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PubMedDate not supplied

A model of computer documentation of hospital specialty rotations.

The importance of a comprehensive documentation system for assisting residents in securing hospital privileges has been widely asserted. Other applications of a documentation system such as encouraging research, providing individual resident evaluations, and providing program evaluation are also worthy reasons for developing a system. This paper describes a computerized system for documenting the inpatient rotation experiences of family practice residents and discusses its potential applications. An example of curriculum evaluation as a use of a documentation system is detailed.

Computer Systems↗
PubMedDate not supplied

The role of epidemiology in prevention of hypertension in Israel.

High blood pressure may be the most important modifiable determinant of severe morbidity and mortality in the adult population in Israel. Because hypertension control can effect a reduction in this morbidity and mortality, programs of secondary--and subsequently primary--prevention can have a far-reaching impact on the state of health in the nation. The primary care delivery system in Israel is structurally well suited to centrally directed initiatives. Major hypertension control programs are being introduced in Israel. The General Federation of Labour Sick Fund (Kupat Holim)--the nation's chief provider of primary care--has recently undertaken a wide-scale initiative for detection and treatment of high blood pressure in its neighborhood primary care clinics. A policy decision has thus been made on a national level; resources for intervention have been made available and activities initiated. The issue in need of resolution, the authors believe, is that of the integration of rigorous epidemiologic methodology into the planning and execution of the programs, particularly in program evaluation and resultant program modification. The authors outline selected epidemiologic characteristics of hypertension in Israel, emphasizing the major role that elevated blood pressure plays as a determinant of mortality; the present status of hypertension control; current programs for control; and the role of epidemiology in preventive programs.

Adult↗
PubMed1981

A new approach for quality assurance.

The 57th Aeromedical Evacuation Squadron developed a combined retrospective evaluation program to identify, evaluate, intervene, and report on deviations from aeromedical evacuation procedures which result in mission delays or less-than-optimal patient care. The primary aircraft for aeromedical evacuation within the United States and nearby stations is the C-9A. The 57th AES operates about six routine missions daily, each making seven to eight enroute stops and airlifting approximately 300 patients and attendants.

Aviation↗
PubMed1993

Implications of the Adult Day Health Care Evaluation Study for program revision and research.

With no additional effort to revise adult day health care (ADHC) services or the types of patients who receive them, it would appear that adding an ADHC program to a VA Medical Center would not achieve the desired objectives. The authors discuss here the advantages, disadvantages, and feasibility of 2 options for program revision. The first is to target ADHC to those types of patients who may be most likely to benefit. A targeting scheme should use the most objective criteria possible and may need to be implemented as part of a case-managed package of community-based services. The second option for program revision is to reduce the costs of ADHC services. A cost model developed as a part of the study demonstrated the effect of possible revisions, including increasing enrollment, reducing staffing costs, decreasing length of stay in ADHC, and increasing substitution of ADHC for other services. These changes differ in the level of administrative support and clinician behavior change needed for their implementation. This report then concludes with a discussion of the implications of the results for implementation of VA-ADHC versus contract ADHC, and a discussion of possible directions for future research.

Adult↗
PubMed1996

Concurrent utilization review and inappropriate hospital stay: evaluation of a program.

Using a crossover design, we tested the hypothesis that concurrent utilization review by a utilization officer would reduce length of stay and inappropriate bed days in a tertiary care hospital. The intervention groups included 396 consecutive patients admitted to specified services during two 1-month study periods and followed for at least 1 month or until discharge. Controls were 410 patients admitted to the same services during a preceding or subsequent month, separated by a 1-month washout period. Intervention cases had daily review of their care plan and medical condition by the utilization officer to identify existing or likely inappropriate hospital stay. The officer used interdisciplinary and interdepartmental consultation in attempting to resolve identified problems. A separate research nurse identified the controls and gathered data on the medical condition and care plan for a random 50% sample of both intervention and control cases. These data were used by a multidisciplinary panel to count and classify the reasons for inappropriate hospital days. Overall, there were no significant differences between the corresponding intervention and control groups for length of stay or proportion of inappropriate days. There was evidence of a time-related reduction in both length of stay and inappropriate days only in the subgroup of patients with a length of stay of < 15 d. As further evidence of this period effect unrelated to the intervention, length of stay had been declining for 1 of the groups of services before this study began. We concluded that concurrent utilization review, as practiced in this study, was ineffective in the short term. However, utilization review and modification of hospital processes can reduce inefficiency, as evidenced by the time-related reduction in inefficiency illustrated in our study.

Admitting Department, Hospital↗
PubMed1997

[Promotion Program Health Survey (SGO). IX. Evaluation of the program section 'Toxicology'].

As a part of the SGO Health Research Promotion Programme, in collaboration with the Toxicological Research Stimulation Programme, a research programme in the field of toxicology was realized. The study ran from 1990 to 1994 (4 years) and comprised animal and clinical research into the possible adverse effects of exposure of the foetus and the neonate to polychlorobiphenyls (PCBs), polychlorodibenzoparadioxins and polychlorodibenzofurans via the placenta and maternal milk. The clinical studies in neonates revealed a slight alteration of the thyroid metabolism (still within normal limits) after increased exposure to dioxides and PCB (as measured in maternal plasma, cord plasma and maternal milk), while slight neurological abnormalities without clinical relevance were also observed. It is concluded from these study results that there are no grounds to advise against breast feeding.

Animals↗
PubMed1994

A nurse-managed inpatient program for patients with chronic mental disorders.

The deinstitutionalization movement has left a legacy of need for appropriate care for inpatients with chronic refractory mental illness. This article describes a nurse managed program for such patients based on the principles of a therapeutic milieu. The program was formally defined for a 6-month period with an effort to include outcome measures for program evaluation. Multidisciplinary treatment team planning with a psychiatric nursing clinical specialist as team leader provided a format for putting therapeutic concepts into practice. The nurse clinical specialist and two nurse practitioners served as case managers as well as primary care providers. Program evaluation showed that cost-effective quality care could be achieved with a reduction in polypharmacy and overall neuroleptic usage. The notion of a restraint appropriate environment, with the goal of minimizing restraint use, was introduced and put into practice.

Adult↗
PubMed1990

Improving a hospital pharmacy externship program.

The revision and implementation of a pharmacy student externship program at a cancer treatment and research facility are described. The Department of Pharmacy Academic Programs evaluated the student externship program of the Division of Pharmacy at The University of Texas M. D. Anderson Cancer Center and identified a variety of weaknesses. These included scheduling conflicts, insufficient supervision and feedback, excessive task orientation, lack of defined roles and responsibilities of program participants, and generally poor organization. As a result, the program was revised by establishing specific goals, defining program participants and their roles, setting specific responsibilities for externs and encouraging self-initiated learning, developing standardized evaluation forms and documentation requirements, and educating the pharmacy staff about the program. Since the revised program was implemented in June 1988, 21 students have completed externship rotations. Their evaluations of the program suggest greater satisfaction with this important educational experience than was realized before the revision was undertaken. A more organized approach to the externship program gave pharmacy students a better opportunity to experience the range of professional activities and challenges that occur in the institutional practice setting.

Cancer Care Facilities↗
PubMedDate not supplied

Heart at work: the evolution and evaluation of a low-cost worksite health promotion program.

Worksite health promotion programs developed and promoted by community groups are one of the many program options that corporate decision makers may choose to enhance the health and well-being of their employers. This article describes the development of the American Heart Association's health promotion program, "Heart At Work." The findings from extended field studies and other program evaluation activities are summarized. Implications of evaluation studies to the "Heart At Work" program and health promotion programs in general are discussed.

American Heart Association↗
PubMed1985

A BASIC computer program for evaluating the effect of sample distribution on the least-squares regression slope estimate.

Least-squares regression analysis is widely used in analytical method comparison studies even though model assumptions are typically violated. The advantages favoring the use of the least-squares technique, when applicable, are that its theoretical characteristics are thoroughly developed and the calculations are straightforward and universally known. In order to aid an investigator in determining whether or not the least-squares technique can be acceptably applied in a given method comparison situation, a BASIC computer program is developed that evaluates the bias of the least-squares slope estimate as a function of the precision characteristics of the analytical methods and the proposed sampling distribution for the method comparison experiment.

Clinical Laboratory Techniques↗
PubMed1986

Evaluation in a down-loaded mental health system.

Speculation that policy and funding shifts in the nation's mental health system would negatively impact program evaluation services in community mental health centers (CMHC) is substantiated. Performance of program evaluation activities was investigated in 71 CMHCs in 15 states over a two-year period. Twenty-five percent of the centers reported cutbacks, including staff attrition and diminished funding devoted to evaluation functions. The majority of centers reported no changes, but many directors representing these centers also indicated that they had never fully developed a capacity for performing evaluations and would cease to devote attention to these activities without available funding. In some centers evaluation functions are being transferred to clinical administrators; integrated into quality assurance activities; performed "as needed' by external consultants; or ignored altogether. Many centers are developing or enhancing a computerized information system to improve internal efficiency and to meet state accountability requirements. The professional issues raised to these trends as well as their implications for federal and state policy are discussed.

Community Mental Health Centers↗