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PubMed1986

Satisfaction with hospital emergency department as a function of patient triage.

For most people, waiting is inherently dissatisfying and emergency department patients are no exception. Most patients and people accompanying the patient find the treatment waiting time in emergency medical care facilities to be a source of great dissatisfaction. The dissatisfaction is compounded in many cases by the anxiety of all associated with the patient and the discomfort or pain the patient feels. Consequently it was not surprising to find in this investigation that waiting time for treatment and treatment cost were major causes of consumer dissatisfaction. Satisfaction of emergency department patients decreased as the medical need became less urgent. This finding should be of considerable concern to hospital administrators. With the trend toward new forms of health care delivery systems such as "emergicenters" and the increase in the number of physicians per capita, the emergency department will no longer be the most attractive or the only alternative available to the patients who have a nonemergency medical need. For emergency departments to remain profitable, it will be more important than ever before to meet the needs and expectations of their current and potential users. This can be accomplished by a program designed to reduce cost and waiting time and improve communication, and by other programs to educate the user so that the user's expectations more closely conform with what is actually needed or can be economically provided.

Anxiety↗
PubMed2005

Long-term follow-up of a longitudinal faculty development program in teaching skills.

BACKGROUND: The long-term impact of longitudinal faculty development programs (FDPs) is not well understood. OBJECTIVE: To follow up past participants in the Johns Hopkins Faculty Development Program in Teaching Skills and members of a comparison group in an effort to describe the long-term impact of the program. DESIGN AND PARTICIPANTS: In July 2002, we surveyed all 242 participants in the program from 1987 through 2000, and 121 members of a comparison group selected by participants as they entered the program from 1988 through 1995. MEASUREMENTS: Professional characteristics, scholarly activity, teaching activity, teaching proficiency, and teaching behaviors. RESULTS: Two hundred participants (83%) and 99 nonparticipants (82%) responded. When participants and nonparticipants from 1988 to 1995 were compared, participants were more likely to have taught medical students and house officers in the last year (both P<.05). Participants rated their proficiency for giving feedback more highly (P<.05). Participants scored higher than nonparticipants for 14 out of 15 behaviors related to being learner centered, building a supportive learning environment, giving and receiving feedback, and being effective leaders, half of which were statistically significant (P<.05). When remote and recent participants from 1987 through 2000 were compared with each other, few differences were found. CONCLUSIONS: Participation in the longitudinal FDP was associated with continued teaching activities, desirable teaching behaviors, and higher self-assessments related to giving feedback and learner centeredness. Institutions should consider supporting faculty wishing to participate in FDPs in teaching skills.

Adult↗
PubMed2005

Resident research and scholarly activity in internal medicine residency training programs.

OBJECTIVES: 1) To describe how internal medicine residency programs fulfill the Accreditation Council for Graduate Medical Education (ACGME) scholarly activity training requirement including the current context of resident scholarly work, and 2) to compare findings between university and nonuniversity programs. DESIGN: Cross-sectional mailed survey. SETTING: ACGME-accredited internal medicine residency programs. PARTICIPANTS: Internal medicine residency program directors. MEASUREMENTS: Data were collected on 1) interpretation of the scholarly activity requirement, 2) support for resident scholarship, 3) scholarly activities of residents, 4) attitudes toward resident research, and 5) program characteristics. University and nonuniversity programs were compared. MAIN RESULTS: The response rate was 78%. Most residents completed a topic review with presentation (median, 100%) to fulfill the requirement. Residents at nonuniversity programs were more likely to complete case reports (median, 40% vs 25%; P=.04) and present at local or regional meetings (median, 25% vs 20%; P=.01), and were just as likely to conduct hypothesis-driven research (median, 20% vs 20%; P=.75) and present nationally (median, 10% vs 5%; P=.10) as residents at university programs. Nonuniversity programs were more likely to report lack of faculty mentors (61% vs 31%; P<.001) and resident interest (55% vs 40%; P=.01) as major barriers to resident scholarship. Programs support resident scholarship through research curricula (47%), funding (46%), and protected time (32%). CONCLUSIONS: Internal medicine residents complete a variety of projects to fulfill the scholarly activity requirement. Nonuniversity programs are doing as much as university programs in meeting the requirement and supporting resident scholarship despite reporting significant barriers.

Adult↗
PubMedDate not supplied

Aligning financial incentives with quality of care in the hospital setting.

This article describes the structure, implementation, and early results of a performance-based hospital incentive program designed by a large nonprofit health plan. The Hospital Quality Service and Recognition program, developed by the Hawaii Medical Service Association, was launched in 2001 to reward high-quality medical care at the hospital level. This pay-for-performance program used administrative claims data, survey data, and hospital-reported information to assess hospital performance in risk-adjusted complications and risk-adjusted length of stay (LOS), patient satisfaction, and hospital processes of care measures. Financial incentives were provided to participating hospitals based on their performance on these measures. Preliminary outcomes of the program evaluated over a 4-year period after implementation revealed improvements in aggregated rates of risk-adjusted surgical complications and efficiency of care as evidenced by a substantial decrease in risk-adjusted average LOS for several surgical procedures. Quality improvement was demonstrated in several other program components including emergency department satisfaction. This quality incentive program offers an innovative approach for encouraging delivery of high-quality and service-oriented care in a statewide network of participating hospitals.

Hawaii↗
PubMedDate not supplied

Is attribution retraining necessary? Use of self-regulation procedures for enhancing the reading comprehension strategies of children with learning disabilities.

The present study investigates the need to include explicit attribution retraining in a program designed to teach reading comprehension strategies to children with learning disabilities (LD). The program had two versions: (a) self-regulation procedures and (b) self-regulation procedures plus explicit attributional retraining. Sixty children with LD were assigned to two training groups (with and without attributional retraining) and a control group. Twenty normally achieving students served as an additional control group. The effects were assessed via attribution measures and cognitive and metacognitive reading comprehension tests. Results indicated that children from both training groups improved on measures of cognitive strategies, but their gains were very low on metacognitive measures. In addition, regardless of training condition, students from both groups showed equally good attribution profiles.

Behavior Therapy↗
PubMed1980

Public health social work: a training model.

Despite the disparate historical evolution, public image, and traditional approached to problem solving characteristic of the social work profession and the field of public health, the potential for professional collaboration has never been greater. Indeed, the comprehensive management of social-health problems demands an interdisciplinary educational program designed to train upcoming professionals. The 4-year old, joint MSW-MPH program at the University of Minnesota provides a setting in which the public health social work student develops the philosophies, values, and skills of both social work and public health, and applies them to appropriate social-health settings. The purpose of this paper is to describe the Minnesota model and examine its implications for faculty and community professionals interested in developing similar training programs.

Curriculum↗
PubMedDate not supplied

Medication use patterns and health outcomes among patients using a subsidized prescription drug program.

OBJECTIVE: To evaluate medication adherence, medication safety, health care utilization, and health outcomes among patients enrolled in a subsidized prescription program. DESIGN: Cross-sectional study. SETTING: Conducted as part of the Prescription Access program, a subsidized prescription program serving indigent patients residing in Franklin County, Ohio. PATIENTS: Patients qualifying for enrollment in the program were uninsured and had a household income of 200% or less of federal poverty level. Approximately 5% of the 2,500 patients (mean age, 70.6 years) enrolled in the program were systematically selected from a computer-generated patient enrollment report. INTERVENTION: Telephone interviews conducted by a pharmacist or advanced student pharmacist between January and September 2002. MAIN OUTCOME MEASURES: Patterns of medication use and safety, level of health care utilization, and health outcomes. RESULTS: A total of 104 patients reported taking a mean (+/- SD) of 6.7 +/- 3.8 medications. A total of 72 (69%) patients reported taking their medications correctly, and 90 (87%) reported finishing their medication course as prescribed. Medication refills were obtained by 75 (72%) patients, but of these patients, only 55 (73%) indicated that they obtained their refills on time. Adverse effects occurred in 25 (24%) patients, and 2 patients reported an allergic reaction. A total of 51 (49%) patients made unscheduled visits to their primary care physician, another health care facility, an emergency department, and/or were admitted to a hospital. Unscheduled visits occurred more often among nonadherent patients (59%) than adherent patients (44%), but not significantly so. In addition, 82 (79%) patients reported an improvement in health-related quality of life (QOL); 90 (87%) had a means of transportation to obtain medications; and 93 (89%) indicated that they would have to skip medications or give up necessities, if they were not enrolled in a subsidized prescription program. CONCLUSION: An improvement in self-reported QOL and a high rate of medication adherence demonstrate support for the benefits of this and similar subsidized prescription drug programs. A high rate of additional health care utilization, especially among nonadherent patients, indicates an area for further analysis, program revisions, and/or patient education.

Aged↗
PubMed1988

Developing workplace health promotion programs through university and corporate collaboration. A review of the Corporate Health Promotion Research Program.

The unique collaboration of the UCSF School of Medicine with community and national leaders in corporate health promotion has, in less than three years, made the Corporate Health Promotion Research Program a valuable resource to participating corporations. We are able to offer them sound consultation on health promotion programs, based on state-of-the-art research, at minimal cost to the employer or employees. In addition, we are educating employers about quality programs and the process and need for evaluation, in an effort to generate sound findings on the effects of corporate health promotion programs. Corporations are beginning to see that instead of being reactive and spending great sums of money only after employees become ill, it makes good sense to institute programs designed to prevent employees from becoming ill in the first place. With such programs, corporations not only improve the health of their employees (a worthy objective in its own right), but they contribute to containing medical costs at the same time--a clear "win-win" situation for all concerned. In short, corporations are finding that an ongoing, active interest in the health of their employees has a direct bearing on their own long-range health as a business. With this in mind, we feel that medical benefit plans of the future will be comprised of three elements: medical care plus cost-containment plus health promotion programs. With this order of complexity, no one company or professional organization has all the answers--and that should be acknowledged from the outset.(ABSTRACT TRUNCATED AT 250 WORDS)

Data Collection↗
PubMed2001

[Control of the obese population. Educational intervention program].

The purpose of this article is to discover the age, sex and risk factor differences among a group of obese people who participate on a pedagogical program designed for weight loss and one which is not designed for weight loss and to establish the effectiveness of the aforementioned pedagogical program on those obese people who participate in that same program. To these ends, a non-controlled, prospective study was carried out in "L'Eixample" Primary Health Clinic in Lérida. From a group of 192 obese patients at a General Medicine clinic, 93 followed an individualized educational intervention program by means of scheduled nurse visits over a one year time period. This individualized educational program was based on: health information and records, nutritional education, physical exercise, motivation and help during follow-up sessions; all carried out under a scheduled nurse's control program. He overall effectiveness of this program has been 51.6%, or 48 patients; this program should be directed to the under 65 obese age group which do not have any risk factors.

Adolescent↗
PubMedDate not supplied

Community-based chronic disease management program for African Americans.

Seventy-five predominately African American volunteers were enrolled in a community-based intervention program designed to lower blood pressure and HgbA1C levels in an African American population. Program components consisted of exercise, meal planning, weekly support groups, periodic cooking schools, and service coordination. Significant decreases in initial and 1-year values were seen in both systolic blood pressure (P < .0001) and diastolic blood pressure (P = .000) and HgbA1Cs for those with initial values > 7% (P = .013).

Black or African American↗
PubMedDate not supplied

Reaching the hard to reach: innovative housing for homeless youth through strategic partnerships.

This article features three housing programs designed to target the needs of youth aging out of child welfare. One program combines housing and treatment to move substance-dependent youth off the streets; one combines the resources of Urban Peak, the only licensed homeless and runaway youth shelter in Colorado, with the Denver Department of Human Services to prevent youth in child welfare from discharging to the streets; and one addresses the intense mental health needs of this population. It costs Colorado 53,655 dollars to place a young person in youth corrections for one year and 53,527 dollars for residential treatment. It costs Urban Peak 5378 dollars to move a young person off of the streets. This article describes how data have driven program development and discusses how policy implications and relationships with the public and private sector can leverage additional resources.

Adolescent↗
PubMed1997

Student and supervisor perceptions of the quality of supervision in athletic training education.

OBJECTIVE: To assess the perceptions of the quality of athletic training supervision via the internship route to certification and the NATA-approved/CAAHEP programs. DESIGN AND SETTING: A questionnaire was mailed to head athletic trainers or NATA/CAAHEP program directors and athletic training students in 40 programs nationwide (stratified random sample). SUBJECTS: Head athletic trainers (20), NATA-approved or CAAHEP-accredited program directors (20), and athletic training students in those educational programs (149). MEASUREMENTS: The Athletic Training Supervisory Skills Inventory (ATSSI) was adapted from the Supervisory Evaluation Form (SEF) and athletic training literature. The ATSSI was reviewed by 30 certified athletic trainers, and their feedback was incorporated into the final version of the questionnaire. The ATSSI contains 46 questions that cover six major domains of athletic training supervisor behavior. RESULTS: Overall, there were no differences in how internship route supervisors and NATA/CAAHEP program directors rated their own supervisory skills. Also, there were few differences in how students in those two types of athletic training education programs rated their supervisors. CONCLUSIONS: This exploratory study's limitations included a one-time assessment approach and a small sample of supervisors. Future studies in supervision should take a longitudinal approach and include a larger sample size.

Journal Article↗
PubMed2006

Preferred teaching and testing methods of athletic training students and program directors and the relationship to styles.

OBJECTIVE: The purpose of this study was (1) to investigate differences between athletic training students' and program directors' preferences for teaching and testing methods and (2) to investigate the relationship between style and preferred teaching and testing methods using the Gregorc Style Delineator (GSD) and the Preferred Teaching and Testing Method Inventory (PTTMI). PARTICIPANTS: We cluster sampled 200 undergraduate students (100% return; 68 men, 132 women; mean age, 20.12 +/- 2.02 yrs) and simple random sampled 100 program directors (43% return; 22 men, 21 women; mean age, 40.05 +/- 9.30 yrs) from Commission on Accreditation of Allied Health Education Programs-accredited athletic training education programs. DESIGN AND MEASUREMENT: We used a correlational research design to compare the preferred teaching and testing methods of undergraduate students and program directors. All subjects completed a demographic survey, the GSD, and the PTTMI. Our analyses included two separate 2 (role: student and program director) x 8 (method: teaching or testing techniques) and two separate 4 (style: concrete sequential, abstract sequential, abstract random, concrete random) x 8 (method: teaching and testing techniques) mixed-model analyses of variance. RESULTS: We found that athletic training students and program directors had significantly different preferences for teaching (p < 0.01) and testing (p < 0.01) methods, respectively. No significant relationships were revealed between athletic training students' and program directors' Mind Style typologies and their preferences for teaching or testing method. CONCLUSIONS: We recommend that athletic training and allied health educators consider implementing pedagogy that accentuates students' styles and consider self and students' preferences for preferred teaching and testing methods as time and topic permit.

Administrative Personnel↗
PubMed1986

A microcomputer system for the practising cardiac surgeon.

The authors present a computer program designed for the practising cardiac surgeon who wishes to computerize patient data. The program is efficient, versatile and can be adapted to individual needs. It can be used with any IBM PC-compatible machine and requires little knowledge of computer science. More than 250 items on 30 000 patients can be stored and all this information analysed simultaneously. The program can chart a patient's profile and tabulate the information of the entire registry. It can generate lists of patients with their surgeons, cardiologists, diagnoses, operations and dates of intervention. It can also be used for mailing purposes.

Cardiac Surgical Procedures↗
PubMed1970

Coordination of regional libraries with Regional Medical Program projects.

The Medical Library Assistance Act authorized the Regional Medical Library Program to improve information services in health fields, as well as other programs designed to help the health worker. Both the RMLP and the Regional Medical Program are based on regional cooperation to enhance the value of available resources, and to enable health workers away from main centers to use them. Services which Regional Medical Libraries must supply are described. As this program develops, more than conventional library services will be provided. Regional Medical Programs stress the continuing education of health-related personnel, and their need for health information; libraries are necessarily involved in such programs. The regions of the RMP are smaller than those of the RMLP, and the smaller regional focus may be an advantage. Specific examples of the coordination of library services and library-oriented programs are given.

Information Services↗
PubMedDate not supplied

The EPIGRAM computer program for analyzing mortality and population data sets.

EPIGRAM is a computer program designed to improve access to State-level underlying cause mortality data. The program produces results for population, deaths, death rate, age-adjusted death rate, years of potential life lost (YPLL), YPLL rate, and confidence intervals. Results can be compared variously among age groups, counties, causes of death, races, regions, and years. The program's menu-driven interface facilitates the selection or modification of analysis parameters. Current selections are retained so the user can modify one parameter at a time. Based on the parameters that the user selects, the program produces a series of tables, one for each instance of a particular parameter. Each output table has columns for male, female, and both sexes combined, and an indefinite number of user-defined rows for age groups, causes of death, counties, races, regions, or years. EPIGRAM has major advantages over other methods for analyzing mortality and population data. The program uses relatively small amounts of memory and disk space, executes rapidly, is flexible, can be used by inexperienced computer users, provides online help screens and tutorials, and runs under DOS or UNIX without modification. The program currently is used to analyze mortality and population data for Texas. Although it is not currently available for distribution, support is being sought for its evaluation and possible implementation in State health departments to analyze data for other States, or other data sets, such as hospital discharge data or cancer incidence data.

Cause of Death↗
PubMed1993

A driving program for the visually impaired.

This driving program for the visually impaired individual was devised in 1986, as a specific adjunct to the pre-existing training program, designed for the cognitive and physically impaired patients. Two important purposes of the program are: 1) To give the low vision practitioner and staff the capability to be able to recommend a specific training program for telescopic and visually impaired drivers. 2) To try to ensure that every visually impaired telescopic driver (prescribed with a telescopic system by the low vision center) would not only meet legal visual acuity and visual field requirements for the State of Michigan, but would also improve the competency of using their telescopic system for driving.

Automobile Driver Examination↗
PubMed1993

Prenatal education in the work place.

Advances in neonatal care have improved survival rates among premature and low-birth-weight (LBW) infants, but highly technical care for these infants costs more than $2 billion a year in the United States. The incidence of premature and LBW infants can be reduced by prenatal education programs that focus on nutrition, obtaining prenatal care, avoiding dangerous substances, and recognizing preterm labor. In an effort to contain health care costs, many companies self-insure employee health benefits and offer health promotion programs designed to improve life style behaviors. This article examines providing a prenatal education program in the work place as a way of reducing the incidence and costs of prematurity and low birth weight.

Curriculum↗