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PubMed1978

Program evaluation as health services research.

Evaluation of health program is necessary for more rational allocation of scarce resources. Steps in evaluation include: 1)Specification of the program goals, 2) Description of the program, 3) Definition and measurement of outcome, 4) Assessment of intervening variables, 5) Analysis of data, and 6) Implementation of findings. Examples from impirical evaluation studies are presented to illustrate one practical application of these steps. While the random controlled trial is a most powerful tool, it is very difficult to apply in complex human services programs. In the future, more use of multivariate matching of groups to approximate a quasi experimental situation will be needed. Education of health professionals in methods of evaluation is necessary to promote planned improvement in health services.

Boston↗
PubMed1991

Program evaluation as a measure of the quality of a new approach to community psychiatric care.

The effectiveness of a new approach to providing psychiatric rehabilitation services in community settings will be assessed using a combination of quality assurance principles and program evaluation techniques. A new Assertive Community Rehabilitation Program (ACRP) is evaluated and compared with existing hospital rehabilitation programs. Measures of service efficiency, admission, discharge and readmission rates, and service costs are made for 100 new referrals, 99 inpatients and 117 outpatients. Follow-up interviews use standardized measures of clients' quality of life, clinical status, client and staff satisfaction, and community resource utilization. After 19 weeks of operation, the ACRP has prevented more admissions, and discharged more inpatients than the comparison programs. Readmission rates have not differed. Results at the end of the one-year project using this program-based quality assurance approach will facilitate managerial decisions about the future of rehabilitation services.

Adult↗
PubMed1976

The politics of program evaluation: the mental health experience.

The authors discuss evaluation studies of the community mental health centers program. The emphasize that program evaluation is a political activity to influence the allocation of public resources. They examine its relationship to decision-making, power conflicts, and bureaucratic goals. They point out that the evaluator is seldom totally objective. They also emphasize the increasing use of evaluation by politicians.

Community Mental Health Services↗
PubMed1990

Drug-use evaluation programs for psychotropic medications.

Drug-use evaluation (DUE) programs for psychotropic medications at a state-operated mental health center are described. DUE programs were developed at Western Missouri Mental Health Center to monitor prescribing of medications in the hospital and ambulatory-care settings. DUE criteria were developed for all major groups of psychotropic medications: antipsychotics, antidepressants, antianxiety and hypnotic agents, lithium, and antiparkinsonian drugs. The criteria appear on special forms developed for the programs; pharmacists use these forms to evaluate every medication order for inpatients and every 50th medication order for ambulatory-care patients. Physicians are alerted to noncompliant prescribing practices by memorandum, oral consultation, or both. In 3204 inpatient DUEs conducted from July 1986 to December 1988, orders for antiparkinsonian drugs showed the poorest compliance with DUE criteria. In both the hospital and ambulatory-care settings, antiparkinsonian agents required the most follow-up. The overall compliance rate for inpatient DUEs was 84%; for ambulatory-care DUEs, the compliance rate was 64%. As a result of the ambulatory-care DUE program, basic laboratory studies and dyskinesia rating scales are being ordered on a more timely basis. These DUE programs have increased pharmacist monitoring of patient care and improved documentation of medication use.

Drug Utilization↗
PubMed1975

Program evaluation of Texas mental health and mental retardation centers.

The diversity of programs offered by the 24 mental health and mental retardation centers in Texas required that program evaluation take a management-by-objectives approach, with each center examined as a unique system with its own goals, techniques, and activities. The approach required the centers to develop statements of management objectives, which they did with varying degrees of success. The evaluations were carried out by site-visit teams. The authors describe the evaluation process, the difficulties encountered, and some of the beneficial effects.

Community Mental Health Services↗
PubMed1991

Oral rehydration program evaluation by quality assurance sampling in rural Haiti.

An oral rehydration program in rural Haiti was evaluated by quality assurance sampling. The quality assurance sampling method and its application are described. The indicators measured were knowledge of the oral rehydration salts packet, knowledge of preparation of the solution from the packet, oral rehydration therapy use, and knowledge of preparation of the solution from salt and sugar. Coverages of the first two indicators were adequate, coverages of the latter two were inadequate. The method is a useful low-cost approach to evaluation of program coverage.

Child, Preschool↗
PubMed1991

Toy Control Program evaluation.

The Toy Control Program for the Apple IIe microcomputer is a software and hardware package developed for the training of single-switch scanning skills. The specially designed scanning programs provide on screen visual feedback and activate a battery-powered toy to reinforce performance. This study examined whether the training of preschool subjects in single-switch scanning skills with the Toy Control Program would result in increased task completion scores and increased levels of attention to task, as compared with conditions of toy activation only and microcomputer programs with screen reinforcement only. The results showed that the subjects paid significantly more attention to the toys as reinforcers (p less than .01). No significant difference was found for the performance results of the three conditions. These findings support the use of a program like the Toy Control Program, which integrates the instructional capabilities of a computer with the reinforcement potential of a toy and the creativity of a therapist.

Cerebral Palsy↗
PubMed1990

Program evaluation guidelines for the rehabilitation professional.

The overall purpose of the present chapter was to provide a set of guidelines to new rehabilitation investigators for conducting program evaluation in the burgeoning field of clinical rehabilitation. The specific objectives were to encourage investigators to develop a research consultation network, consider the benefits of utilizing a theoretical framework in specifying program objectives, assess program implementation, and to discuss the need and methods for ensuring high quality data. There is currently a widening gap in the United States and Canada between rehabilitation professionals who provide clinical services and those who conduct research on the effects of rehabilitation interventions. This is a matter of great concern and consequence. Without a firm commitment to evaluation, clinical rehabilitation practice may ultimately flounder in the mire of conjecture and ad hominem debate characteristic of therapeutic movements that have come and gone (e.g., the human potential movement). It is essential for the life of the discipline that rehabilitation programs be firmly grounded in both humanitarian and scientific principles.

Goals↗
PubMedDate not supplied

Educational program evaluation: the University of Vermont family nurse practitioner program.

Graduates of the Family Nurse Practitioner (FNP) Program at the University of Vermont, Burlington, were surveyed to determine if the FNPs had enlarged their nursing roles following completion of the program. A sample of Vermont nurses served as a control group. Results of a questionnaire, used to obtain information about the nurses' training, functions, and attitudes, indicated that FNPs performed activities associated with an expanded nursing role more frequently than did their nonpractiioner counterparts. There was evidence that the two groups differed in their attitudes toward various aspects of their nursing roles. The evaluation is an ongoing study; as the number of program graduates increases, further characterization of their roles will be possible.

Attitude of Health Personnel↗
PubMed1989

The Medical Education Evaluation Program of the state of Ohio.

In October 1988, seven foreign medical graduates participated in the first administration of the examination devised by the Medical Education Evaluation Program (MEEP) mandated by the State Medical Board of Ohio. The MEEP was established to provide an objective evaluation of an applicant's clinical competencies; passing the MEEP examination was intended to certify that the applicant's clinical skills were comparable to those of a medical student graduating from a school accredited by the Liaison Committee on Medical Education. An applicant who successfully passed the MEEP examination and fulfilled the other Ohio licensure requirements would be eligible to take the Federation Licensing Examination (FLEX) and apply for an unrestricted license to practice medicine in Ohio. The paper describes the origin and development of the MEEP examination and the testing modalities selected (multiple-choice examinations and the use of standardized patients). Four fundamental areas were tested; these are named and described, along with the method for calculating scores for each area and the criteria for passing the different components of the examination. Although the small sample size prohibited meaningful data analysis for the performance of the first group of MEEP candidates, the MEEP examination appears to meet psychometric standards of certifying and licensing examinations, based on data from comparable tests taken by beginning fourth-year medical students in New England and NBME Part III examination examinees. Some potential pitfalls of the MEEP examination are mentioned, as well as the fact that it presents a challenge to boards of medical examiners of other states to implement performance-based assessments of physicians who graduate from non-accredited medical schools.

Clinical Competence↗
PubMed1977

Plasma glucose levels: long-term effect of diet in the Chicago Coronary Prevention Evaluation Program.

In 150 middle-aged men prone to coronary disease, long-term data based on the Chicago Coronary Prevention Evaluation Program's diet showed that there was a favorable effect on fasting glycemia level and glucose tolerance. This diet for reducing obesity and hypercholesterolemia was low in cholesterol and saturated fat and moderate in polyunsaturated and total fat, with replacement of some fat by carbohydrate. At 2 years, decreased weight and serum cholesterol values of normoglycemic men were accompanied by a modest but significant fall in fasting and postload glycemia; at 4 years. fasting glycemia levels remained slightly below baseline. For men with suspect fasting hyperglycemia at baseline, sustained fall in weight and serum cholesterol value was associated with sizeable long-term reductions in fasting glycemia and improvement of glucose tolerance. Decrease in plasma glucose was significantly related to decrease in weight. No evidence of impairment of glucose tolerance with years-long consumption of this diet was recorded.

Blood Glucose↗
PubMed1979

Program evaluation in a rural community mental health center.

Can a rural community mental health center with limited resources meet the federal guidelines for program evaluation? This case example shows that a rural center can comply with the guidelines through evaluation activities tailored to its special needs and small size.

Colorado↗
PubMed1977

[Evaluating programs for preparation to old age: some theoretical thoughts and a practical example (author's transl)].

In the first part methodically satisfactory experimental designs for evaluating programs for preparation to old age on the basis of Cambell & Stanely (1963) are sketched including conditions which hinder the realization of the ideal notions. In the second part an experiment for comparing two preparatory courses to old age using different methods of instruction is described. It was observed that the more demanding teaching method resulted in more anxiety for old age. This led to the conclusion, that programs for preparation to old age should be planned as a sequence of several units in which the mastering of the new ideas may be learned and in which this learning process may be supervised.

Age Factors↗
PubMed1991

Comprehensive drug-use evaluation program in a health maintenance organization.

Development and use of a drug-use evaluation (DUE) program for hospital and outpatient facilities of a health-maintenance organization (HMO) are described. A full-time pharmacist coordinates the DUE program. Primary components of the DUE program are (1) establishment and use of drug therapy management protocols, (2) periodic review and evaluation of drug-use statistics by the pharmacy and therapeutics (P&T) committee, (3) monitoring of pharmacist interventions, and (4) evaluation of specific drug use within individual medical staff departments. Information from all DUE activities is channeled through the P&T committee and linked to the HMO's overall quality assurance program. The DUE program has the support of the HMO physicians. It has enhanced the quality of drug use and identified opportunities to further improve the quality of patient care. In surveys by the Joint Commission on Accreditation of Healthcare Organizations, the HMO facilities have received no recommendations. Pharmacists and physicians have cooperated to develop a comprehensive DUE program for an HMO.

California↗
PubMed1978

The Behavior Observation Instrument: a method of direct observation for program evaluation.

The background and development of a multicategory direct observation system, the Behavior Observation Instrument (BOI), is described. This time-sampling procedure for recording the behavior of persons is demonstrated in several treatment settings and the results applied to issues of program evaluation. Elements that have prevented direct observation from being widely adopted, such as costs, manpower, and training requirements, are systematically analyzed. A basic psychometric analysis of the instrument is used to determine optimum frequency and duration of observation intervals as well as observer agreement. The results imply that direct observation methods, once assumed by some to belong to the special province of the single-subject design, can be used to assess the effects of programs on groups of psychiatric clients in an efficient and economic manner.

Activities of Daily Living↗
PubMed1975

Readmission discount factors in program evaluation. An output value analysis of an adult psychiatry program.

The application of output value analysis, a type of benefit/cost analysis, to a psychiatric patient population is reported. A method for discounting the value of the program if a patient was readmitted within a year after discharge was introduced. The application of this discount factor reduces the value produced by the program and thereby reduces both productivity and effectiveness indices. When applied to groups known to differ in readmission rates, such as first admissions and readmissions or voluntary and involuntary admissions, the discount factor can accentuate group differences markedly. When selected diagnostic groups were compared, the discount factor could even reverse the relative standing of the groups.

Brain Damage, Chronic↗