evaluation of a medical curriculum. They describe several challenges of such an evaluation approach and illustrate the strategies used to overcome them. In addition, associated relevant empirical findings from this evaluation study are presented.

Austria↗
PubMed1996

Obstacles to conducting program evaluations: implications for public health evaluators.

This article presents a number of obstacles to conducting program evaluations which include: the "word" evaluation itself, the politics of evaluation, inadequate resources, the tendency of organizations to resist change, and a lack of understanding of the context of program evaluations. Underpinning these obstacles is the longstanding definitional dilemma between program evaluation and social science research. Although the article's implications are directed toward public health evaluators, they are generalizable to other evaluators in other disciplines. These obstacles highlight the fact that a major role of any evaluator is to confront and negotiate successfully around them.

Health Services Research↗
PubMed2004

Opinion formation in evaluating sanity at the time of the offense: an examination of 5175 pre-trial evaluations.

Sanity evaluations are high-stake undertakings that explicitly examine the defendant's culpability for a crime and implicitly explore clinical information that might inform a plea agreement. Despite the gravity of such evaluations, relatively little research has investigated the process by which evaluators form their psycholegal opinions. In the current study, we explore this process by examining 5175 sanity evaluations conducted by a cohort of forensic evaluators in Virginia over a ten-year period. Our analyses focus on (i) the clinical, criminal, and demographic attributes of the defendant correlated with opinions indicative of insanity; (ii) the clinical content of the evaluations and the legal criteria referenced as the basis for the psycholegal opinion; (iii) the process and outcome differences in the sanity evaluations conducted by psychologists versus psychiatrists; and (iv) the consistency in these opinions over a ten year period. Analyses predicting an opinion of insanity indicate a positive relationship with psychotic, organic, and affective diagnoses and previous psychiatric treatment. Analyses also indicate a negative relationship with prior criminal history, drug charges, personality disorder diagnosis, and intoxication at the time of the offense. Modest racial disparities were observed with evaluators offering opinions that the defendant was insane more often for white than for minority defendants despite comparable psychiatric and criminal characteristics.

Adolescent↗
PubMed2006

Opinion formation in evaluating the adjudicative competence and restorability of criminal defendants: a review of 8,000 evaluations.

Evaluations of competence to stand trial (CST) are the most common type of criminal forensic evaluation conducted, and courts tend to defer to clinician opinions regarding a defendant's competence. Thus, it is important to study the ways in which clinicians arrive at opinions regarding adjudicative competence and the data they consider in forming their opinions. We reviewed 8,416 evaluations conducted by forensic evaluators in Virginia over a 12 year period, and examined (a) the clinical, demographic, and criminal characteristics of a defendant as related to opinions regarding competence, predicted restorability, and impairment on "prongs" of the Dusky standard, (b) process and outcome differences in evaluations conducted by psychiatrists versus psychologists and inpatient versus outpatient evaluators, and (c) the consistency of incompetence base rates over a 10 year period. Overall, clinicians opined that 19% of defendants were incompetent and considered 23% of these unlikely to be restored to competence. Not surprisingly, psychotic and organic/intellectual disorders were most strongly associated with findings of incompetence. However, there were some notable differences between evaluations by psychologists versus psychiatrists and between evaluations conducted in inpatient versus outpatient settings.

Adult↗
PubMed2006

Bedside echocardiographic evaluation of hemodynamics in sepsis: is a qualitative evaluation sufficient?

OBJECTIVE: Transesophageal echocardiography (TEE) has proven its efficiency in assessing hemodynamics in patients by its ability to evaluate cardiac function and fluid responsiveness. Classically, it requires quantitative measurements, whereas in routine practice TEE is used in our unit especially as a qualitative procedure. We assessed the accuracy of this qualitative central hemodynamic evaluation obtained by TEE at the bedside. DESIGN AND SETTING: Prospective study conducted in a medical ICU between September 2004 and April 2005. All TEE examinations performed in consecutive patients hospitalized for septic shock and mechanically ventilated for an associated acute lung injury were eligible for evaluation. Intensivists trained in echocardiography were asked to classify (a) respiratory changes in the superior vena cava (SVC), (b) left ventricular (LV) systolic function, (c) right ventricular (RV) end-diastolic size, and (d) shape and kinetics of the interventricular septum (IVS). A post-hoc quantitative evaluation was then performed by a trained investigator unaware of the patients' status. RESULTS: We evaluated 83 examinations in 30 patients. Qualitative evaluation was easily able to distinguish patients with significant or nonsignificant SVC respiratory changes, normal, moderately or markedly depressed LV systolic function, and nondilated or dilated right ventricle. Acute cor pulmonale was also well recognized. CONCLUSION: By its ability accurately to evaluate hemodynamic status qualitative TEE could be useful for intensivists in managing circulatory failure in septic shock, rendering the more time-consuming quantitative evaluation useless.

Aged↗
PubMed2004

Patients evaluations of their health care: the expression of negative evaluation and the role of adaptive strategies.

Patient experiences surveys have become common within healthcare and represent an important form of participation, with patients having the potential ability to influence the quality of care. However, there is still a relatively limited understanding of how patients evaluate the quality of their care. We present the findings of a qualitative study, which explored the way in which patients express their evaluations, in an attempt to move the debate forward. The results indicate that patient evaluation appears to be far more complex than routinely acknowledged, particularly in relation to the expression of negative experiences. Patients were reluctant to offer directly negative criticisms, needed particular conditions in which to express their negative evaluations and used a variety of adaptive strategies to overcome social pressures that inhibited negative evaluation and promoted positive evaluation. We argue that standardised approaches to measuring negative evaluations, such as questionnaires, need to become more sensitive to the complexities of negative evaluation. This would enhance the extent to which patients can participate in influencing the quality of care. A number of recommendations are made to develop the sensitivity of future investigations into the negative aspects of patient experiences.

Adaptation, Psychological↗
PubMed2001

Development and evaluation of a method for evaluating pediatric residents' knowledge and skill in performing physical examinations of the ankle and knee.

BACKGROUND: Pediatric residents need the knowledge and physical examination skills to evaluate common musculoskeletal injuries. The ankle and the knee are the 2 most common sites of musculoskeletal injury in young athletes. Methods for evaluating pediatric residents' knowledge and skills in examining the ankle and knee are needed. OBJECTIVES: 1) To describe the development of a method for evaluating pediatric residents' knowledge and skill in performing physical examinations of the ankle and knee, and 2) to report the reliability of this method. METHODS: A written test and a Clinical Skills Assessment Examination (CSAE) with a rating index were developed by the investigators to evaluate pediatric residents' knowledge and skills in examining the ankle and knee. Fifty-eight pediatric residents completed the written test and examined the ankle and knee of one standardized patient at the beginning of a required 1-month adolescent medicine rotation. Forty-eight residents repeated the evaluation at the end of the month. The investigators rated the residents' performance of the CSAE and then assessed interrater reliability using Cronbach's alpha. Test-retest correlation was calculated to assess the reliability of the written test. RESULTS: Test-retest correlation for the written test was 0.72, establishing its reliability. Interrater reliability for rating the CSAE of the ankle and knee was 0.98 and 0.90, respectively. CONCLUSION: Pediatric residents' knowledge and skills in examining the ankle and knee can be reliably evaluated using the written test and CSAE described in this article. These could be used to assess the effectiveness of current curricula in improving pediatric residents' knowledge and skill in evaluating ankle and knee complaints and to assist in the design of future curricula. musculoskeletal, evaluation methods, resident curriculum.

Adolescent Medicine↗
PubMed1995

[The influences of self-evaluation level and items evaluation on test-retest effect: application of temporal comparison theory].

To examine the influences of items evaluation and self-evaluation on test-retest effect, which was first pointed out by Windle (1954) as the influence of prior test experience, a self-evaluative consciousness scale was repeatedly administered to 174 female college students. They were divided into an-hour, a-month, and a-year conditions by intervals of tests. Thirty items of the scale were classified into five levels according to the size of evaluation factor loading. Findings were as follows: 1) Test-retest effect appeared in the group of a-month interval condition, 2) only for the items belonging to the lowest level of evaluation, 3) and this effect was mainly caused by the subjects whose self-evaluative consciousness was not high. Results were discussed in terms of temporal comparison theory proposed by Albert (1977), which states that making an assessment of present self character, a person compares it with his or her past assessment mainly on inferior traits (items), unconsciously trying to raise self-evaluation through responding to these items more positively. This mechanism is supposed to be driven by the motivation of evaluation maintenance.

Adult↗
PubMed1996

Evaluation strategies for CNSs: application of an evaluation model.

Program development has become an essential role function for today's CNS, who must be able to evaluate programs to determine their efficacy. A useful evaluation guide is Stufflebeam's CIPP (context, input, process, and product) model, which includes a framework to evaluate indirect care measures directly affecting cost-effectiveness and accountability. The model's core consists of (1) context evaluation leading to informed, contemplated decisions; (2) input evaluation directing structured decisions; (3) process evaluation guiding implemented decisions; and (4) product evaluation serving to recycle decisions. Strategies for using Stufflebeam's CIPP model are described.

Cost-Benefit Analysis↗
PubMed2001

Evaluating evaluation: implications for assessing quality.

Aims to review the literature on evaluation and to examine research, theory and practice in relation to two key questions: What is evaluation and What is its contribution? Evaluation is increasingly a contemporary concern owing to growing demand for verification of programme results and the current political and economic climate. With the growth in evaluation activity in diverse fields, especially within new domains, those involved in health-care delivery can benefit from an overview of the universal fundamentals of research and theory that translate into improved practice. To evaluate effectively, there is a need for a full understanding of evaluation's nature, purposes and concepts. Identifies and reviews the key subdomains of evaluation, namely: definitions; theoretical underpinning; formulation of goals and objectives; specification of the programme; and cost-benefit analysis.

Cost-Benefit Analysis↗
PubMed1994

Evaluating generalist education programs: a conceptual framework. Generalist program evaluation working group.

This paper provides and applies a conceptual framework and a list of guiding principles for evaluation of generalist education programs. Programs are systematic efforts to achieve specified objectives. Evaluations gather data in order to improve or appraise programs and have a continuum of purposes and methods. Descriptive evaluations characterize the structures, processes, and outcomes of programs; research evaluations definitively assess the effectiveness of a program in terms of outcomes. Intermediate outcomes are changes in knowledge, attitudes, and skills of program participants; conclusive outcomes reflect the quality of performance of graduates in actual clinical situations. Outcomes are affected by inputs--the qualities of students entering the program. Guiding principles of program evaluation ensure that data gathered are useful. The authors illustrate the guiding principles with an actual pilot study that determined that expert pediatricians, general internists, and family practitioners could agree on key generalist competencies and that explores evaluation design based on these competencies. Finally, they consider the implications of undertaking generalist education evaluation.

Adult↗
PubMed1985

Avoiding evaluation cooptation. Lessons from a renal dialysis evaluation.

An evaluation of the impact of terminating contracts to transport low-income patients for renal dialysis demonstrates how evaluators may become apologists for management and conduct studies too narrow for effective decision making. The evaluation found that patients continued to receive treatment; their death rates had not increased. Changes in their economic and emotional status were not studied; consequently, the evaluators erroneously concluded that the clients had not been seriously harmed. The article reviews the process the evaluation used. The authors conclude that to avoid cooptation, evaluators need independent information available through conducting and analyzing pilot studies and meeting with program constituents. To avoid overly narrow studies, the next level of management should participate in their design. To use the information effectively, evaluators need to see themselves as advisors rather than technicians.

Evaluation Studies as Topic↗
PubMed2006

Automated protocol for evaluation of electromagnetic component separation (APECS): Application of a framework for evaluating statistical methods of blink extraction from multichannel EEG.

OBJECTIVE: We present APECS (Automated Protocol for Evaluation of Electromagnetic Component Separation), a framework for evaluating the accuracy of blind source separation algorithms in removing artifacts from EEG data. APECS applies multiple, automated procedures to quantify the extent to which blinks are removed, and the degree to which nonocular activity is left intact. METHODS: APECS was used to evaluate blink removal using three BSS algorithms: Second-Order Blind Inference (SOBI) and two Independent Component Analysis (ICA) implementations, FastICA and Infomax. The algorithms were applied to a series of blink-free EEG datasets, which were contaminated with real or simulated blinks. Extracted components were assumed to contain blink activity if correlation of their spatial projectors to a predefined blink template exceeded some threshold, and if polarity inverted above and below the eyes. Blink-related components were then subtracted to produce filtered data. The success of each data decomposition is evaluated through the use of multiple, automated metrics, to determine which decomposition best approximates the ideal solution (complete separation of blink from nonblink activity). RESULTS: The outcomes for the evaluation measures were generally congruent, but also provided different and complementary information about the quality of each data decomposition. Under our testing framework, Infomax outperformed both FastICA and SOBI. Best results were achieved when blink activity loaded onto a single component. CONCLUSIONS: Multiple metrics, both quantitative and qualitative, are important in evaluating algorithms for artifact extraction. SIGNIFICANCE: Failure to achieve complete separation of blink from nonblink activity can affect experimental outcomes, as illustrated here, using an ERP study of word-nonword discrimination. This illustrates the importance of methods for evaluation of artifact extraction results.

Algorithms↗
PubMedDate not supplied

Continuous improvement evaluation: a framework for multisite evaluation studies.

This article proposes the use of the continuous improvement evaluation (CIE), a framework for multisite demonstration or evaluation studies. This framework is designed for studying intervention programs that change during the evaluation. The development of family drug courts is provided as an example. CIE relies on outcome data collected over time and benchmarked across similar cases in comparison sites; thus, this study was designed to collect data on effectiveness of intervention programs at multiple sites and over time. A weight is calculated for similarity of any two cases based on features they share. In statistical process control charts, these weights are used to compare outcomes at the site against the average of similar cases in comparison groups. Once data are benchmarked, program staff meet to discuss process changes that have led to improvements in outcomes. To ensure that intervention programs have access to evaluation reports on demand, information technology is used to collect, clean, and pool data. Computers generate study reports, and evaluators review reports after release to clients. Statistical tools can be used to evaluate changing programs. Traditional evaluators may be concerned about some threats to validity associated with CIE. The article concludes with a discussion of typical threats to validity and how these threats are addressed in the CIE framework.

Data Collection↗
PubMed1996

Evaluating the Healthy Start program. Design development to evaluative assessment.

The national evaluation of the federally funded Healthy Start program involved translating a design for a process and outcomes evaluation and standard maternal and infant data set, both developed prior to the national evaluation contract award, into an evaluation design and client data collection protocol that could be used to evaluate 15 diverse grantees. This article discusses the experience of creating a process and outcomes evaluation design that was both substantively and methodologically appropriate given such issues as the diversity of grantees and their community-based intervention strategies; the process of accessing secondary data sources, including vital records; the quality of client level data submissions; and the need to incorporate both qualitative and quantitative approaches into the evaluation design. The relevance of this experience for the conduct of other field studies of public health interventions is discussed.

Child Health Services↗
PubMed2002

Relationships of productive life evaluations with changes in evaluations for yields.

The objective of this work was to investigate the relationships of productive life with changes in bull evaluations for yield traits. Two datasets were analyzed. In the first, predicted differences for change in milk yield from first to second lactation of daughters of artificial insemination (AI) Holstein bulls used widely in the southeastern United States were available from a previous study. These were correlated with predicted transmitting abilities (PTA) of productive life from May 2000 USDA sire evaluations. Based on bulls with at least 10 daughters (n = 560) the correlation of PTA productive life with predicted differences for the change in milk yield was 0.30. The correlation increased to 0.36 for bulls with at least 50 daughters (n = 319) and to 0.40 for bulls with at least 75 daughters (n = 284). The second analysis included data on 1831 AI sampled Holstein bulls evaluated by USDA between July 1989 and May 2000. Changes in PTA yields were calculated as PTA from evaluations based on first and second records of daughters minus those from first-record evaluations. Correlation analyses showed that PTA yields from first-record evaluation and changes in PTA yields were positively associated with productive life. Regression coefficients on changes in PTA yields were all positive indicating that increases in PTA for yield traits as daughters aged corresponded with longer productive life. Using changes in AI bull evaluations for yields could improve prediction of productive life for little cost.

Animals↗
PubMed1988

Self-evaluation and its relationship to clinical evaluation.

An exploratory study was undertaken in a three-year nursing diploma program to determine instructor and student perceptions of self-evaluation (SE) and its relationship to clinical evaluation. A cross-section of instructors (n = 9) participated in three rounds of a Delphi survey. From this validated data base a questionnaire was developed and distributed to a stratified sample of 145 students. Combined results were then analyzed and compared. Results indicated that both students and instructors perceive self-evaluation more positively than negatively and they see the main purpose as providing direction for learning. Contrary to the literature and perceptions of surveyed instructors, students did not perceive self-evaluation as a factor in promotion of professional growth. Although students value a participatory role in clinical evaluation, the process of self-evaluation generates anxiety and underrating of performance. The authors conclude that self-evaluation is a developmental skill requiring guidelines and practice, and offer recommendations for its use.

Alberta↗