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PubMedDate not supplied

Problem-solving cancer care education for patients and caregivers.

PURPOSE: A program evaluation was conducted to explore the potential effects of a 90-minute problem-solving education session for persons with advanced cancer and their families. DESCRIPTION OF PROGRAM: Patients with advanced cancer and their families, who were visiting a tertiary-care outpatient setting, were invited to attend a 90-minute individualized educational session that taught basic problem-solving principles using a cognitive-behavioral framework. Pre-education and posteducation data were collected about the confidence of participants in providing care, their feelings about being informed about resources, and their perceptions of their problem-solving ability. RESULTS: At baseline, most participants reported low confidence about their ability to provide cancer care and felt uninformed about community resources, but they viewed themselves as moderate-to-good problem solvers. Forty-two educational sessions were delivered to 49 caregivers and 40 patients. Two months later, participants reported feeling more informed about community resources and achieved higher posteducation scores for problem-solving ability. More caregivers than patients reported that reading The Home Care Guide for Cancer made a great deal of difference in their approach to home care. CLINICAL IMPLICATIONS: Most educational sessions for families affected by cancer focus on delivering information, not on building skills. These findings suggest that a one-on-one educational session that teaches problem-solving skills can be successfully delivered in a busy clinic setting. Family caregivers are especially likely to benefit from this program.

Caregivers↗
PubMed2005

Challenges of preparing allied health professionals for interdisciplinary practice in rural areas.

Meeting the health needs of individuals in rural communities involves addressing the challenges of complex multifaceted health problems, limited local health resources and services, isolation, and distance. Interdisciplinary collaboration can create solutions to health care problems that transcend conventional, discipline-specific methods, procedures, and techniques. This paper reports on the four-pronged approach of the Western Maryland Area Health Education Center used to prepare allied health students to be interdisciplinary team members in rural areas. It describes the development of four interdisciplinary instructional team member training venues (in-class instruction, Web-based modules, service-learning programs, and faculty development workshops) that integrate opportunities to develop and practice interdisciplinary health promotion skills in rural communities. Challenges to implementing the model are described, including developing faculty and student training participation, integrating training venues into existing programs at participating institutions, and designing a unified program evaluation.

Allied Health Personnel↗
PubMed1992

A visual field quantification system for the Goldmann Perimeter.

We have developed a visual field quantification system that can accurately quantify the measurement results by the Goldmann Perimeter (GP). This system calculates the plural indexes introduced in published papers. In recent years, several isopter quantification methods have been proposed. In these methods, the isopters are digitized and the data are input into a computer, after which a computer program evaluates the changes in the isopters quantitatively. However, each program is only able to evaluate private indexes. We have developed a system that quantifies data using multiple methods. This system used five methods that have been introduced in published papers. With this system, a physician can analyze GP data with multiple methods and can diagnose diseases accurately. We have already input about 2500 GP recording papers into the computer by this system. We then calculated the plural indexes, and visualized the temporal changes in the perimetry.

Humans↗
PubMed2001

Implementing guidelines for interdisciplinary care of low back pain: a critical role for pre-appointment management of specialty referrals.

BACKGROUND: Improving health care will require more effective guideline implementation and redesign of delivery processes and systems. Patient referral for specialty care is a key component of health system function that needs to be improved. Low back pain care is a widely documented example of the need for improvement. An interdisciplinary systemwide back pain program was developed using process improvement methods. Proactively managing referrals for specialty care-a departure from traditional referral processes-played a critical role in implementing the program. METHODS: Program components included guidelines for care, defined provider roles, uniform service coding, provider and patient education, pre-appointment specialty referral management, and monitoring of management processes. To evaluate program performance, system back pain visits were compared before, during, and after implementation of referral management. A case series study was performed on 581 consecutive patients with low back pain or lumbar radiculopathy referred for consultative spine care between April 1998 and March 1999. RESULTS: A shift of care was accomplished for acute back pain from spine orthopedists to primary physicians and for chronic back pain from spine orthopedists to medical specialists. More than 95% of initial assignments were accurate. Seventy-six percent of surveyed chronic back pain patients improved, and 90% were highly satisfied with the referral management process. This program has saved an estimated $400,000 per year in manpower cost and has reduced specialty service billings by 20%. DISCUSSION: Pre-appointment referral management offers an approach for improving guideline implementation, access to specialty services, and the effectiveness of care for complex health problems. It deserves broader study and adoption.

Acute Disease↗
PubMed1985

The evaluation and monitoring of a Medicaid second surgical opinion program.

The evaluation of newly implemented and controversial programs often present real problems for the evaluator. When a program is accompanied by a legislatively mandated evaluation, the issues become even more acute. The evaluator, wanting to impact on policy, must strike a balance between the adherence to principles of scientific inquiry, yet be responsive to the needs of policymakers. This paper describes the evaluation and follow-up monitoring of a recently established second opinion program for Medicaid recipients. The program was to terminate in 17 months unless extended by the Wisconsin Legislature. The evaluation found, among other things, marked reductions in the use of surgical services after implementation of the second opinion program. Based in large part on the evaluation, the program was extended with a provision for continued monitoring. The paper discusses the factors that contributed to the evaluation having a major impact on the decision to extend the program.

Evaluation Studies as Topic↗
PubMed1997

Evaluation of a program of university placement for spinal cord injured rehabilitation clients in Louisiana.

The Louisiana State Department of Social Services, Rehabilitation Services (LRS) offers a program of financial support for spinal cord injured persons to attend college. We evaluated this program's effectiveness and attempted to identify factors that may predict student success. We examined the LRS case records of all students with documented SCI who had enrolled in the LRS college program before 1988. We compared the proportion of LRS clients who graduated with the proportion of general population students attending the same schools. We measured the association between graduation and factors that may help predict success. Of the 51 LRS clients studied, 25 (49%) graduated from baccalaureate institutions within 6 years. Of Louisiana students-at-large who attended the colleges that housed LRS students, 36% of those graduated within 6 years. The best predictor of success was the American College Test score. All students with a score of 17 or more graduated. A larger proportion of LRS-sponsored students graduated than did students from the general population.

Adult↗
PubMed2004

Impact of a cardiac risk reduction program in vulnerable patients hospitalized with coronary artery disease.

STUDY OBJECTIVE: To increase the use of guideline-based pharmacotherapy in vulnerable patients (ethnic minorities and the poor) with coronary artery disease (CAD) through a nurse-based quality-improvement program. DESIGN: Retrospective program evaluation. SETTING: Inner-city hospital in Denver, Colorado. PATIENTS: One hundred fifty-one consecutive patients hospitalized with a CAD-related diagnosis. INTERVENTION: A nurse-management program was initiated for patients with angiographically documented CAD, and rates of guideline-based care were compared with rates for historic controls. The intervention consisted of two key elements: patient counseling with language-appropriate education materials and direct physician education regarding the importance of cardioprotective drugs. The 151 patients in the intervention group were compared with 125 historic control patients hospitalized before the program was begun. Multivariable logistic regression analysis was used to assess differences in care with regard to ethnicity, education level, and insurance status, and to adjust for different baseline characteristics. MEASUREMENTS AND MAIN RESULTS: At hospital discharge, patients in the intervention group were more likely to receive statins (71% vs 52%, p=0.001) and angiotensin-converting enzyme inhibitors (79% vs 51%, p<0.001) compared with controls. These differences remained after adjusting for ethnicity, education level, insurance status, and baseline clinical characteristics. Also, a trend was noted toward greater use of aspirin (92% vs 86%, p=0.13) and beta-blockers (79% vs 73%, p=0.24) in the intervention group compared with controls. Patients in the intervention group were more likely to receive counseling for smoking cessation. CONCLUSION: An inpatient nurse-management program improved the quality of care for patients with CAD regardless of sociodemographic status. Properly designed disease-management initiatives can be effective for disadvantaged patients, who often obtain health care through emergency and inpatient services.

Colorado↗
PubMedDate not supplied

Method for ascertaining denominators for evaluation of population coverage with pneumococcal vaccine.

BACKGROUND: Immunization programs may collect numerator data for the estimation of pneumococcal vaccine coverage, but program evaluators do not have appropriate denominator data for estimation of pneumococcal vaccine coverage, particularly among those eligible for vaccine on the grounds of having chronic health conditions. METHODS: We partitioned the Alberta population into 6 mutually exclusive groups, all but one of which met Canadian recommendations for pneumococcal vaccination. Age-sex specific prevalence rates for each group were estimated using data on chronic health conditions from the Alberta over-sample of the 1996 Household component of the National Population Health Survey, from Alberta Health and Wellness rosters of nursing home residents, and from the Alberta Health Care Insurance Plan Stakeholder Registry. We applied these to Alberta Population Projections to estimate the numbers of persons who should be vaccinated. RESULTS: The proportion of persons recommended for vaccination on the grounds of chronic health condition ranged from 1.5% among those aged less than 12 years to 36% among persons aged 80 years or older. The total number of persons recommended for vaccination at mid-year 2000 is estimated to be 638,561 (21.5% of the Alberta population). INTERPRETATION: This methodology provides denominators for the estimation of pneumococcal vaccine coverage and permits monitoring of local and regional progress towards national goals.

Adolescent↗
PubMed1977

A pediatric residency program revisited.

There have been few assessments of residency programs by graduates; therefore, to investigate a practical means of evaluating programs we asked former trainees to relate aspects of their training to present professional needs. Former residents in the Duke pediatric program from 1960 to 1972 were asked to evaluate various aspects of their training. The overall training program was rated favorably, as were most deficiencies were identified in ambulatory pediatric care, such as surgery, dermatology, psychiatry, and radiology. Analysis according to respondent's period of participation in the program and current professional activity revealed little variation in patterns of response. This survey method provides an inexpensive means of monitoring inadequacies in residency programs and provides data to initiate changes.

Curriculum↗
PubMed1987

Evaluation of pediatric community field trips.

A field trip program for junior medical students on a pediatric clinical clerkship acquainted students with the care of normal and handicapped children in community settings of school, day care center, residential treatment, or diagnostic facilities.A program evaluation by pre and post-trip survey demonstrated a positive change in students' knowledge and attitude in general, which was unaffected by such factors as sex, previous experience in a medical setting, and previous experience with handicapped children.As an integral part of the pediatric clerkship, the field trip appears to have been a positive experience for students, as it met their educational and emotional needs. Subjective evaluation indicated that many students formed insightful and compassionate judgments about handicapped children.Although the increase in knowledge and sensitivity of the students, as reflected in the pre-and post-test, was not statistically significant, the benefit to the students, to the personnel of the agencies, and ultimately to the children and families with whom they dealt during their professional careers was important.

Curriculum↗
PubMed1992

The home visit in resident education: program description and evaluation.

A home visit rotation was developed to provide family practice residents with a more comprehensive understanding of the effect of patient life-style on health status. The rotation emphasizes geriatric, community, and rehabilitative medicine. In addition, the curriculum addresses issues related to patient compliance, assessment of activities of daily living, patient psychosocial needs, community services, and exposure to medical equipment of potential use to homebound individuals. Over a three-year period, 209 home visits were made. Program evaluation data suggest that at the end of the three-month rotation, residents were less concerned with personal safety and more likely to agree that home visits were an important part of residency training. A comparison of pre- and post-test knowledge scores indicated significant increases in geriatric medicine, patient compliance issues, patient functional status, and community services. A follow-up telephone interview with patients found that some patients experienced anxiety when the home visit was scheduled, but the majority were positive about the experience.

Aged↗
PubMed1994

Reaching mothers of preschool-aged children with a targeted quit smoking intervention.

Younger women smoke at disproportionately higher rates than other women and their smoking has a major impact on the health of their young children. To address this problem, a smoking cessation intervention combining minimal advice and assistance from a community health nurse and a tailored self-help guide was developed for low-income women with young children. The program evaluation results reported here were gathered from women using publicly funded pediatric services in four agencies with 32 clinic sites in central and eastern Pennsylvania. Unlike volunteers in formal cessation programs, the women varied widely in their readiness to quit smoking. Follow-up data were obtained from 1,230 female smokers, aged 18 to 39, after receiving brief, individualized smoking cessation advice and encouragement to read the self-help guide. One year later, 12.5 percent reported quitting smoking, and 20.2 percent reported having made a serious quit attempt that lasted at least 7 days. These results suggest that, even among smokers with low socioeconomic status and wide variation in their readiness to quit, minimal intervention programs requiring modest resources can promote cessation.

Adult↗
PubMed2000

Diabetes training for dietitians: needs assessment, program description, and effects on knowledge and problem solving.

Recent changes in management and medical nutrition therapy for diabetes mellitus have produced a need to retrain many practicing dietitians. To meet this need, a multidisciplinary group experienced in medical nutrition therapy and educational methods used a formal needs-assessment process to design a new training program. Sugar is Not a Poison (SNAP): The Dietitian's New Role in Diabetes Management is a 2 1/2-day program that uses written text, didactic presentation, and exercises that simulate patient encounters to accomplish 12 learning objectives. Program evaluations show high levels of participant satisfaction. Mean (+/- standard deviation) scores on pre- and postests of knowledge and problem solving were 69 +/- 13% and 86 +/- 9%, respectively (P < 0.01). The SNAP program needs assessment, training methods, and knowledge problem-solving test are relevant to all types of education programs in clinical dietetics.

Diabetes Mellitus↗
PubMed2007

Self-exclusion program: a longitudinal evaluation study.

Few self-exclusion programs have been evaluated and their long-term impact remains unknown. This study has two main goals: (1) to assess changes in gambling behaviour and gambling problems for self-excluded patrons, and (2) to follow self-excluded gamblers for a two-year period (during and after the self-exclusion period). Individuals who excluded themselves (N = 161 at the initial stage) participated in telephone interviews after signing the self-exclusion agreement and were followed at 6, 12, 18 and 24-months. Results show that according to the DSM-IV, 73.1% of the participants were pathological gamblers. The self-exclusion program has many positive effects. During the follow-ups, the urge to gamble was significantly reduced while the perception of control increased significantly for all participants. The intensity of negative consequences for gambling was significantly reduced for daily activities, social life, work, and mood. The DSM score was significantly reduced over time. This reduction also took place between the baseline and the 6-month follow-up. The clinical implications of the results are discussed in relation to the effectiveness of the program. Suggestions are provided in order to increase compliance of self-excluded patrons.

Adult↗
PubMed1984

The New York State community support system: a profile of clients.

In 1979 the New York State Office of Mental Health contracted with the authors and their colleagues for an independent evaluation of its community support services (CSS) program for the chronically mentally ill in the four upstate mental health regions. As a first step in their program evaluation, the authors present initial findings from a 1981 survey of 844 clients sampled from seven selected CSS program sites. The demographic characteristics, clinical characteristics, and levels of functioning of the CSS client sample are discussed and compared with similar data collected by the National Institute of Mental Health (NIMH) in a 1980 survey of chronically disabled adults in its national community support program (CSP). The authors also present a profile of the services received by the CSS clients and, whenever possible, they compare these services with those received by the NIMH CSP clients.

Adult↗
PubMedDate not supplied

Educational practice guidelines for a surgical clerkship.

Similar to the Residents Review Committee's "Essentials for a Residency Training Program," this article provides Educational Practice Guidelines for a required surgical clerkship. The Guidelines presented are ones that can be adopted by any department of surgery in the United States, but in some cases not without significant increase in resources and faculty effort. The 10 essential components provide an opportunity for intensive program evaluation of all medical student clerkship experiences.

Clinical Clerkship↗
PubMedDate not supplied

Time in health: can we measure individuals' "pure time preferences"?

The time dimension in health is assessed and/or explained using the concept of time preference, i.e., preferences about when things occur or the timing of an outcome. It is believed that an individual's time preference can be relatively easily measured. This paper argues that individuals' responses to time-preference-type questions may represent not only their attitudes toward the timing of events (i.e., the points in time at which they are going to occur) but also their attitudes toward other things, such as the sequence of events (i.e., the order of good and bad events over an individual's lifetime health profile). This paper explains the distinction between the time-preference and sequence-preference concepts. Using two recent empirical studies, it demonstrates the inability to measure individuals' pure time preferences. The implications of this empirical obstacle in the context of medical decision making and health-care program evaluation are discussed.

Attitude to Health↗
PubMed1990

[Quantitative evaluation of screening programs for chronic diseases].

This paper addresses an epidemiologic approach to the quantitative evaluation of screening programs for chronic diseases. A new formula is advanced for the quantitative relationship between the yield of a screening program and the natural history of chronic disease, based on the two stage model of disease progression. The formula was applied to follow-up data of the participants and the proportions of cases detected by the screening were estimated as 15.3% for all diseases and 43.8% for hypertensive disorders. The formula is useful for continuous monitoring of ongoing screening programs as well as for potential impact evaluation of hypothetical programs.

Adult↗