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PubMed1999

Cross-validated factor structures and factor-based subscales for PASS and PASSING.

Program Analysis of Service Systems (PASS 3) and Program Analysis of Service Systems' Implementation of Normalization Goals (PASSING) are used internationally to assess service quality in mental retardation and other fields. In two studies, we derived and cross-validated the factor structures of these program evaluation instruments. In Study 1, based on 626 PASS 3 evaluations, four factors provided a good fit to the cross-validation data. In Study 2, based on 633 PASSING evaluations, three factors furnished a good fit to the cross-validation data. Similarities between the two factor structures, parallels with the structural and functional service dimensions emphasized in ecological approaches to evaluation, and practical uses in program evaluation of subscales based on the factors were discussed.

Chi-Square Distribution↗
PubMedDate not supplied

Outcomes results from the evaluation of the APA/HRSA Faculty Scholars Program.

BACKGROUND: The goal of the Ambulatory Pediatric Association/Health Resources and Services Administration National Faculty Development Scholars Program was to improve primary care education in the pediatric setting. The program evaluation focused on four stake-holder objectives: 1) increase the educational skills of community and generalist faculty; 2) create pediatric leadership focused on changing the culture within the medical community to support primary care education; 3) develop an infrastructure that supports sustained faculty development efforts at the local, regional, and national level; and 4) include content areas consistent with Health Resources and Services Administration contract requirements. METHODS: A multimethod evaluation plan, focused on the 107 completing scholars, was implemented utilizing six evaluation instruments. RESULTS: Key outcomes from both quantitative and qualitative outcome measures reveal that all evaluation objectives were achieved. Scholars presented 438 local workshops and 161 regional/national workshops focused on pediatric education with a combined attendance of 7939 participants. More than half of the scholars have now assumed a leadership position in education associated with program participation. Ninety-three percent of the scholars reported organizational/infrastructure changes associated with their program participation ranging from increased numbers of community teaching sites to specific resource allocations to support of faculty development. CONCLUSIONS: The outcomes of this evaluation reveal that the faculty development program achieved its objectives, with participants leading workshops, impacting faculty development infrastructure, advancing their own careers, and being strategically positioned in leadership roles with the skills to improve primary care education in the ambulatory setting.

Ambulatory Care↗
PubMed2002

Challenges encountered in measuring outcome for a rural psychiatric residential program.

Evaluation of outcome measures can provide policymakers with valuable information on the effectiveness of psychiatric rehabilitation. Two specific challenges in collecting outcome measures for psychiatric rehabilitation programs are heterogeneity of outcomes and difficulty with follow-up. These two challenges were illustrated in the process of evaluating Rose Hill Center, a rural residential psychiatric rehabilitation program. The original design was to conduct interviews with former residents and family members and verify healthcare utilization. The difficulty of locating people and their reluctance to participate conspired to lower the follow-up rates. The design was modified to improve the follow-up rate but decrease the details of specific outcomes. The results showed a high but biased follow-up rate, with more information obtained for people who graduated from the program. The residents with planned discharge showed excellent outcomes in terms of living situation, working situation, healthcare utilization, and low severity of current symptoms. High compliance with medication spoke to the program's philosophy of including the residents in the decision-making process. The dual challenges of heterogeneity of outcomes and difficulty in follow-up that limit efforts to document the value of psychiatric rehabilitation are discussed.

Adult↗
PubMedDate not supplied

A pilot program to evaluate pain assessment skills of hospice nurses.

A program was developed to evaluate pain assessment skills of hospice nurses in the home setting, utilizing standardized patients (SPs). Hospice nurses were sent on a routine visit to a "patient's" home to evaluate someone dying of pancreatic cancer. They were not informed in advance that the "patient" was actually an SP, who had undergone intensive training from the staff to prepare him for his role. They performed their usual evaluation and then reported back to the referring physician by telephone. The referring physician, who used a written series of evaluation criteria, graded their assessments. The SP also evaluated the assessment skills of each nurse. After the exercise, the nurses were informed of the "patient's" identity and were provided with the written critique prepared by the SP. A second part of the program included a written examination of their pain assessment and treatment skills, followed by a didactic presentation. This is the first report we know of that has utilized SPs in the home setting to evaluate pain assessment skills in a blind fashion. Our findings indicate that this can be an effective method for measuring pain assessment skills as well as a valuable teaching device.

Adolescent↗
PubMed2006

The effects of two different incentives on recruitment rates of families into a prevention program.

This study experimentally manipulated two incentives for participation (monetary: paid participation for sessions and setting: group vs. individual) in a child behavior problem prevention program to analyze their effects on recruitment and retention of families. A population of 690 eligible families from 15 preschools located in socially disadvantaged neighborhoods was invited to participate in a parent training (PT) program. The study recruited parents by using advertisements that had information describing only the indicated condition (i.e., PT in group-unpaid, or PT individual-unpaid, or PT in group-paid, or PT individual-paid). Results demonstrate significant impact of payment on recruitment and initial attendance. Training setting alone (individual or group) did not significantly influence these rates. Editors' Strategic Implications: A compelling case is made for the utility of monetary incentives to increase proportions of low-income families in prevention research and programs. Evaluators and program designers should note the impressive use of the experimental design and hierarchical linear modeling to test the effects on recruitment.

Adolescent↗
PubMed1990

Analysis of programmed stimulation methods in the evaluation of ventricular arrhythmias in patients 20 years old and younger.

The purpose of this study was to systematically evaluate programmed ventricular stimulation in patients less than 21 years of age undergoing electrophysiologic testing. A standardized protocol was applied in 55 consecutive patients (mean age 14 years) with the following clinical presentations: sustained ventricular tachycardia (VT) (n = 17); ventricular fibrillation (VF) (n = 7); syncope with heart disease (n = 10); nonsustained VT (n = 6); and syncope with an ostensibly normal heart (n = 15). The stimulation protocol consisted of 1 and 2 ventricular extrastimuli during sinus rhythm, followed by 1 to 4 (S2, S3, S4, S5) extrastimuli during pacing at 2 ventricular sites. Of the 17 patients with sustained VT, 12 had induction of the arrhythmia (sensitivity = 71%). Overall, 18 of 55 patients had inducible sustained VT, with this response significantly enhanced by use of S4 or S5 protocols (p = 0.02). Although no syncope patients with an ostensibly normal heart had inducible sustained VT, 7 had polymorphic nonsustained VT in response to ventricular stimulation. The mean number of extra-stimuli preceding the induction of nonsustained or sustained VT or VF did not differ. The induction of VF in 5 cases during this study was preceded in each case by extrastimuli intervals less than or equal to 190 ms. Thus, data indicate that aggressive stimulation protocols appear to be required for induction of sustained VT in most young patients, nonsustained polymorphic VT as a response to aggressive programmed stimulation is of uncertain significance, and that coupling intervals less than or equal to 190 ms may correlate with the induction of VF.

Adolescent↗
PubMed1980

Problems and approaches to the control and surveillance of sexually transmitted agents associated with pelvic inflammatory disease in the United States.

The national gonorrhea control program has expanded since its inception in 1972 and now reflects new information and program evaluations. Initial program objectives to reduce the incidence of disease and the resistance of gonococci to antibiotics have been expanded to reduce the occurrence of pelvic inflammatory disease and to limit the sequelae of PID. The changes since 1972 in the national venereal disease control program have increased the number of people helping control programs and have enhanced our ability to control other sexually transmitted diseases.

Female↗
PubMed1995

The determination and correlation of reproductive parameters of performance-tested Hereford and Simmental bulls.

Purebred Hereford and Simmental bulls (n = 120), managed similarly to bulls in the Ontario Bull Evaluation Program, were evaluated for reproductive parameters. Four diets, equivalent except for the form of dietary fiber, were fed in a growth performance trial. Diet had no direct effect (P > 0.10) on any of the reproductive variables examined. Of the 117 bulls that had complete breeding soundness evaluations, 75% were classified as satisfactory potential breeders, 24% as questionable potential breeders and 1% as unsatisfactory potential breeders. The 2 breeds were significantly different (P < 0.05) for several end of test parameters. When controlling for age and weight differences, Herefords had a higher backfat thickness, smaller scrotal circumference, lower paired testicular weight and lower epididymal weight. Semen morphology and motility did not differ (P > 0.10) between the breeds. When examining simple correlations, scrotal circumference was highly correlated with paired testicular weight, moderately correlated with epididymal weight, daily sperm production and extragonadal sperm reserves, and negatively correlated with backfat thickness. Scrotal circumference was not related to backfat thickness when controlling for breed effects. The degree of germinal epithelium loss was moderately and negatively correlated with the percentage of spermatozoa with normal morphology and progressive motility, epididymal sperm reserves and epididymal weight, but was not correlated with scrotal circumference.

Journal Article↗
PubMed1987

Issues in the evaluation of chemical dependency treatment programs for adolescents.

To summarize, six issues have been identified in this article that need to be considered before adequate assessment of relative efficacy of treatment programs can be attempted, starting at the front door of treatment. First, the differential referral sources that bring these youngsters to treatment must be considered, with their differential perspectives and definitions of problem behavior. Second, the differential characteristics of the patient population must be assessed. This involves, primarily, systematic and thorough medical and psychiatric diagnosis, but it also includes careful assessment of genetic, familial, social, legal, and developmental characteristics that subcategorize these youngsters. As indicated, when this is done the typical adolescent referred for treatment is likely to have a lifetime diagnosis of attention deficit disorder, conduct disorder, some drug use diagnosis (most likely alcohol and marijuana), past legal problems, a family in turmoil (which has included personal, physical, and possibly sexual abuse to the youngster and also genetic loading for alcoholism), or some learning disability. Third, the differential characteristics of treatment programs must be adequately described and catalogued. No such assessment instruments currently exists. The differential characteristics based on philosophy, treatment strategies, personnel selection, patient admission criteria, treatment techniques employed, length and type of treatment, and length and type of aftercare, all must be assessed. Fourth, the presence or absence of differential treatment strategies responsive to the particular needs of individual adolescents must be categorized. In addition to the overall philosophic flexibility of the program, the capability of responding to particular issues such as the presence of major depressive disorder, learning disability, sexual abuse, or the need for a careful neurologic assessment for subtle temporal lobe issues, must be identified in the program. Fifth, the differential response of the youngster to the treatment process as it is progressing must be able to be assessed and considered as a variable. For example, the ability of the youngster to participate in group confrontational sessions and honestly review his or her past behavior is a measurable variable that to date is ignored in program evaluation. Essentially the only variable currently assessed is treatment completion or failure to complete treatment. Sixth, appropriate outcome variables need to be identified and used. While abstinence is a laudable theoretic goal of treatment, the reality falls somewhat short of that goal.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed2000

Clinical indicators in accreditation: an effective stimulus to improve patient care.

The Australian Council on Healthcare Standards (ACHS) established the Care Evaluation Program (CEP) of clinical performance measures in its accreditation program to increase the clinical component of that program and to increase medical practitioner involvement in formal quality activities in their health care organizations. From the introduction of a set of generic indicators in 1993 the program expanded through all of the various medical disciplines and from January 2000 there will be 18 sets (well over 200 indicators) in the program. More than half of Australia's acute hospitals (covering the majority of patient separations) are monitoring the indicators and reporting clinical data twice yearly to the ACHS. In turn they receive a 6-monthly feedback of aggregate and peer comparative results. The ACHS policy had no specific requirement for a set number of indicators to be monitored and it was not mandatory to achieve any specific data threshold to be accredited. However, where an organization's results differed unfavorably from those of its peers some action was expected. Qualitative information is also sent to the CEP and this has enabled a determination of the effectiveness of the indicators. There is documented evidence of improved management and numerous examples of improved patient outcomes. The program remains unique in the scope of the medical disciplines covered and in the formal provider involvement with indicator development. Both the clinical component of accreditation and clinician involvement in quality activities have been increased in an educational process. However, not all of the indicators are of equal value and a reduction in the number of indicators to a 'core' group of the most reliable and responsive ones is in process.

Accreditation↗
PubMed1996

The change process and a clinical evaluation unit at University of Massachusetts Medical Center.

In the late 1980s, the University of Massachusetts (UMass) began its evolution toward the creation of a clinical evaluation unit (CEU). This article presents an overview of the history leading up to the formation of our clinical evaluation program and some of the projects developed to measure and improve clinical outcomes and reduce costs. Our experience in establishing the UMass CEU reflects an attempt to change clinical practice through effecting organizational change.

Case Management↗
PubMed1983

The cost of quality assurance in medicine.

Cost analysis has been frequently neglected in program evaluations but is currently of high relevance in policy decisions on quality assurance in medicine. The Ambulatory Care Medical Audit Demonstration (ACMAD) Project implemented and evaluated a program of medical record-based quality assurance in eleven sites for nine medical topics. Total direct costs for the project were $1.22 million over five years; indirect costs, $694,000. A computerized data system enabled disaggregation of the cost data by person, timing, type of work, project phase, health topic, health center, and research or operational nature. Of the costs incurred, 79% were for operational reasons, with 21% incurred for research reasons. Costs per audited case were 31% higher in hospitals than in neighborhood health centers. Audit topics of low per-case costs tended to have automated case findings, straightforward and limited abstracting, little need to examine multiple visits, and a low proportion of case-found patients ineligible for audit.

Ambulatory Care↗
PubMedDate not supplied

Empowering individuals with early dementia and their carers: an exploratory study in the Chinese context.

This article discusses an early dementia program developed for sufferers and family carers in a Chinese context. Instead of replicating formats of similar programs developed in Western countries, this program considered cultural issues and caring values that are unique to Chinese people. Its main objective was to empower sufferers and carers through educational activities and support programs. Observations and interviews were used for program evaluation. The program creates a "win-win" situation in which both parties experienced pleasurable feelings and developed a close relationship. It also highlights the values of "meaningful occupation" in dementia care. Furthermore, the program broadens our understanding of needs and concerns of sufferers and carers at early stages, which are deemed important to develop continuous dementia programs along the disease course.

Adult↗
PubMed2003

Unmet need and unintended fertility: longitudinal evidence from upper Egypt.

CONTEXT: Although unmet need for family planning is a standard measure for evaluating programs' effectiveness in meeting the reproductive needs of individuals, its validity and accuracy in identifying women most at risk of unintended pregnancy have been questioned. METHODS: Women who participated in the 1995 Egypt Demographic and Health Survey in two governorates in Upper Egypt (Assuit and Souhag) were followed for two years (N=2,444); in-depth data on their fertility preferences, contraceptive use and births were gathered in 1996 and 1997. Transitions among contraceptive need categories from 1995 to 1997 are examined, and rates of unintended (mistimed and unwanted) births are calculated according to contraceptive need status at baseline. RESULTS: In the aggregate, unmet need increased by six percentage points, from 28% to 34%. This change was the net outcome of 14% moving out of unmet need and 20% moving into unmet need (i.e., substantial satisfaction of unmet need was offset by increased demand for contraception). The rate of unintended fertility was far higher among women with unmet need at baseline than among contraceptive users in 1995. Women with unmet need made up about one-quarter of the baseline sample, but they contributed almost one-half of mistimed and unwanted births during the two years. The majority of unintended births were to women who had never practiced contraception, whereas fewer than one-fifth were to women with recent contraceptive experience (including contraceptive failure). CONCLUSIONS: : Unmet need for family planning remains a useful tool for identifying and targeting women at high risk of unintended pregnancy.

Contraceptive Agents↗
PubMed1995

Research on mutual aid and social support: progress and future directions.

Signs of progress in the study of mutual aid and social support include a greater emphasis on the collection of empirical data to evaluate program effects and to comprehend relations between professional and informal sources of aid, as well as a clearer delineation of concepts and creative integration of practices associated with mutual aid. Several directions for future research on support interventions are addressed, including the nature and timing of outcome measures, analyses of the optimal fit of participants to different intervention formats, and the need for research designs that yield information about the necessary and cost-effective components of support interventions.

Forecasting↗
PubMed1994

Data collection strategies for patient-reported information.

The U.S. health care transition demands increased accountability for medical care. This has contributed to increased interest in documenting medical outcomes, including improvements in health-related quality of life and treatment satisfaction. These data can only be obtained by asking patients directly about their current health state, perception of well-being, and satisfaction with care. Systematic collection of patient-reported data is often poorly done because its demands are underestimated and inadequately supported. Rigorous quality assurance is critical in any clinical trial or treatment delivery evaluation program.

Clinical Trials as Topic↗