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PubMed2003

Introducing practice-based learning and improvement ACGME core competencies into a family medicine residency curriculum.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) recommends integrating improvement activities into residency training. A curricular change was designed at the Department of Family and Community Medicine, University of Louisville, to address selected ACGME competencies by incorporating practice-based improvement activities into the routine clinical work of family medicine residents. METHODS: Teams of residents, faculty, and office staff completed clinical improvement projects at three ambulatory care training sites. Residents were given academic credit for participation in team meetings. After 6 months, residents presented results to faculty, medical students, other residents, and staff from all three training sites. Residents, staff, and faculty were recognized for their participation. PROGRAM EVALUATION: Resident teams demonstrated ACGME competencies in practice-based improvement: Chart audits indicated improvement in clinical projects; quality improvement tools demonstrated analysis of root causes and understanding of the process; plan-do-study-act cycle worksheets demonstrated the change process. CONCLUSIONS: Improvement activities that affect patient care and demonstrate selected ACGME competencies can be successfully incorporated into the daily work of family medicine residents.

Academic Medical Centers↗

PubMed1995

[Evaluation of a training program for traditional birth attendants in Quetzaltenango, Guatemala].

In 1992, a training program for traditional birth attendants (TBAs) was initiated in Quetzaltenango, Guatemala, in order to improve the identification and treatment of neonatal disorders and high-risk pregnancies. This program was evaluated by comparing the pattern of hospital referrals by TBAs before and after the training. The study design consisted of a community intervention evaluated by means of several cross-sectional surveys. Comparisons were made between a group of TBAs who had received the training (intervention group) and another group of TBAs from nearby communities who had not received the training (control group). The outcome variables included the TBAs' ability to correctly identify obstetric complications, the point in time at which they sent mothers to the hospital, and perinatal mortality among the children whose mothers were referred to the hospital. Of the 854 women eligible, 845 participated in the study. Following the training program, there was a 200% increase in the number of mothers referred to the hospital by the TBAs. There was also improvement in the ability of the TBAs in the intervention group to refer women with obstetric complications to the hospital, although the effect of the program appeared to have been minimal on both that ability and the reduction of perinatal mortality. Nevertheless, the latter effect should be more precisely determined, since a decrease in perinatal mortality was observed in both the intervention and control groups, with no statistically significant difference.

Adolescent↗

PubMed2005

Problem-based and case-based learning in respiratory care education.

Problem-based learning has been used in respiratory therapy education for a relatively short time. The purpose of PBL is to produce a graduate who has improved critical thinking and life-long learning skills. On a practical note, another goal is to help the graduate pass the NBRC Clinical Simulation examination. PBL is the use of cases to provide a stimulus for the specification of learning issues, or objectives, which the students research and discuss. The heart of the PBL process is the tutorial group, composed ofa group of five to seven students and a faculty facilitator. Students work through the case, listing facts, testing hypotheses, learning pharmacology,and studying the learning issues of the case. Information is learned in thecontext of the patient case, rather than in isolated classes. Cases are presented in the progressive-disclosure model. Student evaluation consists of written examinations, self- and peer evaluation, and with an independent case study process. Program evaluation has shown that students enjoy the process and think that they are performing clinically better than their non-PBL peers. Pass rates for the Clinical Simulation examination are above the national average. A more in-depth study of program outcomes is indicated.

Allied Health Personnel↗

PubMed2006

Caregivers and professionals partnership caregiver resource center: assessing a hospital support program for family caregivers.

BACKGROUND: Given that 71% of caregivers nationally report that they are caring for someone with a long-term or chronic illness, providing support to families-from diagnosis to the bereavement phase--is essential. PURPOSE: This paper describes an exploratory assessment of a hospital-based support program for family caregivers, the Caregivers and Professionals Partnership (CAPP) Caregiver Resource Center. The goal of the program evaluation was to understand the challenges facing caregivers who used the Center, how social workers intervened and the results of their interventions. Authors suggest that caregivers benefit from social work interventions that focus both on the emotional impact of caregiving and the multiple resource issues caregivers face. METHODS: Social workers assisted more than half of participating caregivers with emotional coping issues as well as referrals to community resources. In approximately 75% of cases, social workers followed up with caregivers to engage them in services and ensure that they received ongoing support. FINDINGS: From the perspective of Resource Center social workers, their interventions enhanced caregivers' abilities to cope with their responsibilities. CONCLUSIONS: Supporting caregivers over time and following up to ensure that they access needed services are critical ways to help them cope with care of a loved one. Future research can focus on how to engage caregivers who are isolated or too overwhelmed to ask for help in order to increase their use of caregiver assistance programs.

Adaptation, Psychological↗

PubMedDate not supplied

Best practices in Web-based courses: generational differences across undergraduate and graduate nursing students.

The demand for online courses is greatly increasing across all levels of the curriculum in higher education. With this change in teaching and learning strategies comes the need for quality control to determine best practices in online learning communities. This study examines the differences in student perceptions of the use of technology, educational practices, and outcomes between undergraduate and graduate students enrolled in Web-based courses. The multisite study uses the benchmarking process and the Flashlight Program Evaluating Educational Uses of the Web in Nursing survey instrument to study best practices and examine generational differences between the two groups of students. The outcomes of the study establish benchmarks for quality improvement in online learning. The results support the educational model for online learning and postulates about generational differences for future study.

Adult↗

PubMed2006

The use of tissue models for vascular access training. Phase I of the procedural patient safety initiative.

INTRODUCTION: Following the Institute of Medicine report "To Err is Human," the Agency for Healthcare Research and Quality identified proper central venous catheter (CVC) insertion techniques and wide sterile barriers (WSB) as 2 major quality indicators for patient safety. However, no standard currently exists to teach proper procedural techniques to physicians. AIM: To determine whether our nonhuman tissue model is an effective tool for teaching physicians proper wide sterile barrier technique, ultrasound guidance for CVC placement, and sharps safety. PARTICIPANTS: Educational sessions were organized for physicians at Cedars-Sinai Medical Center. Participants had a hands-on opportunity to practice procedural skills using a nonhuman tissue model, under the direct supervision of experienced proceduralists. PROGRAM EVALUATION: An anonymous survey was distributed to participants both before and after training, measuring their reactions to all aspects of the educational sessions relative to their prior experience level. DISCUSSION: The sessions were rated highly worthwhile, and statistically significant improvements were seen in comfort levels with ultrasound-guided vascular access and WSB (P<.001). Given the revitalized importance of patient safety and the emphasis on reducing medical errors, further studies on the utility of nonhuman tissue models for procedural training should be enthusiastically pursued.

Animals↗

PubMed1994

The NCIC/CCS behavioral initiative. National Cancer Institute of Canada Canadian Cancer Society.

The NCIC's behavioral initiative is comprised of three pillars, each of which is designed to make an important independent contribution toward a reduction in cancer incidence, morbidity or mortality rates. It is also expected that the activities in one area will complement those in the other areas, thereby creating a synergistic effect. To determine if the objectives of the Centre for Behavioral Research and Program Evaluation (CBRPE) are being met, the NCIC has committed to an ongoing assessment of the CBRPE's performance, including an independent review of its scientific merit by a site visit conducted at the end of the second year of the CBRPE's operation. Thus, while the behavioral initiative represents a different type of investment by the NCIC, its contributions will be judged via a process that is central to all NCIC activities--the assessment of scientific merit by teams of persons recognized nationally and internationally for their expertise in social and behavioral research as it pertains to cancer.

Behavioral Sciences↗

PubMed2002

On any Saturday--a practical model for diabetes education.

PURPOSE: Patient self-management is an important part of treating chronic diseases. However, many primary care physicians face barriers in offering office-based diabetes education. This paper will discuss a practical program of community-based diabetes education that can be easily modified for a practitioner's office. PROCEDURE: Half-day diabetes education workshops geared toward local health care providers and patients with diabetes and their families were conducted in two rural communities in Arkansas. Participants were surveyed with respect to the effectiveness of the program and how they would use what they learned in the program. FINDINGS: Thirty-one health care providers and 59 patients with diabetes and their families attended. Program evaluation scores were between 4.1 and 5 on a 5-point Likert scale. One third of the patients commented that they had a better understanding of diet and medication use. Feedback from community health care providers noted that attendance in local diabetes support groups increased after the workshops. CONCLUSIONS: Diabetes complications have a large impact on the health of the population and a growing economic impact on the health care industry. Although there are many barriers to diabetes education and control, a practical half-day diabetes workshop on any Saturday can be effectively developed and implemented.

Community Health Services↗

PubMed1996

Questionnaire development.

The mail questionnaire is one of the most common forms of research conducted in applied health. It is used primarily for assessing community health needs, exploring opinions on health issues, determining self-reports of health behavior, and aiding program evaluations (Torabi, 1991). The accuracy of conclusions based on questionnaire responses depends upon many factors, including the wording of questions, the physical appearance of the questionnaire (Berdie, Anderson & Niebuhr, 1986; Sudman & Bradburn, 1982), and the response rate (Jones, 1993). Therefore, careful planning must precede the development and administration of any questionnaire. This article, providing a summary of some of the issues and techniques to consider when developing and administering a questionnaire, is organized into two main topics: Writing the questions and increasing response rate. Several subtopics are discussed within each of these two main topics, and suggestions for improving questionnaires are made throughout.

Attitude to Health↗

PubMed1998

Generalizability theory: a unified approach to assessing the dependability (reliability) of measurements in the health sciences.

The reliability of health promotion program evaluation measures, behavioral and attitudinal measures, and clinical measures is a concern to many health educators. Classical reliability coefficients, such as Cronbach's alpha, apply to narrowly defined, prespecified measurement situations. Classical theory does not provide adequate reliability assessments for criterion-referenced measures, for measurement situations having multiple sources of error, or for aggregate-level variables. Generalizability theory can be used to assess the reliability of measures in these situations that are not adequately modeled by Classical theory. Additionally, Generalizability theory affords a broader view and a deeper understanding of the dependability of measurements and the role of different sources of error in the variability of measures.

Health Promotion↗

PubMed2003

Newborn screening in the Philippines.

The Newborn Screening Study Group first introduced newborn screening in the Philippines in 1996. This group of pediatricians and obstetricians from 24 hospitals in the metropolitan Manila area developed a newborn screening program: (1) to establish the incidence of six metabolic conditions--congenital hypothyroidism, congenital adrenal hyperplasia, galactosemia, phenylketonuria, homocystinuria and glucose-6-phosphate dehydrogenase deficiency, and (2) to make recommendations for the adoption of newborn screening nationwide. Newborn screening developed in three phases: (1) routine screening for 5 disorders excluding G6PD deficiency in the 24 member hospitals in Metro Manila, (2) addition of screening for G6PD deficiency to the 5-disorder screening panel, and (3) program evaluation with subsequent reduction in the time of sample collection to 24 hrs of age or older (from the initial requirement of 48 hrs. or older) and discontinuation of screening for homocystinuria as a cost cutting measure (due to non-detection of cases). Data from 201 participating hospitals reported in September 2001 confirmed 48 cases of congenital hypothyroidism, 21 cases of congenital adrenal hyperplasia, 2 cases of galactosemia, 4 cases of hyperphenylalanemia and 1,495 cases of glucose-6-phosphate dehydrogenase deficiency. The Department of Health has recognized the significance of the initial data and efforts are now being undertaken to ensure the nationwide implementation of newborn screening.

Health Policy↗

PubMed1999

Are health states "timeless"? The case of the standard gamble method.

The standard gamble method, as currently recommended for use in health care program evaluation, provides an individual's preference score or "utility weight" for living in a given health state for the rest of the individual's life. Many researchers interpret this value as a time-independent or "timeless" one and order health states on a scale of zero (death) to one (full health), regardless of the time spent in the health state. This article examines whether preference scores for a severe pain health state are "timeless," or in other words whether the utility independence assumption is satisfied. Our study results suggest that for the majority of respondents, the preference scores are not independent of time.

Aged↗

PubMed2005

The insufficiency of evidence to establish the business case for quality.

PURPOSE: To determine whether a positive financial return on investment for quality-enhancing interventions is more likely for particular health conditions, in specific organizational settings, or with the use of particular interventions. DATA SOURCES: Electronic search of MEDLINE. DATA EXTRACTION: Search keywords included: business case, cost-effectiveness, cost-benefit, return on investment, costs, cost savings, quality, quality improvement, and program evaluation. RESULTS: Only 15 of 1968 articles identified contained sufficient information on both the costs of implementing quality-enhancing interventions and the resultant changes in costs of care or revenues to permit the calculation of a return on investment. CONCLUSIONS: Scant attention is currently paid in the quality-of-care literature to the cost of implementing quality-enhancing interventions. To understand which quality-enhancing interventions are likely to produce positive returns on investments, data collection and analysis must include tracking the investment and operating costs of implementing the intervention as well as the changes in revenues and costs that result from the intervention.

Cost-Benefit Analysis↗

PubMed2003

Feasibility of referring drug users from a needle exchange program into an addiction treatment program: experience with a mobile treatment van and LAAM maintenance.

We evaluated program entry, retention, and early treatment response of needle exchange program (NEP) attenders referred to a drug treatment program using levomethadyl acetate hydrochloride (LAAM). Of 163 referrals, 114 (70%) entered the program, and 84% were retained for at least 90 days. Comparing baseline and follow-up visits after 1 month, there were significant reductions in the Addiction Severity Index subscale scores for drug and alcohol use and legal situation. We observed a 31% and 22% reduction in heroin- and cocaine-positive urine tests, respectively (p < .0001). Although LAAM is no longer considered a first line treatment for heroin addiction, these results demonstrate the feasibility of utilizing long-acting agonist therapies such as LAAM to treat opioid dependence among NEP attenders.

Adult↗

PubMedDate not supplied

Implementation and refinement of a research utilization course for oncology nurses.

PURPOSE/OBJECTIVES: To describe the implementation and refinement of a yearly research utilization (RU) course for oncology nurses. DESIGN: Formative program evaluation. SAMPLE: 22 oncology nurses selected based on competitively reviewed project proposals. METHODS: The one-day RU course was held five times prior to the annual fall Oncology Nursing Society conference. The course consisted of brief didactic sessions on RU, project presentations by participants, faculty reviews, and discussions of practical issues related to project implementation. MAIN RESEARCH VARIABLES: Course content, usefulness of course components. FINDINGS: Based on immediate postcourse, 6-month, and 12-month feedback, refinements were made to the course. A major change (in year three) was the addition of a "preparation packet," which contained resources about RU and directed students to accomplish specific precourse goals, and access to a faculty mentor. Evaluation scores were good to outstanding for the content and usefulness of the course presentations, critiques by faculty, and discussion sessions. Interviews with participants indicated that a majority completed or were working on their projects within four years of completing the course. CONCLUSIONS: RU and some of its components (pursuing a literature search, making a practice change) are not processes that most nurses are familiar with, but these processes can be taught to nurses with focused clinical concerns. IMPLICATIONS FOR NURSING: An RU course with a low faculty-to-student ratio, adequate course materials, and systematic instruction can lead to research-based changes in practice.

Curriculum↗

PubMed2005

[Participatory evaluation in health programs: a proposal for the Adolescent Health Care Program].

This article presents a model for participatory evaluation of the Adolescent Health Program (PROSAD) in Brazil. The study focuses on the concept of participation, with a review of internationally validated planning methodologies (RAP, logFRAME, ZOPP, PCM) and the programmatic characteristics of PROSAD. The proposed model comprises 4 steps, involving the constitution of the analytical matrix, a self-evaluation workshop, a summary of results, and graphic representation. The model promotes participatory practice in health program management by using techniques that allow a workshop to be held in 70 minutes (mean time), producing results that are recognized and easily grasped by the local team.

Adolescent↗

PubMed1997

Tried, true, and new: public health nursing in a county substance abuse treatment system.

The Milwaukee Target Cities (MTC) project was the only site within 19 federally funded Target Cities programs to feature a public health nursing model as its sole means of providing comprehensive health-related services to indigent substance abuse clients. We first describe MTC's implementation process, focusing on the public health nursing component, and then present a program evaluation section with selected findings from the ongoing qualitative evaluation. Initially, misunderstandings about the nurses' community-based, family-centered strategy of assuring access to health care through cross-system service linkage dogged the nurses' efforts to explain their roles and mission to federal funders, project management, coworkers, and treatment providers. In the end, after federal funding ended, public health nursing left an enduring legacy of partnerships in the county substance abuse treatment system: education about public health nursing, networking, referral processes, and resources to meet the complex health-related needs of indigent substance abusers. Despite the project's many changes, the nurses (a) became specialists in substance abuse, gaining expertise and recognition in a new community, particularly with isolated subpopulations; (b) assured substance abuse clients and their families access to health-related resources through core public health nursing skills; and (c) educated project staff, administrators, providers, and clients about public health nursing.

Child, Preschool↗

PubMed1999

Tracking the State Children's Health Insurance Program with hospital data: national baselines, state variations, and some cautions.

State and federal agencies are concerned with the impact of the State Children's Health Insurance Program (CHIP) on the health care of enrolled children. As part of a broad program evaluation, and at relatively low cost, analysts can track data on hospital admissions for ambulatory care sensitive (ACS) conditions. This article uses hospital data for 19 states to calculate baseline ACS rates and to discuss trends and cross-state variations just prior to the start of the CHIPs. A few cautions and limitations are discussed. An unexpected result in the exploration was a substantial increase in the rate of ACS admissions for self-pay and Medicaid-enrolled children during the period of 1990-1995. During that same period, the admission rate for other insured children fell by more than a third. The comparisons across states are meant to be illustrative; they do reveal a relationship between the rate of asthma admissions and the proportion of self-pay plus Medicaid-enrolled cases.

Adolescent↗