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PubMed1988

Evaluation system assesses rehabilitation.

The program evaluation system has evolved into a valuable tool for improved management of patient programing and accountability, providing objective assessment of patient functions. Each program states primary objectives, measurements, and expectancies to determine how well it has met the objectives. The objectives deal with areas that reflect the patient's overall function, which ultimately determines what level of care the patient will need after discharge. The functional assessment scale (FAS), an ordinal rating scale of values ranging from total dependence to total independence, is used to measure the objectives within the parameters and to assess the severity of the disability, progress, and outcome. Concurrent evaluations enable physicians, therapists, and administrators to identify where problems occur in the individual's program and to change treatment accordingly. The FAS generates quarterly management reports that demonstrate achievement of the objectives, using the measurements and goal expectancy, and facilitate pattern analysis. The system easily integrates with the facility's current operations, including quality assurance.

Activities of Daily Living↗
PubMed2005

Evaluating the program of a smoking cessation support group for adult smokers: a longitudinal pilot study.

Tobacco use is the leading cause of preventable death in Taiwan. In order to increase cessation rates among adult smokers, the Department of Health in Taiwan has begun providing financial support for nicotine replacement therapy (NRT). However, therapies based on multiple interventions can lead to significantly higher cessation rates than NRT alone. This study develops and evaluates the outcomes of a smoking cessation program that provides a combination of physiological and psychological treatment in the context of a short-term support group. In this study, ten adult smokers were recruited by means of advertisements broadcast on local television over a seven-day period and one thousand flyers that advertised free assistance with quitting smoking. The smoking cessation support group was carried in Tainan County, in southern Taiwan. The three-month program consisted of three, monthly group sessions, free nicotine patches, telephone counseling by public health nurses, and telephone interviews by community health volunteers. Those participating in the group were encouraged to keep a record of all smoking behavior and its "triggers" in a diary, list the personal benefits of quitting, draw up a quitting contract, and enlist significant family members to monitor their quitting behavior. Participants were also trained in behavioral strategies to avoid smoking, including imagery rehearsal, relaxation techniques, exercise, and distraction. The outcome of the project was assessed by the following two criteria: (1) carbon monoxide (CO) level in the breath before and after the three-month program, as measured by percentage of carboxyhemoglobin (%COHB), and (2) the self-reported number of cigarettes smoked per month, taken at the outset of the three-month program, at the conclusion of the program, and six months after the termination of the program. The Wilcoxon signed-rank and Friedman tests respectively revealed that there were significant decreases both in the subjects' %COHB level at the 3-month data-point, and in the number of cigarettes smoked at one month from the pretest, at the 3-month test and at the 9-month follow-up test. At the 9-month follow-up, five of the ten participants (50%) were abstinent, and three (30%) had decreased cigarette consumption by at least 49% of their pretest levels. Eighty percent of participants had, therefore, changed their smoking behavior. These results demonstrate the promise of integrated smoking cessation therapy in a group support context and indicate the need to pursue implementation and evaluation of this type of therapy on a larger scale.

Administration, Cutaneous↗
PubMed1979

A quality control program to evaluate accuracy and precision of clinical chemistry determinations.

An external quality control program is described which, apart from documenting the routine performance of clinical chemistry laboratories with respect to accuracy and precision, also indicates the control efficiency of intra-laboratory quality control procedures. Participants are supplied with a large lot of stable control serum to be used in their intra-laboratory quality control program during a prolonged period of time. The statistical analysis of the submitted data consists of an analysis of variance scheme in order to separate systematic from random errors. The systematic laboratory errors are thereafter graded according to a scoring system independent of the standard deviation. The control efficiency of intra-laboratory quality control procedures is derived from a modified version of the measurability and controllability rules of Van der Grinten (1968) Stat. Neerl. 22, 43--63). Application of these rules in clinical chemistry laboratories is a first step towards a dynamic system of process deviation control. Merits of such an approach are discussed. Principles of the analysis of variance technique are dealt with. A graphical procedure to display its results is shown. Testing procedures to justify application of the analysis of variance technique are discussed and several features are illustrated.

Analysis of Variance↗
PubMed2000

[Evaluation of health programs, services and technologies].

The field of program, services and technology evaluation in general, and in health care in particular, is going through an important growth and conceptual and methodological diversification. It is also the object of an increasing demand for its participation as an effective supportive instrument in the decision-making process, and a constant need in the dynamics of health systems and services. In this paper, based on literature review, nuclear criteria involved in the organization of all evaluation processes are identified, and articulated with the existing institutionalized evaluation practices in developed countries, that is, program evaluation, quality assessment and management and technology assessment. In conclusion, the incipient development of a methodological evaluation output in Brazil is analyzed.

Health Services↗
PubMed1989

[Evaluation of a program: cost/benefit analysis].

The authors evaluate a program of peripheral obtention of analytical samples during a 37-month period in the Granada province, which it has been able to extend to 40.44% of the population. An analysis of the cost/benefit ratio and the efficacy in the implantation of the program (77.78%) during that period was carried out. The results were compared with those achieved with this program in other Spanish provinces. Finally, an indicator was proposed (expected mean number of users per 1000 inhabitants and month) which might permit to know in advance the effectiveness of the implantation of the Program in a given area.

Cost-Benefit Analysis↗
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↗
PubMed1998

The socio-cultural impact of the family health program: an evaluation proposal

This paper develops a critical analysis of the implications of defining the family as an object of intervention in health, taking as reference case the Family Health Program and proposing an evaluation of its socio-cultural impact. As a strategic space for manifestation, confrontation, and therefore observation of the health-illness process, the family requires a multidisciplinary approach to its structure, dynamics, and behavior in the face of health-related problems, determinants, and actions. We present a proposal for assessment of the Family Health Program based on the premise that problems and practices in the health field are socio-culturally determined.

Journal Article↗
PubMed1989

Oregon Head and Spinal Cord Injury Prevention Program and evaluation.

Head and spinal cord injuries are the leading causes of death and disability in the age group from 15 to 24. The Oregon Head and Spinal Cord Injury Prevention Program study sought to determine whether an educational assembly program would affect students' knowledge, attitude, and behavior. An observation study on shoulder belt use showed no increase in usage following the program. Seven Portland high schools (4 experimental, 3 control) participated in a questionnaire evaluation. Two weeks before and after the educational assemblies, 1,331 student surveys were distributed nonrandomly in classrooms. Presurveys were matched to postsurveys by student name, resulting in 626 matches. Survey items are grouped into three categories: knowledge, attitude, and behavior. The experimental schools demonstrated a statistically significant increase in knowledge (two-tailed t test, p less than 0.01), suggesting that knowledge had been imparted. No change was found in attitude or behavior. To produce changes in attitude and behavior a reinforcement program might be necessary. Evaluation of the impact of the program on incidence may be premature.

Accidents, Traffic↗
PubMed1998

Personal privacy versus public accountability: a technological solution to an ethical dilemma.

The tension between personal privacy and public accountability produces one of the major ethical dilemmas facing behavioral health program evaluators and service system researchers. This article discusses the source of this tension and introduces a research methodology that allows program evaluators to fully and equally respect both ethical principles. This methodology uses contemporary computer and statistical technology in conjunction with aggregated, de-identified information derived from existing databases to provide valid and reliable measures of the performance of treatment programs while it protects the personal privacy of individuals.

Codes of Ethics↗
PubMed2001

An interdisciplinary course in the basic sciences for senior medical and PhD students.

Integrating clinical and basic sciences throughout the medical school curriculum has become a major objective of various innovations in medical education. While early clinical exposure has evolved as an efficient means of introducing clinical studies in the preclinical years, interdisciplinary integration of basic sciences during the clinical years remains a challenge. The authors describe their three years of experience with an interdisciplinary course designed to demonstrate the continuum of medical information from the clinic to the basic sciences. In this course, sixth-year medical students are required to choose one of three to four different one-week programs, each of which requires them to conduct an in-depth investigation of a defined clinical topic. Program coordinators are encouraged to work in clinician-basic scientist teams and to use a variety of teaching methods, with an emphasis on tutored individual and group learning based on critical readings of original papers. Coordinators are also encouraged to enable graduate research students to participate. From 1998 to 2000, students participated in nine programs, seven of which were coordinated by interdisciplinary teams. Several clinical and basic science disciplines were represented in each program, and various teaching methods were used. Graduate students participated in two of the programs. Evaluation of the programs (a debriefing discussion as well as short written evaluations) indicated moderate to good achievement of the course objectives.

Curriculum↗
PubMed2000

Assessing program fidelity in substance abuse health services research.

This paper addresses how treatment fidelity and related constructs (e.g. program implementation) can be assessed in alcohol, drug abuse and mental health services research. First, it introduces definitions of fidelity and related concepts, and then describes various concepts and tools from program evaluation that have proven useful for assessing fidelity. Next, several of these are illustrated in detail through a case study of a multisite fidelity assessment in substance abuse services research: the process evaluation of the NIAAA Homeless Cooperative Agreement Program. This evaluation included analysis of implementation at the program- and participant-level, the development of scales from the individual services data to estimate intervention strength, fidelity, and "leakage" (i.e. the degree to which services intended exclusively for intervention groups were inadvertently delivered to comparison groups) and the methods with which these data were used to assess whether programs were implemented as planned.

Health Services Research↗
PubMed1989

Time preference for health in cost-effectiveness analysis.

In program evaluation, should a predicted health status gain of 1 quality-adjusted life year (QALY) occurring 10 years from now be valued the same as a 1-QALY increase realizable 5 years from now? Or 1 year from now? If not, how should these future gains (or losses) be evaluated from a present-time perspective? Such questions arise frequently in cost-effectiveness analyses of disease prevention-health promotion programs. This report argues there are actually two distinct interpretations of time preference jointly relevant in many multiperiod program evaluations. 1) In ongoing programs where both present and future population cohorts are, in effect, vying for resources, decision makers must establish a relative social weighting of cohorts by specifying (now) the dollar worth of any unit QALY gain achievable in each. This is a problem of intergenerational equity in the resource allocation process. 2) Individuals, in any cohort, may possess a time preference for the sequence of events comprising their own multiperiod health outcomes. Current models, typically discounting future health gains to present value at some constant rate (r), can well accommodate the first interpretation but not (simultaneously) the second. In response, this report introduces a two-step evaluation procedure featuring the "scenario strategy," a holistic multiattribute preference approach to evaluating multiperiod health outcomes. It allows one to isolate statistically time preference effects at the individual or group level and to incorporate them naturally into the overall evaluation of multiperiod outcomes. A survey-based example and an appendix illustrate the main points.

Attitude to Health↗
PubMedDate not supplied

Using a population-based cancer reporting system to evaluate a breast cancer detection and awareness program.

During May 1987, a total of 10,207 Wisconsin women were screened as part of a statewide Breast Cancer Detection and Awareness program sponsored by the Wisconsin Division of the American Cancer Society. Data from a population-based cancer reporting system were used to predict the number of expected breast cancer cases for that year. After controlling for secular and seasonal trends, we found that, compared with the number of cases that would have been expected, 51 more cases of localized breast cancer were diagnosed in the state during the time of the program. This study demonstrates the public health impact of a statewide screening program and the usefulness of a cancer reporting system in program evaluation.

Adult↗
PubMed1994

The homeless visit: enhancing residents' understanding of patients who are homeless.

BACKGROUND: With their interest in providing continuous, comprehensive care, family physicians are well-suited to treat persons who are homeless. Yet family practice residents most frequently encounter homeless patients in crowded public hospitals where time constraints and competing philosophies of patient care create suboptimal conditions and encourage the development of cynical attitudes and behavior patterns. EDUCATIONAL INTERVENTION: To address these problems, the Department of Family Medicine at Baylor College of Medicine in Houston developed a homeless visit program in which second-year residents spent one half day at a day center for the homeless. Residents interview the center's homeless clients, address their medical and psychosocial problems, and review each client's case with a faculty physician. Residents have the opportunity to explore the underlying causes of homelessness, the impact of homelessness on clients' health and well-being, and the bureaucratic barriers that homeless individuals must overcome to regain entry into the health care system. PROGRAM EVALUATION: After the first year, the program was evaluated to assess whether its original objectives had been met. Each of the second-year residents reported that the experience had been worthwhile. They recommended that the program expand the number of half days spent with homeless patients and the ancillary personnel, equipment, and supplies available. Each of these changes has been implemented and the program continues to thrive and improve. CONCLUSION: The homeless visit serves as a successful model for resident programs willing to devote as little as a half day in a 3-year curriculum toward training residents to better understand the intricate relationship between homelessness, physical and emotional needs, and an environment that simultaneously promotes illness and hinders medical attention.

Curriculum↗