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At least 1,603 records · Page 89Linked to original sources
PubMed2001

Economic analysis of a child vaccination project among Asian Americans in Philadelphia, Pa.

OBJECTIVE: To ascertain the cost-effectiveness and the benefit-cost ratios of a community-based hepatitis B vaccination catch-up project for Asian American children conducted in Philadelphia, Pa, from October 1, 1994, to February 11, 1996. DESIGN: Program evaluation. SETTING: South and southwest districts of Philadelphia. PARTICIPANTS: A total of 4384 Asian American children. INTERVENTIONS: Staff in the community-based organizations (1) educated parents about the hepatitis B vaccination, (2) enrolled physicians in the Vaccines for Children program, and (3) visited homes of children due for a vaccine dose. Staff in the Philadelphia Department of Public Health developed a computerized database; sent reminder letters for children due for a vaccine dose; and offered vaccinations in public clinics, health fairs, and homes. MAIN OUTCOME MEASURES: The numbers of children having received 1, 2, or 3 doses of vaccine before and after the interventions; costs incurred by the Philadelphia Department of Public Health and the community-based organizations for design, education, and outreach activities; the cost of the vaccination; cost-effectiveness ratios for intermediate outcomes (ie, per child, per dose, per immunoequivalent patient, and per completed series); discounted cost per discounted year of life saved; and the benefit-cost ratio of the project. RESULTS: For the completed series of 3 doses, coverage increased by 12 percentage points at a total cost of $268 660 for design, education, outreach, and vaccination. Costs per child, per dose, and per completed series were $64, $119, and $537, respectively. The discounted cost per discounted year of life saved was $11 525, and 106 years of life were saved through this intervention. The benefit-cost ratio was 4.44:1. CONCLUSION: Although the increase in coverage was modest, the intervention proved cost-effective and cost-beneficial.

Adolescent↗
PubMed2005

Teaching professionalism within a community context: perspectives from a national demonstration project.

Most medical schools now include some component of professionalism in their curriculum, ranging from "white coat" ceremonies to didactic and small-group, case-based discussions. Often this format does not provide a context for the course content nor does it necessarily make the curricular themes relevant to population groups and communities most vulnerable to the inequities and injustices present in health care. The authors describe a community-based professionalism curriculum for preclinical and clinical year medical students and report evaluation data from three years (2001-2003) of this national demonstration project. The curriculum emphasized four themes: service, community, advocacy, and ethical behavior and was based on a service-learning pedagogy applied within community-based organizations. As part of the program evaluation, 95 students from 33 medical schools between the years 2001 and 2003 (response rate: 84.8%) completed an anonymous questionnaire. When asked what did they learn about professionalism that they did not learn (or expect to learn) in their medical school curriculum, the most common themes were (1) factors and influences affecting professional behavior, with many specifically citing pharmaceutical companies and insurance carriers (46.3%); (2) the role and importance of physician advocacy on behalf of their patients (37.9%); and (3) issues specific to the needs of vulnerable and disadvantaged populations (20.0%). This project demonstrates that community-based experiences can provide unique and relevant learning in a professionalism curriculum that can complement existing medical-school-based efforts.

Adult↗
PubMedDate not supplied

Impact of management development on nurse retention.

PURPOSE: Nurse retention is essential to maintain quality healthcare organizations. In an effort to mitigate the loss of nurse managers, a management education program was created for new and transitioning nurse managers that included scholarships for nurses from long-term and rural acute care settings. Program evaluation was based upon the outcomes of anticipated turnover and employee satisfaction. DESIGN AND METHODS: Using a preprogram and postprogram evaluation, the Index of Work Satisfaction (IWS) and the Anticipated Turnover Scale (ATS) were used to survey participants. Descriptive statistics as well as Wilcoxon statistics for group comparisons were used for analysis. FINDINGS: ATS scores were significantly reduced (P < .05) for all program participants. Further analysis of scholarship recipients indicated that the management program significantly increased their intent to stay (P < .08) in their current positions. However, because of a large rate of attrition, findings can only be considered preliminary. CONCLUSIONS: While the high level of attrition among the scholarship recipients is disappointing, potential attendance barriers are discussed, particularly from long-term care settings. Management development programs may improve the satisfaction and retention of critically needed managers and enhance development of future nursing leaders.

Adult↗
PubMed1992

Evaluation of six computerized drug interaction screening programs.

Six widely used computerized drug interaction screening programs were evaluated according to criteria developed by a panel of pharmacists. A panel of six pharmacists from various practice settings developed criteria that were used to evaluate six computerized drug interaction screening programs: Medicom Micro Plus, Medical Letter, S-O-A-P, Drug Interactions by Hansten, Drug Therapy Screening Systems (DTSS), and RxTriage. The criteria were that the programs be user friendly and efficient, provide guidance, and be relevant to the user's practice setting. Also, they should detect interactions, quickly alert the user, and guide the user to the appropriate action. The user should be able to set the level of clinical significance, screen only current drugs in a patient profile, and print out summaries. The panel selected nine known drug interactions to test the programs' knowledge bases. Only Medicom Micro Plus and DTSS detected all nine drug interactions; Medical Letter missed three. RxTriage and Drug Interactions received the highest ratings in user friendliness and efficiency, but both missed two interactions. RxTriage was rated most relevant to their practice by hospital and community pharmacists, and Drug Interactions was rated most relevant by faculty practitioners. S-O-A-P received low ratings overall. Of the six drug interaction screening programs evaluated, none was considered by the panel of pharmacists to be ideal.

Data Display↗
PubMed2005

Evaluation of school-based health center programs and services: the whys and hows of demonstrating program effectiveness.

Evaluation and dissemination of the outcomes of school-based health center (SBHC) services is essential for the continual growth and funding of SBHCs in the United States. Since their inception, SBHCs have been practice sites for nurse practitioners and have used interdisciplinary teams to provide care for underserved school-aged children. Early research and evaluation focused on describing the types of services and the quality of care provided. Supporters of SBHCs were anxious to demonstrate that the care provided was "as good as" care delivered in traditional primary care practices. Documentation of program impacts, such as changes in population health indicators or improved academic achievement, has been more elusive. Current evaluation priorities outlined by the National Assembly on School-Based Health Care include evaluation of mental health services using a new online tool; assessing productivity of SBHC staff; measuring quality; and attempts to link SBHC care with improved academic outcomes.

Adolescent↗
PubMed1998

Education for health promotion and disease prevention: convince them, don't confuse them.

Promotion of health and prevention of disease have become some of the most emphasized issues of the 1990s. The government, health professionals, and private organizations have made the primary prevention of disease a priority. Quality education is a major intervention by which prevention is realized. However, superior quality educational offerings entail significant pre-preparation via the development of clear and realistic teaching/learning plans, faculty knowledge of educational psychology, metacognition and cognitive processing, understanding of cultural diversity, incorporation of adult learning principles, the use of varied teaching/learning strategies, and astute application of program evaluation skills. Educators, like nurses, physicians, and allied health professionals, must work with people to mutually decipher their healthcare needs and plan educational experiences that learners can merge with their own life experiences and ethnocultural perspectives. In addition, educators should use health education materials that match learners' literacy levels. Most importantly, such programs must be thoughtfully evaluated in light of the achievable goals that were outlined during preplanning stages. Without outcomes assessment as part of health promotion/disease prevention education programs, health educators are less likely to produce interventions that learners value and from which they truly benefit. Optimally, education programs about health promotion/disease prevention should generate long-term critical thinking processes that produce positive health choices, behavioral change, and healthy life styles.

Adult↗
PubMedDate not supplied

Formative evaluation of an Inspection Certificate Program (ICP) pilot in Toronto.

The inspection certificate program consists of food establishments voluntarily posting a certificate to inform patrons that inspection reports can be accessed from operators or the public health department. A three-month pilot program was evaluated for program improvement purposes. Only 65% of the selected operators were willing to participate, which suggests a challenge to fully implementing the program. Thirty-nine randomly selected restaurant operators participated. Most operators posted the certificate at the front entrance, and patrons indicated that reports were clear. Operators were supportive of the program. Some operators reported that the program was good for business and offered suggestions to improve it. A total of 583 requests for reports were made which suggests that the program empowered patrons to request reports, mostly from operators. Most patron evaluation forms came from a few operators that had no deficiencies, which limits generalizability.

Accreditation↗
PubMed1997

Self-management of asthma by adult patients.

Review of eighteen adult self-management education program evaluations comprising clinical trials showed significant achievement in five categories of outcome: (1) asthma knowledge; (2) patient perceptions and psychological status; (3) behavior related to medicine use, delivery devices and environmental triggers; (4) functioning and control of symptoms; and (5) health care use. Not every program achieved in all of these categories, probably because interventions of adequate power to elicit change in one category of outcome were not powerful enough to realize change in another category. An alternative explanation may be that in some studies assessment measures were inadequate. Asthma management by patients is influenced by their social environment and this aspect of control is least well understood. A small qualitative study suggested themes among adult patients that describe intra- and interpersonal factors enabling or hindering self-management including: the ability to acquire information; self-regulation; relations with family, friends and coworkers; and, relationships with clinicians. Research is needed that provides greater understanding of social environments in asthma management, produces standardized measurement tools, and tests more robust and theory-based interventions.

Adult↗
PubMedDate not supplied

Impact of organizational redesign.

Little in-depth objective information is available about the outcomes of restructuring or reengineering. One reason for this is the difficulty of conducting traditional research within the context of dynamic organizational development activities. The authors describe an alternative program evaluation approach that proved successful for assessing and enhancing large-scale organizational change in an acute-care medical center. Sample results are presented and recommendations made for increasing an evaluation's usefulness by tailoring reports to the user.

Hospital Restructuring↗
PubMed1989

Models of vocational assessment of handicapped students.

During the last twenty years, increasing emphasis has been placed upon the provision of comprehensive vocational assessment to disabled and disadvantaged persons to assist them in obtaining employment. Vocational evaluation programs have proliferated in rehabilitation facilities, manpower programs, vocational-technical schools and public schools. An increasing body of literature and research has delineated service-delivery models and competencies needed by vocational evaluation specialists. Increasing numbers of universities have implemented graduate training programs in vocational evaluation; and a national professional certification process has been developed. Most of this activity has been centered at rehabilitation facilities at the same time that public schools are becoming the norm for educating disabled students. As vocational assessment for disabled students moves into this relatively new setting, it is being modified. This article explores models of vocational assessment for disabled students which incorporate modifications to suit the special needs of the public school setting.

Persons with Disabilities↗
PubMed1994

Time series models of individual substance abusers.

Time series analysis is a statistical procedure appropriate for repeated observations on a single subject or unit. The goal of the analysis may be to determine the nature of the process that describes an observed behavior or to evaluate the effects of a treatment or intervention. Model identification involves specifying which of several alternative Autoregressive Integrated Moving Average (ARIMA) models best describes the series and may be used to investigate basic processes. This is illustrated by an example involving selecting the model of nicotine regulation that best represents smokers. Intervention analysis involves determining if there are any changes in level or direction for the series as a result of the intervention. Two types of applications have potential for the substance abuse area: (1) evaluation of the effects of an intervention on a single individual, and (2) evaluation of organizational-level changes (i.e., program evaluation). This is illustrated by an example that examines the effect of relaxation therapy on blood pressure. Pooled time series procedures are employed to combine the data from several different individuals or units, either by cross-sectional analysis or meta-analysis. In addition, several other issues are discussed that are critical to performing a time series analysis: selection of an appropriate computer program, alternative procedures for handling missing data, procedures for multiple observations at each occasion, and corrections for seasonal data.

Humans↗
PubMedDate not supplied

Aligning financial incentives with quality of care in the hospital setting.

This article describes the structure, implementation, and early results of a performance-based hospital incentive program designed by a large nonprofit health plan. The Hospital Quality Service and Recognition program, developed by the Hawaii Medical Service Association, was launched in 2001 to reward high-quality medical care at the hospital level. This pay-for-performance program used administrative claims data, survey data, and hospital-reported information to assess hospital performance in risk-adjusted complications and risk-adjusted length of stay (LOS), patient satisfaction, and hospital processes of care measures. Financial incentives were provided to participating hospitals based on their performance on these measures. Preliminary outcomes of the program evaluated over a 4-year period after implementation revealed improvements in aggregated rates of risk-adjusted surgical complications and efficiency of care as evidenced by a substantial decrease in risk-adjusted average LOS for several surgical procedures. Quality improvement was demonstrated in several other program components including emergency department satisfaction. This quality incentive program offers an innovative approach for encouraging delivery of high-quality and service-oriented care in a statewide network of participating hospitals.

Hawaii↗
PubMed2003

An evaluation of four programs for the management of aggression in psychiatric settings.

Regulatory agencies are encouraging health care facilities to address the problem of violence to employees. In response to this pressure, most psychiatric facilities now require and implement formal education for the nursing staff on a yearly or biannual basis in the management of aggressive behavior (MAB). Although some of the programs are good, not all are based on sound professional and clinical principles and very little is publicly known about the results of scientific study of these programs. Our goal with this report is to evaluate several commonly used programs for the management of aggressive behavior using a set of predetermined criteria. Hopefully, this discussion will stimulate a debate over the effectiveness of these programs, and others, that dot the landscape and foster clinical research that examines staff injury rates as well as other common and clinically important patient outcomes, such as violence.

Aggression↗
PubMed2000

A student health advocate program.

School nurses are in a unique position to influence health education in the school system. However, it is likely that school nurses have varying opportunity, due to staffing patterns, to effectively use their health education background to reach large numbers of students. This article explores the benefits of providing a school nurse-facilitated student health advocate program. The student health advocate program is a creative approach, designed to access a greater audience of students for health education and health promotion activities. It also cites research supporting the choice of peer education as a health education/health promotion strategy. The initiation of a student health advocate program, the role of the school nurse, student activities, program evaluation, and nursing implications are discussed. Positive benefits accrued for both the student health advocate and the mentored student.

Adolescent↗
PubMed2004

Dual-system utilization affects regional variation in prevention quality indicators: the case of amputations among veterans with diabetes.

OBJECTIVE: To determine the impact of dual-system utilization by veterans on regional variation in lower-extremity amputation rates. STUDY DESIGN: Retrospective longitudinal cohort analysis. PATIENTS AND METHODS: Subjects were veterans with diabetes who used Veterans Health Administration (VHA) care and were dually enrolled in Medicare fee for service in fiscal years (FY) 1997--1999. We evaluated the impact of Centers for Medicare and Medicaid Services (CMS) data on prevalence of baseline foot risk factors, medical comorbidities, and amputations in FY 1997--1998, and ranking of 22 regions using risk-adjusted major and minor amputation rates in FY 1999. RESULTS: The addition of CMS data significantly increased the prevalence of amputations and risk factors for the 218,528 dually eligible veterans (all Pvalues <.001). In FY 1999, we identified 3.1 minor and 4.5 major amputations per 1000 patients (VHA data) versus 5.5 minor and 8.6 major amputations per 1000 patients (VHA/CMS data); the prevalence of any peripheral vascular condition in FY 1997--1998 was 5.7% (VHA) versus 13.0% (VHA/CMS). The impact of including CMS data varied across regions for amputation outcomes, ranging from an additional 34.3% to 150.7%. Using observed-to-expected amputation ratios and 99% confidence intervals, the addition of CMS data changed the outlier status for 8 of 22 regions for both major and minor amputations. CONCLUSION: Risk covariates and amputation outcomes were substantially underestimated using VHA data only. Our findings demonstrate the importance of evaluating dual-system utilization when conducting program evaluations for healthcare systems with a substantial number of dual enrollees.

Aged↗
PubMed1994

Tackling wastage and inefficiency in the health sector.

Governments and the public are concerned about waste and inefficiency in the health sector. Although there are likely to be various underlying causes, wastage often results from limited information and from limited accountability for decisions about the use of resources. Corruption and fraud occur where there are conflicting interests in combination with limited accountability. Policy-makers, managers, providers and service users should feel responsible for ensuring that scare health resources are used efficiently. They should actively combat wastage by identifying the causes, and then make corresponding changes in policy, management and technical procedures.

Costs and Cost Analysis↗