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Planning and program development for psychiatric home care.

The psychiatric home care program of the Visiting Nurse Association and Hospice of Northern California (VNAHNC) was developed in March of 1984. The largest such program in the Bay area, the program generated a revenue of more than $1 million, made 9,756 visits, and served more than 500 patients in 1992. When discussing the program at two national conferences, members of the home care community asked many questions about the feasibility of starting up their own psychiatric home care programs. This article addresses the most frequently asked questions.

Aged↗

Vision, leadership and partnership: how to enhance the nursing and midwifery contribution to research and development.

AIM: This paper reports an evaluation of nursing and midwifery research and development activity in Northern Ireland. BACKGROUND: Research and development is integral to the quality of patient care. Nurses and midwives have an important contribution to make and, whilst the professional landscape has changed significantly, with improved funding and productivity, there remains much room for improvement. To advance this agenda it is necessary to evaluate progress across the spectrum of research and development activity. The policy literature gives examples of the methods by which this can be achieved, but there is less evidence about evaluation criteria, or the methods by which research and development progress is assessed at organizational, national and international levels. METHOD: A comprehensive analysis of the literature was undertaken to develop a 'Research and Development Best Practice Framework'. This was then used as the basis for structured interviews with 32 organizational leads for three main stakeholder groups: health and care providers (n = 20), education providers (n = 7) and funders of research and development (n = 5). Data collection was from March to November 2004. FINDINGS: Despite general recognition of its value, only a minority of organizations had an up-to-date corporate strategy that included nursing and midwifery research and development. There was considerable variability in the systems, support structures, capacity and productivity of nurses and midwives throughout these organizations. In most, no-one had sole responsibility for leading the professional research and development agenda but, where such leadership was in place, improved outcomes were apparent. Building effective partnerships for research and development and forward planning through developing an organizational strategy were also key indicators of success. CONCLUSION: Our findings confirm progress, but also reinforce the need to develop a clear vision, enhance leadership potential and forge effective partnerships to advance the research and development agenda in nursing and midwifery.

Attitude of Health Personnel↗

Guidelines for developing multidisciplinary treatment plans.

The formulation of a multidisciplinary treatment plan is important not only because it is required by federal and accreditation agencies but because it increases communication, consistency, and direction among members of the treatment team. Input from all disciplines is most effectively obtained through the multidisciplinary treatment planning conference. The author provides guidelines for formulating a plan in each of four major steps: assessment, problem identification, planning (including priorities, long- and short-term goals, and interventions), and evaluation.

Goals↗

Effect of early referral to an endocrinologist on efficiency and cost of evaluation and development of treatment plan in patients with thyroid nodules.

Radionuclide uptake and scan and sonogram, frequently ordered before referral to an endocrinologist, are expensive and poor predictors of thyroid nodule malignancy. We estimated costs of excessive imaging and other studies by reviewing the records of all patients (n = 70) referred to a single, consulting endocrinologist, for thyroid nodule evaluation in a 2-yr interval and subsequently, presenting only pertinent histories and results of physical examinations, thyroid function tests, and thyroid autoantibodies, to a second, reviewing endocrinologist (RE) who was blinded to diagnosis and management. Concordance in diagnosis and management between consulting endocrinologist and RE was 87.1% and 93.4%, respectively. Accuracy of diagnosis, loss of patient's time (8.7 h, average), and cost of unnecessary testing, defined as tests not required by the RE for diagnosis and management according to published guidelines, were determined. Unnecessary testing included 153 physician's office or diagnostic laboratory visits, 44 sets of thyroid function tests, 32 radionuclide uptake and scan, 39 thyroid sonograms, and 3 computed tomography scans. The total direct cost of unnecessary tests was estimated at $27,290 ($390/patient) in addition to costs of 30 unnecessary physician's office visits. Only 2 of 8 surgical referrals required surgery, whereas 6 other patients required surgery, including 3 with papillary carcinoma. We conclude that early referral to an endocrinologist of patients with suspected thyroid nodules results in significant savings in cost of evaluation, patient's time, and increased diagnostic precision. Six of the 8 patients referred for surgery before endocrine consultation had benign thyroid disease that did not require surgery. Six additional patients were referred to surgery, 3 of whom had papillary thyroid carcinoma. Early referral of patients with suspected thyroid nodules to an endocrinologist results in significant savings in both cost and patient's time as well as increased precision of diagnosis.

Adolescent↗

Developmental marketing strategies for community mental health.

This article contains a marketing plan that was specifically designed for The Greater Lawrence Mental Health Center in Lawrence, Massachusetts. It is a full service, non-profit mental health facility that employs 85 allied health professionals and serves Lawrence and its neighboring communities. The plan was developed by a marketing consultant, in conjunction with the agency's Executive and Administrative Directors. This article illustrates a format for developing a marketing plan, and includes specific approaches that must be considered. The concepts are generic, and can be applied to similar endeavors undertaken by a comparable agency.

Community Mental Health Centers↗

The value of engaging stakeholders in planning and implementing evaluations.

Stakeholder participation in evaluation has surfaced as a major factor contributing to the effectiveness of HIV prevention programs. In recognition of the multiple benefits, the Centers for Disease Control and Prevention (CDC), has used a framework to involve stakeholders in the evaluation of its programs. This article describes the framework used by the CDC and provides examples of four studies that involved various stakeholders from health departments, community-based organizations, and community planning groups to national and regional organizations in designing and implementing evaluations that yielded results useful for program improvement. The participatory process involved stakeholders in each of the four phases of the framework: evaluation planning, implementation, development of action plans, and dissemination. Lessons learned include the importance of having a facilitator to coordinate activities and ongoing communication with those involved in the evaluation. Stakeholders shared that using the evaluation results for action planning was beneficial for improving their programs. Despite many challenges faced in the stakeholder evaluation process, most stakeholders agreed that many benefits grew out of the multiple perspectives presented and understanding of the service agencies.

Centers for Disease Control and Prevention, U.S.↗