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A comparison of productivity and learning outcome in individual and cooperative physical therapy clinical education models.

BACKGROUND AND PURPOSE: This program evaluation was designed to evaluate productivity and the learning processes used during individual and cooperative clinical education experiences. SUBJECTS AND METHODS: Clinical instructors (n=23) and senior students (n=20) at the bachelor's degree level who were engaged in an individual learning experience at an Australian school provided workload productivity data on their daily patient care, administration, and teaching activities. An evaluation of the teaching and learning processes was conducted via questionnaire at the end of the experience. This same information was provided by a group of clinical instructors (n=8) and senior students (n=16) who were engaged in a cooperative learning experience. RESULTS: Clinical instructors in both learning experiences had to reduce their normal levels of productivity to supervise the students. The amount of patient care provided by students, however, compensated for this reduction in clinical instructor productivity. The extent of productivity gains in areas other than patient care were greater for the cooperative learning experience. Clinical instructors and students rated the individual and cooperative learning experiences similarly, although the students rated 3 particular learning processes more highly in the cooperative learning experience. CONCLUSION AND DISCUSSION: Advantages with respect to patient care, teaching, and administrative productivity were identified for each learning experience. From the perspective of the students, the cooperative learning experience appeared to provide additional educational benefits.

Australia↗

Quit and Win smoking cessation contest for Wisconsin college students.

OBJECTIVE: To determine effectiveness of smoking cessation contests at 3 Wisconsin colleges. DESIGN: Pre-post program evaluation, with 6-month follow-up. SETTING: Two-year technical college, private 4-year college, and state university in spring and fall of 2000. SUBJECTS: One hundred fifty-two college smokers. INTERVENTIONS: Students participated in 7-week stop-smoking contests. Successful quitters were eligible for prizes. Smoking status was assessed at 6-month follow-up by telephone survey. RESULTS: The cessation rate for 18- to 24-year-olds was 30% at the end of the contests. At the 6-month followup, 12% of participants were not smoking. Participants who smoked fewer cigarettes per month were more likely to quit smoking at the end of the contests. Although no difference was found between 2- and 4-year college participants, heavier smokers from 4-year colleges were more likely to quit. CONCLUSIONS: Because of their similarity to effective smoking promotions, contests should be considered a cost-effective strategy for this age group.

Adolescent↗

The standard gamble method: what is being measured and how it is interpreted.

OBJECTIVE: The Standard Gamble (SG) technique is recommended for measurement of individuals' preferences under uncertainty and to express the outcome of different therapeutic choices in utility values to be used in clinical decision analysis and health program evaluation. The article alerts users of this technique to problems stemming from inappropriate interpretation of results of measurements using the SG method. STUDY DESIGN: We review different situations where the SG method is used to measure individuals' or group preferences. PRINCIPAL FINDINGS: We demonstrate inappropriate interpretation of the time dimension at the individual level; issues stemming from the aggregation of individual utility values measured using different time horizons; the potential for double counting of the time preference effect when discounting future quality-adjusted life years (QALYs); and problems associated with using the SG technique to measure temporary health states. CONCLUSIONS: The inappropriate interpretations stem mainly either from ignoring the time dimension, which is inextricably bound to the health of the individual, or form adding assumptions, in addition to those required by von Neumann-Morgenstern (vNM) utility theory, that are not supported by empirical evidence. An alternative approach to QALYs, the healthy years equivalent (HYE), which incorporates the SG but avoids many of these problems, is described.

Decision Support Techniques↗

Treatment effects model for assessing disease management: measuring outcomes and strengthening program management.

This paper describes an analytical methodology for obtaining statistically unbiased outcomes estimates for programs in which participation decisions may be correlated with variables that impact outcomes. This methodology is particularly useful for intraorganizational program evaluations conducted for business purposes. In this situation, data is likely to be available for a population of managed care members who are eligible to participate in a disease management (DM) program, with some electing to participate while others eschew the opportunity. The most pragmatic analytical strategy for in-house evaluation of such programs is likely to be the pre-intervention/post-intervention design in which the control group consists of people who were invited to participate in the DM program, but declined the invitation. Regression estimates of program impacts may be statistically biased if factors that impact participation decisions are correlated with outcomes measures. This paper describes an econometric procedure, the Treatment Effects model, developed to produce statistically unbiased estimates of program impacts in this type of situation. Two equations are estimated to (a) estimate the impacts of patient characteristics on decisions to participate in the program, and then (b) use this information to produce a statistically unbiased estimate of the impact of program participation on outcomes. This methodology is well-established in economics and econometrics, but has not been widely applied in the DM outcomes measurement literature; hence, this paper focuses on one illustrative application.

Aged↗

Perceptions of the educational contract among Saudi residents and western staff physicians in Saudi Arabia.

BACKGROUND: Approved residency programs are increasingly being set up in Saudi Arabia and require that many Western staff physicians be rapidly deployed. METHOD: A non-university hospital in Saudi Arabia that employs several expatriate staff physicians undertook focused program evaluations of residencies in four disciplines in 1991 and again in 1992. Interviews, written comments, and questionnaires were used to collect residents' ratings of their training and clinical instructors and the residents' and staff physicians' perceptions regarding their educational contract, i.e., the personal agreement between teachers and learners. According to educational contract theory, clinical teachers adopt three basic roles (expert, model, or facilitator), as do residents (dependent, competitive, or participant). Chi-square with Yates' correction was used for statistical analysis. RESULTS: All 137 possible responses were returned (72 in 1991 and 65 in 1992). In 1991 the residents and staff physicians perceived the Saudi residents as mostly dependent, and 71% of the residents thought that the staff physicians were experts or models. This percentage conflicted with the staff physicians' own perceptions of their role as facilitators (46%). In 1992 the staff physicians increasingly perceived the residents as competitive (from 5% in 1991 to 10% in 1992), and the residents increasingly perceived the staff physicians to be facilitators (from 28% to 50%). CONCLUSION: The study compelled the staff physicians and residents to reexamine their perceptions of the educational contract between them. The resultant tendency toward convergence of perception was instructive and mutually beneficial.

Contract Services↗

Assessing outcomes of an academic computing initiative.

Academic computing initiatives rank high on the list of priorities of many dental schools. However, outcomes of academic computing initiatives have not been presented. The objectives of this program evaluation were to: 1) document a strategic initiative for academic computing over a five-year period; 2) assess outcomes; and 3) demonstrate how outcomes assessment changed strategic goals for the future. In 1992, Temple University School of Dentistry developed an academic computing plan. The plan proposed to develop the computer literacy of faculty, teach students the computer skills they need to be successful in their careers, and introduce computer-aided instruction as a new teaching tool. Before a new five-year plan was developed in 1997, the original plan's outcomes were summarily assessed. Assessment instruments included faculty and student surveys, budgets, inventory records, and utilization statistics. The school has reached two of three goals of the 1992 plan. Eighty percent of all full-time faculty have computers, are computer literate, and use computers for a variety of purposes. The school has implemented a comprehensive predoctoral dental informatics curriculum. However, the implementation of computer-aided instruction has not met expectations. Goals of the 1998-2003 plan include establishing an online learning infrastructure, improving student access, implementing computer-based oral health records, and further improving the computer literacy of faculty and students. Planning and supporting academic computing initiatives is a substantial challenge. Factors such as institutional culture, capital investment, ongoing support, and technological change influence plans and their success. While process and structure can be assessed relatively easily, measures for changed educational outcomes are still lacking.

Budgets↗

Meeting the reproductive health care needs of adolescents: California's Family Planning Access, Care, and Treatment Program.

PURPOSE: To examine the effect of the California Office of Family Planning's Family Access, Care, and Treatment Program (Family PACT), which was established in 1997 to provide comprehensive, reproductive health services for low-income adolescents and adults. Program evaluation was used to measure access to services, develop a profile of users, identify service utilization patterns, and assess the sensitivity of the health care system to the needs of adolescents. METHODS: Data sources include baseline data on California's previously established family planning services, enrollment, and claims data for the first 4 years of Family PACT, client exit interviews, and on-site observations. RESULTS: Adolescents represented 21% of all clients served by Family PACT in fiscal year 2000-2001 (FY 2000-2001). Adolescent clients served increased from 100,000 in FY 1995-1996 to more than 260,000 in FY 2000-2001(161% increase). The proportion of males has increased from 1% to 11%. In FY 2000-2001, Hispanics comprised 50% of adolescent clients, followed by 32% white, 9% African-American, and 6% Asian, Filipino, or Pacific Islander. Over one-half were aged 18 or 19 years, 42% were aged 15 to 17 years, and 5% were aged younger than 15 years. Contraceptive methods most often dispensed were barrier methods (55% for females, 72% for males), oral contraceptives (44%), contraceptive injections (16%), and emergency contraceptives (7%); 57% received sexually transmitted infection screening. CONCLUSIONS: By linking eligibility determination to the delivery of services, removing cost barriers, increasing the numbers and types of providers offering publicly funded services, and ensuring confidentiality, greater numbers of adolescents obtained needed reproductive health care, thus ensuring an opportunity to reduce unintended pregnancies and sexually transmitted infections.

Adolescent↗

Evaluation of a computer program for teaching laboratory diagnosis of acid-base disorders.

A computer program was evaluated as a tool for increasing the diagnostic acumen of medical housestaff and students in identifying acid-base disorders. The participants were randomized into two groups; group A (N = 20) was encouraged to use the software, and group B (N = 19) was denied access. Pre- and post-tests were administered to delineate the groups' ability to identify correctly an acid-base disorder from laboratory data (electrolytes and arterial blood gas). During 6 weeks, group A used the computer for a mean of 2.83 h (range 1 to 6). The mean +/- SE number of correct answers out of 20 questions, prior to use of the computer program, were 5.7 +/- 0.8 (95% confidence interval 3.9 to 7.5) for group A and 5.2 +/- 0.6 (95% confidence interval 3.9 to 6.5) for group B. These results were not statistically different. Correct responses increased significantly in group A to 10.3 +/- 0.9 (P < 0.0001, 95% confidence interval 8.4 to 12.2) but did not increase significantly in group B. The data suggest that this software program was effective in increasing the diagnostic capabilities of medical housestaff and students for identifying acid-base disorders.

Acid-Base Imbalance↗

[Evaluation of the prenatal care program in Curitiba, Paraná, Brazil: a cohort study of primigravidae].

A prenatal care program was evaluated to measure its effectiveness and impact. In 1999 a new prenatal care program was introduced in Curitiba, Paraná State, Brazil, in health services under the Unified National Health System, introducing organizational changes in order to enhance accessibility, increase the number and distribution of prenatal visits, and ensure minimum necessary procedures. To evaluate how these changes were assimilated in routine practice, a cohort study was proposed in a sample of 660 primigravidae randomly selected among women enrolled in the program before the 20th week of gestation, from March to August, 2000. Two home visits and consultation of maternity cards or patient records during prenatal and hospital care were performed. The results indicate good accessibility and professional adherence to the protocol, but problems still remain with initiating care before the end of the first trimester and adequate distribution of consultations. According to the study criteria, adequate care was found for only 38.6% of the women, pointing to the complexity of factors that influence adequate prenatal care.

Brazil↗

Need for an external proficiency testing program for cytokines, chemokines, and plasma markers of immune activation.

An external evaluation program for measuring the performance of laboratories testing for cytokines and immune activation markers in biological fluids was developed. Cytokines, chemokines, soluble cytokine receptors, and other soluble markers of immune activation (CSM) were measured in plasma from a healthy human immunodeficiency virus (HIV)-seronegative reference population and from HIV-seropositive individuals as well as in supernatant fluids from in vitro-stimulated human immune cells. The 14 components measured were tumor necrosis factor (TNF) alpha, gamma interferon, interleukin-1 (IL-1), IL-2, IL-4, IL-6, IL-10, Rantes, MIP-Ia, MIP-Ibeta, soluble TNF receptor II, soluble IL-2 receptor alpha, beta(2)-microglobulin, and neopterin. Twelve laboratories associated with the Adult and Pediatric AIDS Clinical Trial Groups participated in the study. The performance features that were evaluated included intralaboratory variability, interlaboratory variability, comparison of reagent sources, and ability to detect CSM in the plasma of normal subjects as well as the changes occurring in disease. The principal findings were as follows: (i) on initial testing, i.e., before participating in the program, laboratories frequently differed markedly in their analytic results; (ii) the quality of testing of a CSM in individual participating laboratories could be assessed; (iii) most commercial kits allowed distinction between normal and abnormal plasma CSM levels and between supernatants of stimulated and unstimulated cells; (iv) different sources of reagents and reference standards frequently provided different absolute values; (v) inexperienced laboratories can benefit from participating in the program; (vi) laboratory performance improved during active participation in the program; and (vii) comparability between analyses conducted at different sites can be ensured by an external proficiency testing program.

Adult↗

Evaluating a primary prevention program in a multicultural population: the importance of representations of back pain.

OBJECTIVE: This study was carried out during 4 years of longitudinal research assessing back pain problems and the impact of a back pain primary prevention program on the employees of a food and non-food chain store. The impact of the teaching program was reevaluated in a secondary analysis, taking into account subjects' prior representations of back pain. METHODS: Subjects were grouped according to their cultural origins and socioprofessional levels. Their representations were assessed by means of open questions before and after the teaching program. RESULTS: The teaching program reinforced pre-existing representations in those participants socioculturally nearest the teachers; it had a weak or even disturbing impact on those furthest removed from the teachers in sociocultural terms. CONCLUSION: The differential impact of the teaching program in this study indicates that participants' prior representation play a role in the outcome of a Back School teaching program. Thus, the participants' representations should be taken into account when designing the program and when assessing participants' suitability for such programs, their adherence, and the outcome.

Back Pain↗

Preliminary evaluation of a multicomponent program for nutrition and physical activity change in primary care: PACE+ for adults.

BACKGROUND: Patient-centered Assessment and Counseling on Exercise plus nutrition (PACE+) is an intervention based in primary care settings to help patients change physical activity and dietary behaviors. METHODS: One hundred seventy-three adults were assessed before and after a 4-month intervention. All patients completed a computerized assessment and created tailored "action plans" to change one physical activity and one nutrition behavior that they then discussed with their provider. After the visit, subjects were randomized to one of four extended intervention conditions: control, mail only, infrequent phone and mail, and frequent phone and mail. Self-report of five target behaviors (moderate and vigorous physical activity stage of change, dietary fat, fruit/vegetable intake, and overeating behaviors) was collected at baseline and 4 months. Acceptability measures were also taken. RESULTS: Participants in all conditions improved on all behaviors over time, supporting the utility of the computer and provider counseling components. The extended intervention did not produce differential results with respect to mode (phone or mail) or intensity (frequent or infrequent). However, for each behavior, participants who targeted the behavior to change improved significantly more than those who did not target the behavior. Acceptability of the intervention was high. CONCLUSIONS: Primary care-based, interactive health communication to improve physical activity and dietary behavior is feasible and has promising initial results.

Adult↗

[Evaluation of an educational program on smoking, alcohol and drug abuse].

The learning program with the title "Consuming critically" has the objective to influence the learner so that he will completely abstain from smoking, drinking of alcoholic beverages and the abuse of medication or at least reduce the respective consumption. A reduction in consumption or a reduction in the predisposition to consume for those who were none-consumers was considered the criteria for a successful utilization of the program. The program was evaluated with a representative sample including all types of schools at the 8th grade in the Basle Schools. By a standardized questionnaire behaviour and attitudes were measured. Regarding the smoking of cigarettes changes in the desired direction could be shown in both behaviour and attitude. No effect could be proven as to the consumption of alcoholic beverages. A significant positive change in the attitude towards the proper use of medication could be demonstrated while the corresponding consumption pattern remained unchanged.

Adolescent↗

The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fracture.

INTRODUCTION: Fracture care often represents the first opportunity for clinical management of osteoporosis; however, many patients do not receive any evaluation after a fracture. In Glasgow, Scotland, fewer than 10% of fracture patients underwent bone mineral density (BMD) testing. In an effort to better meet the needs of fracture patients by providing routine assessment and, where necessary, treatment for osteoporosis after their fracture, a novel service (The Fracture Liaison Service) was designed and implemented in two separate National Health Service trusts in Glasgow. METHODS: An agreed-upon standard of care for men and women 50+ years of age with fractures was established in collaboration with orthopedic surgeons and primary care physicians. The Fracture Liaison Service assumes responsibility for fracture case-finding and for assessing and performing diagnostic evaluations (including axial DXA), and making specific treatment recommendations for the secondary prevention of osteoporotic fractures. RESULTS: During the first 18 months of operation, more than 4,600 patients with fractures of the hip, wrist, humerus, ankle, foot, hand, and other sites were seen by the Fracture Liaison Service's osteoporosis specialist nurses. Nearly three quarters of these patients were considered for BMD testing; treatment was recommended for approximately 20% of the patients without need for BMD testing. Overall, 82.3% of patients who had BMD testing were found to be osteopenic or osteoporotic at the hip or spine. CONCLUSIONS: The Fracture Liaison Service has successfully identified and evaluated most patients with fractures. Only those patients who declined were not evaluated. The ultimate success of the program will be measured by the subsequent fracture experience of these patients, but clear improvements in diagnosing and treating low bone mineral density in patients with fracture have already been demonstrated.

Absorptiometry, Photon↗