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Evaluating program design in the state hospital setting.

This study used a benchmarking and goal attainment approach to identify the extent to which two state hospital-based programs were doing what they were intended to do. The 1989 version of the Moos Ward Atmosphere Scale (WAS) was used to collect information from staff and patients in resocialization and admissions programs. Analysis of variance revealed differences between and within programs, and t tests revealed differences between the study sample and the WAS norms. Program descriptions, information from the literature, and features of the measurement scale were used to interpret the findings and develop recommendations for improvements.

Analysis of Variance↗

Evaluation of a comprehensive advisement program designed to enhance student retention.

Nursing schools are experiencing an increase in enrollment. However, students are done a disservice when there are no strategies to retain them. A primary strategy for enhancing student retention is the implementation of an effective advisement program. The authors describe the implementation and evaluation of a comprehensive advisement system that was a major component of a special project grant from the division of nursing designed to enhance student retention.

Counseling↗

Developing patient education programs with multimedia technology incorporating patient feedback into program design.

The University of Texas Medical Branch in Galveston has been the site of a three year project to develop a unique set of computer-based health promotion programs for patients in community-based settings. The Healthy Touch Series is a collection of four interactive multimedia programs that were produced to provide health promotion information to underserved groups on topics related to maternal-infant health. The programs have bilingual audio tracks in English and Spanish and run on a CD-ROM platform with touch-screen control. Use of the technology with a large group of patients led to many modifications and alternations. Formative evaluation results review the key concepts we learned.

Audiovisual Aids↗

Exercise for stress management. Program design and troubleshooting.

Exercise is undoubtedly an important facet of stress reduction, and patients should be encouraged in every way possible to use exercise as part of stress-management programs. However, exercise may itself create a set of disorders, usually overuse, inflammatory syndromes. Physicians should have a firm understanding of the methods available for treating such problems and returning the patient to his or her exercise program. While it is not reasonable for a patient to cling to an "exercise-at-all-costs" attitude, neither is it reasonable for a physician to treat all exercise-related problems by the simple advice to stop exercising.

Athletic Injuries↗

Computer-assisted quality control: considerations for program design.

A well-designed laboratory computer system has the potential of enhancing all phases of quality control. Of most importance is the choice of an underlying approach that is statistically valid and robust. Specification of quality goals, participation in regional programs, and use of a flexible multi-rule approach are recommended. Careful attention to general and specific design is necessary to achieve full system potential. The design process must include detailed consideration of file and record structure, data integrity, flexibility of input and output, and display and report formats. For statistical run evaluation, theoretic validity, operational process, and ease of understanding by the user must be considered.

Computers↗

The Family Caregiver Program: design and effectiveness of an education intervention.

How can family caregivers develop the knowledge and confidence necessary to be successful in providing care to their loved ones at home? This article describes a formal education program for family caregivers, created by Winchester Hospital's Community Health Institute in Massachusetts, to meet their needs. The article also describes a study that Winchester Hospital's Community Health Institute undertook to evaluate the effectiveness of this education program on increasing the skills and confidence of family caregivers.

Activities of Daily Living↗

The effect of welfare reform on SSA's disability programs: design of policy evaluation and early evidence.

During the past several years, the U.S. social safety net has gone through substantial changes involving an emphasis on personal responsibility and incentives, the shift of certain responsibilities to the states, and new limits on entitlements for benefits. Two pieces of recent legislation affected the Social Security Administration's (SSA's) disability programs. Section 105 of Public Law 104-121, enacted on March 29, 1996, mandated the removal of persons from the Supplemental Security Income (SSI) and Social Security Disability Insurance (DI) rolls for whom drug addiction and alcoholism (DA&A) were material to the determination of disability. It eliminated allowances on the basis of DA&A immediately and required the termination of benefits to all persons receiving benefits at the time of enactment. The other major piece of legislation was the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996, which was later amended by the Balanced Budget Act (BBA) of 1997. PRWORA converted the Aid to Families with Dependent Children (AFDC) program from an open-ended entitlement program into a block grant, Temporary Assistance for Needy Families (TANF), incorporating time limits on the receipt of benefits as well as strict work requirements. PRWORA also tightened child eligibility for SSI, narrowed eligibility for noncitizens, and reduced funding for food stamps. The BBA restored SSI eligibility for noncitizens receiving SSI prior to August 1996 and for legal noncitizens residing in the United States prior to August 1996 who become disabled in the future. SSA designed three studies to assess the effects of this legislation. Two of the studies focused on direct effects on SSA's disabled beneficiary population, targeting drug addicts and alcoholics and SSI children. The third study focused on the indirect effects of PRWORA, particularly the replacement of AFDC with TANF, on SSA's programs. The three studies were tied together by a concern of the overall effects--direct or indirect--of the legislative changes on SSA's beneficiary populations and a host of interrelated evaluation issues. The key methodological challenge of these evaluations is the nonexperimental nature of the evidence. The legislative pieces mandating the changes designed to affect SSA's target populations were implemented nationally, without prior demonstration projects. Nonexperimental strategies, such as comparison group designs, must therefore be used to measure the effects of interest. Other challenges relate to the time frames. Since implementing the changes requires a certain amount of time, and outcomes are realized over a period of time after that, the information that can be made available to interested policymakers in the short run is inherently limited to descriptive data on the populations affected and to impressionistic evidence from case studies and process study analyses. The timing problem is particularly acute with respect to measuring the indirect effects of replacing AFDC with TANF, because the most important likely effects will occur over a period of several years, and this time frame may substantially vary across states as a result of the decentralized nature of TANF programs. Finally, the analyses that can be conducted are constrained by the lack of relevant data from existing surveys. Administrative record data alleviate the need for survey information for some purposes, but the lack of survey data still seriously constrains the analyses that can be done in the short term. Because of these methodological challenges, SSA designed an evaluation strategy that uses several methods and data sources, including quantitative analyses of data from surveys and administrative records (particularly data from the Survey of Income and Program Participation, or SIPP, matched to data from administrative records) and qualitative analyses through case studies. (ABSTRACT TRUNCATED)

Alcoholism↗

Critical factors for designing programs to increase the supply and retention of rural primary care physicians.

CONTEXT: The Physician Shortage Area Program (PSAP) of Jefferson Medical College (Philadelphia, Pa) is one of a small number of medical school programs that addresses the shortage of rural primary care physicians. However, little is known regarding why these programs work. OBJECTIVES: To identify factors independently predictive of rural primary care supply and retention and to determine which components of the PSAP lead to its outcomes. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: A total of 3414 Jefferson Medical College graduates from the classes of 1978-1993, including 220 PSAP graduates. MAIN OUTCOME MEASURES: Rural primary care practice and retention in 1999 as predicted by 19 previously collected variables. Twelve variables were available for all classes; 7 variables were collected only for 1978-1982 graduates. RESULTS: Freshman-year plan for family practice, being in the PSAP, having a National Health Service Corps scholarship, male sex, and taking an elective senior family practice rural preceptorship (the only factor not available at entrance to medical school) were independently predictive of physicians practicing rural primary care. For 1978-1982 graduates, growing up in a rural area was the only additionally collected independent predictor of rural primary care (odds ratio [OR], 4.0; 95% CI, 2.1-7.6; P<.001). Participation in the PSAP was the only independent predictive factor of retention for all classes (OR, 4.7; 95% CI, 2.0-11.2; P<.001). Among PSAP graduates, taking a senior rural preceptorship was independently predictive of rural primary care (OR, 2.5; 95% CI, 1.3-4.7; P =.004). However, non-PSAP graduates with 2 key selection characteristics of PSAP students (having grown up in a rural area and freshman-year plans for family practice) were 78% as likely as PSAP graduates to be rural primary care physicians, and 75% as likely to remain, suggesting that the admissions component of the PSAP is the most important reason for its success. In fact, few graduates without either of these factors were rural primary care physicians (1.8%). CONCLUSIONS: Medical educators and policy makers can have the greatest impact on the supply and retention of rural primary care physicians by developing programs to increase the number of medical school matriculants with background and career plans that make them most likely to pursue these career goals. Curricular experiences and other factors can further increase these outcomes, especially by supporting those already likely to become rural primary care physicians.

Family Practice↗

Patients' rights advocacy: implications for program design and implementation.

Individuals held in mental health care facilities often have been deprived of their basic civil and legal rights. In Canada and the United States, legislation now exists to ensure the protection of these rights, and advocacy programs have been developed to apply and enforce this legislation. It is important for mental health professionals to be aware of the relevance and need for advocacy programs. Equally important is the appreciation of the structural issues involved in developing and administering advocacy programs. In examining a number of patients' rights advocacy programs, strengths, weaknesses, and general success factors are identified. Recommendations are then made for the development, implementation, and modification of advocacy programs. A review of this area indicates a need for empirical research in a number of areas, and directions for future research are discussed.

Canada↗

Evaluation of a program designed to help family and significant others to motivate resistant alcoholics into recovery.

Little empirical work has been done in the alcohol field on the issue of motivating reticent people into treatment. This study explored the impact of a program that involved counseling an alcoholic's social network to eventually confront the alcoholic in urging him or her to seek treatment. Twenty-four social networks (relatives plus significant others) participated in this study and of these, seven formally confronted the alcoholic. Social networks were not randomized to confronting vs nonconfronting conditions, although the comparison groups were equivalent on several important dimensions. Results indicate that alcoholics who were confronted were significantly more likely to enter an alcohol detox or rehabilitation program and to remain continuously abstinent than were nonconfronted alcoholics. This study suggests that the alcoholic's social network can be helped to become highly influential in motivating the alcoholic to seek treatment.

Adult↗

Disease management: program design, development, and implementation.

Disease management is an emerging approach to patient management, customer satisfaction, and cost containment that comprises disease modeling; patient segmentation and risk assessment; clinical protocols; and wellness, self-management, and education. Implementing a disease management program poses significant challenges to healthcare organizations. To successfully implement a disease management program, a tightly integrated continuum of care, sophisticated information systems, and disease management support systems must be in place. Strategic partnerships with outside vendors may speed program implementation and provide opportunities to develop risk-sharing relationships.

Costs and Cost Analysis↗

Designing effective programs.

Important in the development of research-based practice models is the impact on them of program design. In this article, the concept of program design is reduced to elements that can be examined for their reliability, validity, relevance, and internal consistency. Defining these elements contributes to understanding what types of interventions have what effects on what types of clients with what types of problems.

Child↗

A computer program designed for the analysis of data from rat caries studies.

The Keyes method for scoring dental caries in the rat animal model has been used as the basis for a computer-assisted scoring system on the Apple Macintosh personal computer that is described here. The program provides the ability to draw on diagrams of the rat molar dentition and to enter enamel lesion scores (L, E) and dentinal lesion scores (Ds, Dm, and Dx) for all aspects of the molars. The scores and drawings may be changed at any time. Total carious teeth and totals of L, E, Ds, Dm, and Dx are automatically calculated and presented upon user command. Error trapping for typographical errors is provided. In addition, the program provides automatic storage of the collected information, searching and sorting on any of the experimental parameters and on-disk help files that can be accessed from any place within the program. The capacity to obtain printed copy of any or all of the stored information is provided in the program. The program also enables the creation of external data files containing totals for carious teeth, in addition to L, E, Ds, Dm, and Dx totals for each animal of each group represented in the data base. These files are suitable for the transfer of data to commercially available programs for graphical and statistical analyses. The programming technique we describe could be extended to other model systems with standardized scoring for oral disease.

Animals↗

A syntax program designed to present base linguistic structures to language-disordered children.

An intervention strategy for teaching syntax to language-disordered children is described, and the results of its use in a controlled study with 11 children are reported. The therapy program attempts to move the child from single words through a series of successive approximations to use of the construct noun + "is" + verbing + noun, incorporating auditory directions and visual stimuli in the form of cards and boards upon which the cards are sequentially ordered. The results of the experimental group who participated in this therapeutic sequence were compared to those of 11 control subjects and suggested significant gains as measured by the pre- to postprogram performance (t = 2.31, p 0.05). Advantages and limitations of this type of intervention strategy are also discussed.

Audiovisual Aids↗

Effective program designed for long-term surveillance following colonoscopic polypectomy of adenomas.

Eighty-six patients who had adenoma and underwent colonoscopic polypectomy were examined by colonoscopy over a long period (mean follow-up time: 5 years) to establish an effective long-term surveillance program. The incidence of neogenetic lesions in patients with a large monoadenoma (diameter 0.5 cm; LA 69.7%) and polyadenoma (PA 74.2%) was higher than in those with a small monoadenoma (diameter <0.5 cm; SA 27.3%). We found 4 and 2 carcinomas in patients with LA and PA, respectively. The high incidence of neogenetic lesions in patients with LA (40.7%) and PA (50.0%) did not decrease with the passage of time. Long-term surveillance with total colonoscopy should be performed every two years in patients with large monoadenoma or polyadenoma for effective detection of neogenetic lesions.

Adenoma↗

Stress management: a program designed to facilitate coping.

1. Continual exposure to work-related stressors compounds nurses' workloads, increases their stress levels, and places increased demands on their abilities to adapt. 2. Nurses need to learn and routinely use coping measures to prevent exhaustion and burnout. 3. An in-house stress management program can help nurses learn to cope with constant exposure to work-related stressors, halt the cyclic process of stress, prevent burnout, and decrease turnover.

Adaptation, Psychological↗

A study of a structured exercise program with members of an ICCD Certified Clubhouse: program design, benefits, and implications for feasibility.

Individuals with serious mental illness (SMI) have significantly greater risk of comorbid health problems and premature death, and there is need for interventions that can improve physical fitness and overall health. Accordingly, a study was conducted which evaluated the effectiveness of a structured physical exercise program that was developed as part of a wellness project in an ICCD Certified Clubhouse. Seventeen clubhouse members completed a 16-week program with evidence of significant improvement in aerobic capacity and perceived mental health as well as positive trends in perceived improvements in physical and social functioning. Qualitative data indicated satisfaction with the program by all participants, especially the value of group support, while also highlighting the need for greater attention to nutrition as part of a future program. Moreover, the study found that a structured exercise program can be successfully provided to members of an ICCD Certified Clubhouse.

Adult↗