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At least 1,675 records · Page 93Linked to original sources
PubMed1991

Goal attainment scaling and outcome measurement in postacute brain injury rehabilitation.

Relationships among two-month and final goal attainment scaling (GAS) scores, preadmission and final Portland Adaptability Inventory (PAI) scores, and work outcome for 16 graduates of a comprehensive, postacute brain injury rehabilitation program were examined. Final GAS scores were higher for program graduates who obtained the most desirable work outcomes, and preadmission and final PAI scores were lower for the successful program graduates. Final GAS scores were significantly correlated with other outcome measures. Preadmission PAI scores predicted work outcome, and two-month GAS scores predicted final GAS scores. Initial PAI scores distinguished between program successes and failures, but not between program successes and dropouts. A brief look at one case illustrates the modified application of GAS in postacute brain injury rehabilitation. Results of this study and case analyses support GAS as a quantifiable, individualized measure that is useful for (1) monitoring patient progress, (2) structuring team conferences, (3) ongoing rehabilitation planning and decision-making, (4) concise, relevant communication to family, referral sources, and funding sources, and (5) overall program evaluation when used in the context of other objective outcome measures. Although our results support the clinical utility of GAS, further study is recommended to assess the psychometric characteristics of GAS in this application.

Adult↗
PubMedDate not supplied

The determinants of physical activity and exercise.

Evaluation and delivery of physical activity and exercise programs appear impeded by the substantial numbers of Americans who are unwilling or unable to participate regularly in physical activity. As a step toward identifying effective interventions, we reviewed available research on determinants relating to the adoption and maintenance of physical activity. We categorized determinants as personal, environmental, or characteristic of the exercise. We have considered supervised participation separately from spontaneous activity in the general population. A wide variety of determinants, populations, and settings have been studied within diverse research traditions and disciplines. This diversity and the varied interpretation of the data hinder our clearly summarizing the existing knowledge. Although we provide some directions for future study and program evaluation, there is a need for research that tests hypotheses derived from theoretical models and that has clear implications for intervention programs. We still need to explore whether general theories of health behavior or approaches relating to specific exercises or activities can be used to predict adoption and maintenance of physical activity.

Age Factors↗
PubMedDate not supplied

A case management approach to pediatric asthma.

Although a controllable disease, asthma costs our nation billions of dollars each year due to hospitalizations, emergency room visits, and lost time from school and work. In 1993, a case management program within a large inner-city health maintenance organization (HMO) was developed to address these concerns by empowering patients and their families to control asthma exacerbations. Program evaluation of 114 patients indicates a decrease in hospitalization and emergency costs. ER visits were decreased by 50% and hospitalizations, measured by discharges, were decreased by 66%. In addition, office encounters increased by 25% during this same time period.

Asthma↗
PubMed2004

Principles for assessing disease management outcomes.

Disease management (DM) is rapidly becoming an important force in the late 20th and early 21st century as a strategy for managing the chronic illness of large populations. Given the increasing visibility of DM programs, the clinical, economic and financial impact of this support are vital to DM program accountability and its acceptance as a solution to the twin challenges of achieving affordable, quality health care. Measuring and reporting outcomes in DM is difficult. DM programs must adapt to local market conditions and customer desires, which in turn limits generalizability, and still account for the overlapping/interlocking/multifaceted nature of the interventions included in any DM program. The Disease Management Association of America convened a Steering Committee to suggest a preferred approach, not a mandated or standardized approach for DM program evaluation. This paper presents the Steering Committee's "Consensus Statement" and "Guiding Principles" for robust evaluation.

Disease Management↗
PubMed2003

Learning technologies at the service of higher education: global trends and local Israeli opportunities.

This paper provides an overview of global trends in e-Learning and opportunities opened by harnessing learning technologies at the service of the Israeli higher education. The introduction of innovative learning technologies is examined in light of an organizational change. A series of substantial issues should be taken into account to successfully manage the change. Among these are: rethinking of academic learning and instruction, redefining the role of the teachers and the students, decoupling the learning materials and the learning process, new approaches to student assessment and program evaluation, and instituting a well thought out organizational plan including a support center. The above-mentioned issues guided the introduction of a recent call for project proposals for the integration of technologies into Israeli higher education. The main principles, criteria and results of this call are described.

Curriculum↗
PubMed1984

Management consulting and evaluation.

The basic functions and procedures of management consulting are contrasted here with formal program evaluation. A case example further illustrates the differing approaches used in programmatic problem solving. The similarities and differences between these two professional specializations are highlighted in order to understand better the unique but complementary contribution each makes to the improvement of program operations.

Consultants↗
PubMedDate not supplied

A three-year census of dependent elderly.

One attempt to limit the rising health care cost for the expanding elderly population has been to control institutional utilization through community care programs. Evaluative research in this field has focussed on comparing community programs to institutionalization, rather than a simpler and more relevant examination of prevailing patterns of care. This latter approach is important for several reasons: it allows one to examine the effects of new programs; to predict future service needs; to evaluate effectiveness and appropriateness of current patterns of care; and it provides the basis for a co-ordinated approach to planning and policy. For the past three years, all institutions and community agencies in Calgary that provide care to the elderly have co-operated in an annual census to determine the location and services received by each person over 65. Study findings suggest directions for future policy and planning, and raise questions for future research.

Activities of Daily Living↗
PubMed1991

Adult day health care evaluation study: methodology and implementation. Adult Day Health Care Evaluation Development Group.

The Adult Day Health Care Evaluation Study was developed in response to a congressional mandate to study the medical efficacy and cost effectiveness of the Adult Day Health Care (ADHC) effort in the Department of Veterans Affairs (VA). Four sites providing ADHC in VA facilities are participating in an ongoing randomized controlled trial. Three years of developmental work prior to the study addressed methodological issues that were problematic in previous studies. This developmental work resulted in the methodological approaches described here: (1) a patient recruitment process that actively recruits and screens all potential candidates using empirically developed admission criteria based on predictors of nursing home placement in VA; (2) the selection and development of measures of medical efficacy that assess a wide range of patient and caregiver outcomes with sufficient sensitivity to detect small but clinically important changes; and (3) methods for detailed, accurate, and efficient measurement of utilization and costs of health care within and outside VA. These approaches may be helpful to other researchers and may advance the methodological sophistication of long-term care program evaluation.

Aged↗
PubMedDate not supplied

International service learning in midwifery and nursing education.

The health of women and childbearing families is a global concern that must be addressed if we are to be successful in ensuring healthy families. Numerous strategies have been suggested to increase appreciation for the global factors that influence maternal and child health and the overall health status of a community. Inclusion of cultural content in courses offered in educational programs and provision of clinical learning experiences in diverse communities have commonly been used in midwifery and nursing education. This article reviews the concept of service learning and its application in a course that provides an opportunity for students to participate in an international immersion program. Evaluation of the course found that participants increased their knowledge and skills in providing reproductive health care, developed appreciation for the knowledge and skills of traditional birth attendants, and expanded their world view of women and families in communities.

Altruism↗
PubMed2005

Research findings and strategies for assessing telemedicine costs.

With varying degrees of enthusiasm, researchers and decision-makers support the use of telemedicine. Forms of telemedicine are appearing in health-care delivery, and are often integral to transforming health-care information technology. Despite this, the appropriate role of telemedicine in the delivery process remains ambiguous, at least partly because of its uncertain impact on costs. Cost savings and benefits are often suggested by the logic of its impact on health care and by the promise of technology, but definitive information on the costs and benefits remain elusive. The objectives of this paper are to review the state of telemedicine cost research, to examine major issues affecting the yield from this research, and finally to recommend strategies for improving future research. As this paper demonstrates, the productivity of telemedicine cost studies suffers from an under-utilization of appropriate program evaluation and economic methods. This review of telemedicine cost literature will appraise telemedicine cost studies and their findings within a broad analytic framework. Telemedicine cost studies will be assessed on their methods of statistical inference, use of critical economic concepts, and contextual definition for the determination of costs and benefits.

Cost-Benefit Analysis↗
PubMed1999

A randomized outcome evaluation of group exercise programs in long-term care institutions.

BACKGROUND: Physical activity programs in nursing homes typically consist of seated, range of motion (ROM) exercises, regardless of resident abilities. The Functional Fitness for Long-Term Care (FFLTC) Program was designed not only to maintain ROM, but also to improve strength, balance, flexibility, mobility, and function. In addition, it was tailored to meet the needs of both high and low mobility residents. METHODS: The feasibility and efficacy of the FFLTC Program were evaluated with 68 residents (mean age 80) from five institutions. Persons were classified as low or high mobility and randomized into either the FFLTC program or a seated ROM program. Classes were conducted in groups of 4 to 10 residents by trained facility staff for 45 minutes, three times per week. Assessments at baseline and 4 months consisted of mobility, balance, gait, flexibility, functional capacity, and several upper and lower extremity strength measures. RESULTS: Attendance averaged 86% for the FFLTC and 79% for the ROM classes. Four months of exercise led to significant improvements in mobility (16%), balance (9%), flexibility (36%), knee (55%), and hip (12%) strength for the FFLTC group. Shoulder strength was the only improvement found for the ROM group. The ROM group significantly deteriorated in some areas, particularly hip strength, mobility, and functional ability. CONCLUSIONS: Institutionalized seniors, even those who are physically frail, incontinent and/or have mild dementia, can respond positively to a challenging exercise program. The FFLTC program demonstrated clear benefits over typical, seated ROM exercises. Moreover, with minimal training, the program can be safely delivered at low cost by institutional staff and volunteers.

Activities of Daily Living↗
PubMed1991

Peer education in friendship cliques: prevention of adolescent smoking.

The use of the term 'peer' teacher in adolescent health education programs has been applied with a variety of definitions. In some programs student teachers have been in the same grade as those they instructed; in others, they have been older students teaching lower grade students. The method of selection of student teachers has also varied. In some programs, a popular vote of students has been used to choose the student teachers; in other programs, the adult teachers and principals have chosen the student teachers. The purpose of the program reported here was to conduct smoking prevention education in friendship cliques taught by the clique's peer leaders. The friendship cliques and their peer leaders were identified by a computerized algorithm analysis of responses to a friendship questionnaire. The curriculum focused on social skills to prevent smoking and consisted of 8 weeks of education during the sixth and seventh grade years of 347 adolescents. The program evaluation compared the friendship cliques with 'model' students identified by school officials who taught their classmates and adult teachers instructing their students. The prevention rates of friendship cliques suggest that research studying this approach is needed. A practical means of identifying friendship cliques and their leaders is suggested.

Adolescent↗
PubMed2003

Organizational structure, team process, and future directions of interprofessional health care teams.

For a nationwide Geriatric Interdisciplinary Team Training (GITT) program evaluation of 8 sites and 26 teams, team evaluators developed a quantitative and qualitative team observation scale (TOS), examining structure, process, and outcome, with specific focus on the training function. Qualitative data provided an important expansion of quantitative data, highlighting positive effects that were not statistically significant, such as role modeling and training occurring within the clinical team. Qualitative data could also identify "too much" of a coded variable, such as time spent in individual team members' assessments and treatment plans. As healthcare organizations have increasing demands for productivity and changing reimbursement, traditional models of teamwork, with large teams and structured meetings, may no longer be as functional as they once were. To meet these constraints and to train students in teamwork, teams of the future will have to make choices, from developing and setting specific models to increasing the use of information technology to create virtual teams. Both quantitative and qualitative data will be needed to evaluate these new types of teams and the important outcomes they produce.

Aged↗
PubMed1995

Organizing and implementing a hospital-wide first-responder automated external defibrillation program: strengthening the in-hospital chain of survival.

First-responder automated external defibrillation (AED) in the hospital is consistent with the American Heart Association's (AHA) early defibrillation standard or care. With trained personnel and automated external defibrillators immediately available, early defibrillation should have a greater impact on survival than early cardiopulmonary resuscitation (CPR). Therefore, in our hospitals we modified basic life support to include automated external defibrillation (BLS-AED) for all personnel who are expected to respond to a cardiac arrest, with rapid defibrillation taking priority over CPR. We describe how we organized and implemented this hospital-wide first-responder BLS-AED program. Planning the process includes gaining support from key leaders who are responsible for resuscitation practice, and identifying the target audience of the training program. Hospital unit needs for AED or conventional defibrillation and equipment must be identified, the training program developed, and existing policies and procedures modified. Several barriers to implementation may exist. Education about the efficacy and safety of AED and experience once the BLS-AED program is in place can overcome attitudes and bias. Concerns about the cost of equipment and training must be addressed. Program evaluation may include patient issues such as measuring the time to the first defibrillation and patient outcome; as well as training and retention issues.

Adult↗
PubMed2006

Description of a research-based health activism curriculum for medical students.

INTRODUCTION: Few curricula train medical students to engage in health system reform. AIM: To develop physician activists by teaching medical students the skills necessary to advocate for socially equitable health policies in the U.S. health system. SETTING: Montefiore Medical Center, the University Hospital of the Albert Einstein College of Medicine, Bronx, NY. PROGRAM DESCRIPTION: We designed a 1-month curriculum in research-based health activism to develop physician activists. The annual curriculum includes a student project and 4 course sections;health policy, research methods, advocacy, and physician activists as role models; taught by core faculty and volunteers from academic institutions, government, and nongovernmental organizations. PROGRAM EVALUATION: From 2002 to 2005, 47 students from across the country have participated. Students reported improved capabilities to generate a research question, design a research proposal,and create an advocacy plan. DISCUSSION: Our curriculum demonstrates a model for training physician activists to engage in health systems reform.

Curriculum↗
PubMed1996

Qualitative methods for intervention research.

Intervention research takes place in field settings and requires understanding of social meanings and social processes. These are tasks for which qualitative research methods are well suited. The purpose of this paper is to provide a starting point for those who would like to learn more about the qualitative research methods used in disciplines where the study of social phenomena in naturalistic settings is common-particularly sociology, cultural anthropology, and human services program evaluation. The paper discusses some ways that qualitative and quantitative methodologies can usefully work together, outlines four key differences in the initial premises of quantitative and qualitative research approaches, briefly reviews some methodological techniques useful in gathering and analyzing qualitative data, and provides suggestions for further reading on various aspects of qualitative research.

Anthropology, Cultural↗
PubMed2002

A program to increase seat belt use along the Texas-Mexico border.

A school-based, bilingual intervention was developed to increase seat belt use among families living along the Texas-Mexico border. The intervention sought to increase seat belt use by changing perceived norms within the community (i.e., making the nonuse of seat belts less socially acceptable). The intervention was implemented in more than 110 classrooms and involved more than 2100 children. Blind coding, validity checks, and reliability estimates contributed to a rigorous program evaluation. Seat belt use increased by 10% among children riding in the front seat of motor vehicles in the intervention community, as compared with a small but nonsignificant decline in use among control community children. Seat belt use among drivers did not increase.

Child↗
PubMedDate not supplied

Client-centered approach to develop a seating clinic satisfaction questionnaire: a qualitative study.

OBJECTIVE: The purpose of this study was to develop a program evaluation tool through a client-centered approach. Client satisfaction questionnaires previously developed for service recipients of a pediatric seating clinic have reflected the professionals' views on what should be asked. METHOD: Seven parents and caregivers of recent service recipients of the seating clinic participated in tape-recorded semistructured interviews. They were asked their views on the seating clinic, how the service could be improved, and the quality of the seat received through the clinic. RESULTS: Data were coded into nine themes related to the process and the product. Using these themes and the vocabulary used by the participants, we developed a satisfaction questionnaire. The validity of the questionnaire was evaluated by requesting feedback on clarity, content, and design from all participants and from a panel of five health professionals. CONCLUSION: A client-centered approach can be used to develop a client satisfaction tool that reflects the needs of the users. Future work will involve testing the tool in the clinical setting.

Ambulatory Care↗