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PURPOSE: This article is the fifth in a series of critical reviews of the clinical effectiveness and cost-effectiveness studies of comprehensive, multifactorial health promotion and disease management programs conducted in worksites. As with the previous reviews, the purpose of this article is to review and assess the randomized control trials that have focused on both clinical and cost outcomes of worksite health promotion and disease management programs. For this current review, a new category of quasi-experimental studies has been added because this represents a major new trend in such interventions over the last 2 years. Comprehensive worksite programs are those that provide an ongoing, integrated program of health promotion and disease prevention that integrates specific components into a coherent, ongoing program that is consistent with corporate objectives and includes program evaluations of both clinical and cost outcomes. DATA SOURCES: A comprehensive search was conducted using a multistage process that included MEDLINE, ERIC, ADI, EDGAR, CARL, Inform, and Lexis-Nexis databases and direct inquiries to worksite researchers. INCLUSION AND EXCLUSION CRITERIA: The search identified 27 new studies to which the following inclusion criteria were applied: research conducted in the United States; results published in English; methodological quality of nonexperimental (pre- and postmeasures but no comparison group); quasi-experimental to randomized control trials; and both clinical and cost outcomes. Exclusion criteria were studies outside of the United States; non-English publications; and clinical or cost outcomes only. Fifteen studies remained for this review. FINDINGS EXTRACTION METHODS: Findings extraction and analysis of the 15 studies was done by extracting the relevant population, intervention design, clinical results, and cost outcomes from the published article. As in previous reviews, findings are summarized in a table format that extracts and describes each study by the following: (1) study author(s); (2) corporate site; (3) purpose of the evaluation; (4) employee population; (5) percentage of program participants; (6) number of employees included in the evaluation; (7) brief description of the intervention; (8) evaluation design; (9) evaluation period; (10) outcomes; (11) research rating; and (12) findings. FINDINGS SYNTHESIS: Based on these 15 studies, a methodological critique was conducted with brief reference to appropriate prior studies. Conclusions regarding study quality and new trends over the time period of 1998 to 2000 are discussed. MAJOR CONCLUSIONS: Results from randomized clinical trials and quasi-experimental designs suggest that providing individualized risk reduction for high risk employees within the context of comprehensive programming is the critical element of worksite interventions. Despite the many limitations of the current methodologies of the 15 new studies, the vast majority of the research to date indicates positive clinical and cost outcomes.
Since 1989, the public health education section of the University of São Paulo (USP), Brazil, has been using the focus group technique to identify educational problems and evaluate programs being developed. The focus group is a research technique that allows qualitative data to be collected through group sessions involving 6 to 15 persons with some shared trait (for example, sex, age, occupation, role in the community). The group discusses various aspects of a specified subject. This paper describes five research projects in which this technique was used. The projects were carried out by professors in the School of Public Health/USP in the state of São Paulo between 1989 and 1992 with population groups and in health institutions. These experiences showed that the technique is efficient, permitting rapid identification and in-depth analysis of problems from the point of view of the population. Among the drawbacks to the technique is that it uses a small and nonrandom sample, which means that in certain cases focus groups should be considered a complement to quantitative studies. The data described here provide knowledge of perceptions, ideas, opinions, expectations, and social images-in short, the cultural and verbal universe of the population. With this information, educators and administrators can plan and evaluate education programs on the basis of the needs and views of the people they serve, putting into practice the plan to make education more democratic and responsive to the needs of its public.
The Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) requires that accredited programs evaluate trainees' clinical skills at various times during trainees' programs. The Commission does not attempt, however, to describe for programs either the nature of the skills nor how they are to be evaluated, leaving this to the programs to create. This paper describes the development and uses of the Basic Skills Evaluation Device (BSED). Using a published list of skills (Figley & Nelson, 1989), data from the literature, and data collected from COAMFTE accredited and candidacy programs, the authors and their colleagues developed a device for supervisors to use in evaluating beginning family therapists. Data regarding the reliability of the device are presented, along with limitations and suggestions for various ways of using the device.
In trying to make a comprehensive caries risk profile for an individual, one faces a situation that several factors need to be considered and weighted together. Summarising these factors could be a complex process and to facilitate the practical application, a computer-based risk assessment model for caries, the Cariogram, was developed. The Cariogram program operates basically in such a way that information on a number of factors are collected about the patient, transferred to 'scores' and these scores then entered into the program. According to its built-in algorithm, the program evaluates the data and presents the summarised result expressed as one figure, a pie-diagram, illustrating the 'Chance of avoiding cavities' in the future. This thesis deals with the evaluation of the Cariogram model and, as a first step, it was important to investigate if the program was in line with how colleagues, dental students and dental hygienists would evaluate a set of cases. The first two studies (Paper I and II) confirmed that the 'opinion' on the risk profile of the risk assessment program was in line with the opinions of the majority of the responders in these groups. In the third study (Paper III), the Cariogram's assessments were tested against the "reality" for the first time. The model was used to assess risk for caries among children and to evaluate the program by comparing the caries risk assessments of the risk model with the actual caries increment of the children over a two-year period. The hypothesis was that the Cariogram should be able to sort the children into caries risk groups according to the actual caries increment and the results confirmed the theory. It was also demonstrated that the Cariogram assessed caries increment more accurately than any included single factor model. Following the evaluation of the program on the children, the aim of the fourth study (Paper IV) was to evaluate the model for risk assessment in a group of elderly individuals. Comparing the caries risk assessment of the program with the actual caries increment over a five-year period showed that the program was able to arrange this group of elderly individuals into risk groups that reflected the actual caries incidence. The aim of the fifth study was to compare the risk profiles of the children with the risk profiles of the elderly. The evaluation of caries risk among the children showed that 3% was considered having very high caries risk, while 50% appeared in the low risk group. The corresponding values for the group of elderly individuals were 26% and 2%. Overall, the risk for caries, as assessed by the Cariogram, was twice as high for the elderly as for the children (V). The present thesis also tries to explore the concept of risk, the terminology and definitions related to risk, risk management and risk assessment in dentistry.
This article describes Project Eagle, a model for short-term psycho-educational therapy with gifted and talented American Indian adolescents and their parents. Descriptions of Project Eagle s program organization as well as its culturally relevant techniques and activities are provided. The program evaluation includes: participant ratings of the activities, cultural relevance, feelings of being respected, interaction with parents and overall effectiveness of the program. Additional qualitative analysis provides information regarding the program s impact upon participants.
Converging factors contribute to elevated tuberculosis (TB) incidence and complicate case management in the U.S. states bordering Mexico. These factors include a) Mexico's higher TB rate; b) low socioeconomic status and limited access to health care in the border area; c) frequent border crossings and travel in the United States for employment, commerce, health services, and leisure; d) language and sociocultural differences; and e) lack of coordinated care across health jurisdictions on both sides of the U.S.-Mexico border. Prevention and control efforts that address the challenges created by border-crossing populations require collaboration among local, state, and national TB control programs in both countries. In June 1999, to facilitate future discussions with Mexican counterparts, CDC convened a meeting of TB control officials from the four U.S. states bordering Mexico (i.e., California, Arizona, New Mexico, and Texas) to address TB prevention and control in the border area. Focus areas included a) surveillance needs, b) case management and therapy completion, c) performance indicators and program evaluation, and d) research needs. Meeting participants' deliberations and resulting proposals for action by CDC and state and local TB control programs are detailed in this report.
The portfolio is an effective way to document and evaluate academic and career development. The authors discuss various applications of the process of portfolio implementation via computer in a graduate school of nursing. Portfolio guidelines, format, and a program outcome grid are presented. The portfolio also provides product information that can be used by faculty members for program evaluation.
Organized screening for breast cancer in Canada began in 1988 and has been implemented in all provinces and 2 of the 3 territories. Quality initiatives are promoted through national guidelines which detail best practices in various areas, including achieving quality through a client-service approach, recruitment and capacity, retention, quality of mammography, reporting, communication of results, follow-up and diagnostic workup, and program evaluation; it also offers detailed guidelines for the pathological examination and reporting of breast specimens. The Canadian Breast Cancer Data Base is a national breast cancer screening surveillance system whose objective is to collect information from provincial-screening programs. These data are used to monitor and evaluate the performance of programs and allow comparison with national and international results. A series of standardized performance indicators and targets for the evaluation of performance and quality of organized breast cancer screening programs have been developed from the data base. Although health care is a provincial responsibility in Canada, the collective reporting and comparison of results both nationally and internationally is beneficial in evaluating and refining both screening programs and individual radiologist performance. The results of Canadian performance indicators compare favourably with those of other well-established international screening programs. There are variations in performance indicators across the provinces and territories, but these differences are not extreme.
OBJECTIVE: The Chilean quality assurance (QA) program evaluation took place in July 1999, at the request of the Chilean Ministry of Health. The main objectives of the evaluation were to identify key aspects of the 8-year-old Chilean QA program that could be considered by other countries and to make strategic recommendations. SETTING: In 1991, the Ministry of Health of Chile launched a national QA program. A national-level team initiated countrywide training of health care providers in QA skills, the development of quality committees at facility levels to direct local quality improvement activities, and training of quality monitors to provide technical support for training and quality improvement activities. DESIGN: The evaluation team, consisting of two international consultants and a regional consultant from the Costa Rican Ministry of Health, visited six regions and seven health 'servicios' (geographically defined administrative units within a region). The regions and servicios were purposefully chosen to represent different geographic areas, types of facilities, and levels of performance of QA activities. The evaluation was based on a framework developed and applied by the Quality Assurance Project (Center for Human Services, USA). Group and individual interviews with staff complemented document and record reviews. RESULTS: The evaluation team found that Chile's QA program had been successful in achieving sustainability and institutionalization. Factors contributing to this success included the enabling environment, management and leadership, technical functions, and support functions. CONCLUSION: The Chilean QA program constitutes an interesting experience for consideration by other countries. Key features include its sustainability, nationwide coverage, decentralization, and alliance of quality improvement and regulation. Training results are impressive: almost 20% of Ministry of Health personnel received training, and 19 training modules are in use. Coaches are active and technically sustaining quality assurance activities nationwide.
Outcome monitoring has become a focus of accountability for public and nonprofit human service agencies. Besides providing answers to funders' questions about the services' impact, outcome monitoring helps administrators improve program effectiveness. After a three-year development period and a one-year implementation experience, SumOne for Kids represents a technically advanced outcome-monitoring system for children's mental health and/or child welfare services. Initiated, designed, and tested by 31 children's service agencies throughout Pennsylvania, and with state bureaucrats' and policy makers' encouragement, SumOne for Kids represents an effort to create a bottom-up/top-down process for implementing a statewide outcome-monitoring system. This article describes the genesis of this outcome-monitoring system, primary design principles, use of social validation for outcome selection, resolution of methodological difficulties, and reasons for selecting functional over clinical outcomes. The article reviews lessons learned through the development experience instructive to children's service managers, program evaluators, and industry leaders interested in establishing outcome-monitoring systems.
The Implementation Study of the Fort Bragg Evaluation documented how the Demonstration was executed and whether it met the expectations of the continuum of care philosophy upon which it was based. Based on the theory-driven and component approaches to program evaluation, a case study methodology was employed. First, the theories and assumptions about the Demonstration were explicated to derive a program model. Next, the program-as-implemented was compared to the program-as-planned. Barriers responsible for diluting full-scale implementation were documented. This study provides a comprehensive description of how the Demonstration was put into place and the evidence necessary to conclude that the Demonstration was executed with high fidelity, despite barriers, to provide an excellent test of the program theory.
Many clearinghouses have been organized within the last decade to promote mutual aid and to provide referral information about self-help groups to potential members. Few of the assumptions that underpin the operation of these programs have been evaluated, however. This paper presents an evaluation of the Self-Help Information Service, a clearinghouse integrated with a generic information and referral service. The results were generally positive with respect to operator and consumer satisfaction, community responsiveness, and the system's capacity to undertake numerous service and research functions. They also pointed up several changes that might be made to improve the system's impact. It is concluded that a new practice specialty might be developed within a clearinghouse context, and that the clearinghouse concept might serve as one cornerstone of a funding policy that supports the self-help approach.
As the delivery and reimbursement methods for mental health services change rapidly, measuring treatment outcome and client satisfaction has become critical. This article describes a case example of a treatment outcome and client satisfaction assessment program at the Children's Health Council, a private nonprofit agency affiliated with Stanford University that provides comprehensive mental health services to children and families in Palo Alto, California. Approximately 300 families receive mental health treatment per year at the agency. The simple and inexpensive program presented herein can be used and modified by other mental health professionals and agencies struggling to develop satisfactory treatment outcome and client satisfaction evaluation programs.
For more than 10 years, preventive cardiology has obtained many positive results. Cardiologists can alter the prognosis of cardiovascular disease in primary and secondary prevention. In primary prevention or during the chronic phases of coronary artery disease, prevention is mainly based on drugs. However, prevention can be achieved only if patients have a good understanding of their disease, fair relationships with their physicians and a strict compliance with their treatments. Patient education is useful for the patient in order to control cardiovascular risk. In France, the PEGASE program evaluates the efficacy of an educational program in high risk patients. The final objective of this program is to spread this educational program for high risk patients to cardiologists all over the country.
BACKGROUND: Self-management support (SMS) is the area of disease management least often implemented and most challenging to integrate into usual care. This article outlines a model of SMS applicable across different chronic illnesses and health care systems, presents recommendations for assisting health care professionals and practice teams to make changes, and provides tips and lessons learned. Strategies can be applied across a wide range of conditions and settings by health educators, care managers, quality improvement specialists, researchers, program evaluators, and clinician leaders. Successful SMS programs involve changes at multiple levels: patient-clinician interactions; office environment changes; and health system, policy, and environmental supports. PATIENT-CLINICIAN INTERACTION LEVEL: Self-management by patients is not optional but inevitable because clinicians are present for only a fraction of the patient's life, and nearly all outcomes are mediated through patient behavior. Clinicians who believe they are in control or responsible for a patient's well-being are less able to adopt an approach that acknowledges the central role of the patient in his or her care. SUMMARY AND CONCLUSIONS: Self-management should be an integral part of primary care, an ongoing iterative process, and patient centered; use collaborative goal setting and decision making; and include problem solving, outreach, and systematic follow-up.
UNLABELLED: The ToolShop server offers a possibility to compare a protein tertiary structure prediction server with other popular servers before releasing it to the public. The comparison is conducted on a set of 203 proteins and the collected models are compared with over 20 other programs using various assessment procedures. The evaluation lasts circa one week. AVAILABILITY: The ToolShop server is available at http://BioInfo.PL/ToolShop/. The administrator should be contacted to couple the tested server to the evaluation suite. CONTACT: leszek@bioinfo.pl SUPPLEMENTARY INFORMATION: The evaluation procedures are similar to those implemented in the continuous online server evaluation program, LiveBench. Additional information is available from its homepage (http://BioInfo.PL/LiveBench/).
Toxic or environmental exposures have been suggested as a possible cause of symptoms reported by Gulf War veterans. To further explore this hypothesis, we analyzed findings in 18,495 military personnel evaluated in the Department of Defense Comprehensive Clinical Evaluation Program. The program was established in 1994 to evaluate Persian Gulf veterans eligible for Department of Defense medical care who had health concerns after service in the Persian Gulf during Operation Desert Shield/Desert Storm. The evaluation included a structured clinical assessment, a physician-administered symptom checklist, and a patient questionnaire addressing self-reported exposures, combat experiences, and work loss. Among 18,495 patients examined, the most common symptoms were joint pain, fatigue, headache, memory or concentration difficulties, sleep disturbances, and rash. Symptom onset was often delayed, with two-thirds of symptoms not developing until after individuals returned from the Gulf War and 40% of symptoms having a latency period exceeding one year. There was no association between individual symptoms and patient demographics, specific self-reported exposures, or types of combat experience. Increased symptom counts were associated with work loss, the number of self-reported exposures, the number of types of combat experience, and certain ICD-9 diagnostic categories, particularly psychological disorders. Prolonged latency of symptom onset and the lack of association with any self-reported exposures makes illness related to toxic exposure less likely.