Addressing women's health needs and improving birth outcomes: results from a peer-to-peer state Medicaid learning project.

PubMed

Johnson, Kay

2012-08-01

High rates of maternal mortality, infant mortality, and preterm births, as well as continuing disparities in pregnancy outcomes, have prompted a number of state Medicaid agencies to focus on improving the quality and continuity of care delivered to women of childbearing age. As part of a peer-to-peer learning project, seven Medicaid agencies worked to develop the programs, policies, and infrastructures needed to identify and reduce women's health risks either prior to or between pregnancies. The states also identified public health strategies. These strategies led to a policy checklist to help leaders in other states identify improvement opportunities that fit within their programs' eligibility requirements, quality improvement objectives, and health system resources. Many of the identified programs and policies may help states use the upcoming expansion of the Medicaid program to improve women's health and thereby reduce adverse birth outcomes.

Relative value unit-based compensation incentivization in an academic vascular practice improves productivity with no early adverse impact on quality.

PubMed

Awad, Nadia; Caputo, Francis J; Carpenter, Jeffrey P; Alexander, James B; Trani, José L; Lombardi, Joseph V

2017-02-01

Given the increased pressure from governmental programs to restructure reimbursements to reflect quality metrics achieved by physicians, review of current reimbursement schemes is necessary to ensure sustainability of the physician's performance while maintaining and ultimately improving patient outcomes. This study reviewed the impact of reimbursement incentives on evidence-based care outcomes within a vascular surgical program at an academic tertiary care center. Data for patients with a confirmed 30-day follow-up for the vascular surgery subset of our institution's National Surgical Quality Improvement Program submission for the years 2013 and 2014 were reviewed. The outcomes reviewed included 30-day mortality, readmission, unplanned returns to the operating room, and all major morbidities. A comparison of both total charges and work relative value units (RVUs) generated was performed before and after changes were made from a salary-based to a productivity-based compensation model. P value analysis was used to determine if there were any statistically significant differences in patient outcomes between the two study years. No statistically significant difference in outcomes of the core measures studied was identified between the two periods. There was a trend toward a lower incidence of respiratory complications, largely driven by a lower incidence in pneumonia between 2013 and 2014. The vascular division had a net increase of 8.2% in total charges and 5.7% in work RVUs after the RVU-based incentivization program was instituted. Revenue-improving measures can improve sustainability of a vascular program without negatively affecting patient care as evidenced by the lack of difference in evidence-based core outcome measures in our study period. Further studies are needed to elucidate the long-term effects of incentivization programs on both patient care and program viability. Copyright © 2016. Published by Elsevier Inc.

Rewarding healthy behaviors--pay patients for performance.

PubMed

Wu, Joanne

2012-01-01

Despite a considerable investment of resources into pay for performance, preliminary studies have found that it may not be significantly more effective in improving health outcome measures when compared with voluntary quality improvement programs. Because patient behaviors ultimately affect health outcomes, I would propose a novel pay-for-performance program that rewards patients directly for achieving evidence-based health goals. These rewards would be in the form of discounts towards co-payments for doctor's visits, procedures, and medications, thereby potentially reducing cost and compliance issues. A pilot study recruiting patients with diabetes or hypertension, diseases with clear and objective outcome measures, would be useful to examine true costs, savings, and health outcomes of such a reward program. Offering incentives to patients for reaching health goals has the potential to foster a stronger partnership between doctors and patients and improve health outcomes.

Germany's Disease Management Program: Improving Outcomes in Congestive Heart Failure

PubMed Central

Kottmair, Stefan; Frye, Christian; Ziegenhagen, Dieter J.

2005-01-01

Hospital admissions among patients with congestive heart failure (CHF) are a major contributor to health care costs. A comprehensive disease management program for CHF was developed for private and statutory health insurance companies in order to improve health outcomes and reduce rehospitalization rates and costs. The program comprises care calls, written training material, telemetric monitoring, and health reports. Currently, 909 members from six insurance companies are enrolled. Routine evaluation, based on medical data warehouse software, demonstrates benefits in terms of improved health outcomes and processes of care. Economical evaluation of claims data indicates significant cost savings in a pre/post study design. PMID:17288080

Implementation and outcomes of commercial disease management programs in the United States: the disease management outcomes consolidation survey.

PubMed

Fitzner, Karen; Fox, Kathe; Schmidt, Joseph; Roberts, Mark; Rindress, Donna; Hay, Joel

2005-08-01

Despite widespread adoption of disease management (DM) programs by US health plans, gaps remain in the evidence for their benefit. The Disease Management Outcomes Consolidation Survey was designed to gather data on DM programs for commercial health plans, to assess program success and DM effectiveness. The questionnaire was mailed to 292 appropriate health plan contacts; 26 plans covering more than 14 million commercial members completed and returned the survey. Respondents reported that DM plays a significant and increasing role in their organizations. Key reasons for adopting DM were improving clinical outcomes, reducing medical costs and utilization, and improving member satisfaction. More respondents were highly satisfied with clinical results than with utilization or cost outcomes of their programs (46%, 17%, and 13%, respectively). Detailed results were analyzed for 57 DM programs with over 230,000 enrollees. Most responding plans offered DM programs for diabetes and asthma, with return on investment (ROI) ranging from 0.16:1 to 4:1. Weighted by number of enrollees per DM program, average ROI was 2.56:1 for asthma (n = 1,136 enrollees) and 1.98:1 for diabetes (n = 25,364). Most (but not all) respondents reported reduced hospital admissions, increasing rates of preventive care, and improved clinical measures. Few respondents provided detailed information about DM programs for other medical conditions, but most that did reported positive outcomes. Lack of standardized methodology was identified as a major barrier to in-house program evaluation. Although low response rate precluded drawing many general conclusions, a clear need emerged for more rigorous evaluation methods and greater standardization of outcomes measurement.

42 CFR 422.152 - Quality improvement program.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., quality of life indicators, depression scales, or chronic disease outcomes). (iii) Staff implementation of... 42 Public Health 3 2014-10-01 2014-10-01 false Quality improvement program. 422.152 Section 422... (CONTINUED) MEDICARE PROGRAM (CONTINUED) MEDICARE ADVANTAGE PROGRAM Quality Improvement § 422.152 Quality...

42 CFR 422.152 - Quality improvement program.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., quality of life indicators, depression scales, or chronic disease outcomes). (iii) Staff implementation of... 42 Public Health 3 2012-10-01 2012-10-01 false Quality improvement program. 422.152 Section 422... (CONTINUED) MEDICARE PROGRAM (CONTINUED) MEDICARE ADVANTAGE PROGRAM Quality Improvement § 422.152 Quality...

42 CFR 422.152 - Quality improvement program.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., quality of life indicators, depression scales, or chronic disease outcomes). (iii) Staff implementation of... 42 Public Health 3 2013-10-01 2013-10-01 false Quality improvement program. 422.152 Section 422... (CONTINUED) MEDICARE PROGRAM (CONTINUED) MEDICARE ADVANTAGE PROGRAM Quality Improvement § 422.152 Quality...

The Impact of Prolonged Participation in a Pro-Social Cognitive Behavioral Skills Program on Elementary Age Students, with Behavior Related Disorders, Behavior Accelerative, Behavior Reductive, and Return to Regular Classroom Outcomes

ERIC Educational Resources Information Center

Esser, Ted H.

2012-01-01

Overall, pretest-posttest results indicated statistically significant pretest beginning program compared to posttest ending program percentage of behavioral improvement for on task, following directions, and positive interactions outcomes improvement for individual students who completed the elementary grades pro-social cognitive behavioral skills…

The effectiveness of skills training for improving outcomes in supported employment.

PubMed

Mueser, Kim T; Aalto, Steve; Becker, Deborah R; Ogden, John S; Wolfe, Rosemarie S; Schiavo, Diane; Wallace, Charles J; Xie, Haiyi

2005-10-01

This study evaluated whether a supplementary skills training program improved work outcomes for clients enrolled in supported employment programs. Thirty-five recently employed clients with severe mental illness who were receiving supported employment services at a free-standing agency were randomly assigned to participate in either the workplace fundamentals program, a skills training program designed to make work more "successful and satisfying," or treatment as usual. Knowledge of workplace fundamentals (for example, identifying workplace stressors, problem solving, and improving job performance) was assessed at baseline and at nine months; employment outcomes and use of additional vocational services were tracked for 18 months. Clients in the workplace fundamentals group (N=17) improved more in knowledge of workplace fundamentals than those in the control group (N=18) at the nine-month follow-up, but the two groups did not differ in the number of hours or days worked, salary earned, or receipt of additional vocational services over the 18-month period. In general, clients in this study had higher educational levels and better employment outcomes than clients in most previous studies of supported employment, making it difficult to detect possible effects of the skills training intervention on work. Supplementary skills training did not improve work outcomes for clients who were receiving supported employment.

A Checklist-based Intervention to Improve Surgical Outcomes in Michigan: Evaluation of the Keystone Surgery Program

PubMed Central

Reames, Bradley N.; Krell, Robert W.; Campbell, Darrell A.; Dimick, Justin B.

2015-01-01

Importance Previous studies of checklist-based quality improvement interventions have reported mixed results. Objective To evaluate whether implementation of a checklist-based quality improvement intervention, Keystone Surgery, was associated with improved outcomes in patients undergoing general surgery in large statewide population. Design, Setting and Exposure Retrospective longitudinal study examining surgical outcomes in Michigan patients using Michigan Surgical Quality Collaborative clinical registry data from the years 2006–2010 (n=64,891 patients in 29 hospitals). Multivariable logistic regression and difference-in-differences analytic approaches were used to evaluate whether Keystone Surgery program implementation was associated with improved surgical outcomes following general surgery procedures, apart from existing temporal trends toward improved outcomes during the study period. Main Outcome Measures Risk-adjusted rates of superficial surgical site infection, wound complications, any complication, and 30-day mortality. Results Implementation of Keystone Surgery in participating centers (n=14 hospitals) was not associated with improvements in surgical outcomes during the study period. Adjusted rates of superficial surgical site infection (3.2 vs. 3.2%, p=0.91), wound complications (5.9 vs. 6.5%, p=0.30), any complication (12.4 vs. 13.2%, p=0.26), and 30-day mortality (2.1 vs. 1.9%, p=0.32) at participating hospitals were similar before and after implementation. Difference-in-differences analysis accounting for trends in non-participating centers (n=15 hospitals), and sensitivity analysis excluding patients receiving surgery in the first 6- or 12-months after program implementation yielded similar results. Conclusions and Relevance Implementation of a checklist-based quality improvement intervention did not impact rates of adverse surgical outcomes among patients undergoing general surgery in participating Michigan hospitals. Additional research is needed to understand why this program was not successful prior to further dissemination and implementation of this model to other populations. PMID:25588183

Moneyball for Head Start: Using Data, Evidence, and Evaluation to Improve Outcomes for Children and Families

ERIC Educational Resources Information Center

Mead, Sara; Mitchel, Ashley LiBetti

2016-01-01

Head Start is a valuable federal program that improves the lives of our nation's most vulnerable children and their families. Research shows that Head Start programs improve children's learning at school entry and have a positive impact on long-term life outcomes. Research also suggests that Head Start could have a stronger impact on children's…

Improving Weight Loss Outcomes of Community Interventions by Incorporating Behavioral Strategies

PubMed Central

Crane, Melissa M.; Thomas, J. Graham; Kumar, Rajiv; Weinberg, Brad

2010-01-01

Objectives. We examined whether adding behavioral weight loss strategies could improve the outcomes of a community weight loss campaign. Methods. Shape Up RI is a 12-week, online, team-based program for health improvement in Rhode Island. In study 1, we randomly assigned participants to the standard Shape Up RI program or to the program plus video lessons on weight loss. In study 2, we randomly assigned participants to the standard program or to the program plus video lessons; daily self-monitoring of weight, eating, and exercise; and computer-generated feedback. Results. Adding video lessons alone (study 1) did not result in significantly improved weight loss (2.0 ±2.8 kg vs 1.4 ±2.9 kg; P = .15). However, when the video lessons were supplemented with self-monitoring and feedback (study 2), the average weight loss more than doubled (3.5 ±3.8 kg vs 1.4 ±2.7 kg; P < .01), and the proportion of individuals achieving a weight loss of 5% or more tripled (40.5% vs 13.2%; P < .01). Participants in study 2 submitted self-monitoring records on 78% of days, and adherence was significantly related to outcome. Conclusions. Adding behavioral strategies to community campaigns may improve weight loss outcomes with minimal additional cost. PMID:20966375

High Case Volumes and Surgical Fellowships are Associated with Improved Outcomes for Bariatric Surgery Patients: A Justification of Current Credentialing Initiatives for Practice and Training

PubMed Central

Kohn, Geoffrey P; Galanko, Joseph A; Overby, D Wayne; Farrell, Timothy M

2010-01-01

Background Recent years have seen the establishment of bariatric surgery credentialing processes, centers-of-excellence programs and fellowship training positions. The effects of center-of-excellence status and of the presence of training programs have not previously been examined. The objective of this study is to examine the effects of case volume, center-of-excellence status and training programs on early outcomes of bariatric surgery. Study Design Data were obtained from the Nationwide Inpatient Sample from 1998 to 2006. Quantification of patients’ comorbidities was made using the Charlson Index. Using logistic regression modeling, annual case volumes were analyzed for an association with each institution’s center-of-excellence status and training program status. Risk-adjusted outcome measures were calculated for these hospital-level parameters. Results Data from 102,069 bariatric operations were obtained. Adjusting for comorbidities, greater bariatric case volume was associated with improvements in the incidence of total complications (odds ratio [OR] = 0.99937 for each single case increase, p=0.01), in-hospital mortality (OR = 0.99717, p<0.01), and most other complications. Hospitals with a Fellowship Council-affiliated gastrointestinal surgery training program were associated with risk-adjusted improvements in rates of splenectomy (OR = 0.2853, p<0.001) and bacterial pneumonias (OR = 0.65898, p=0.02). Center-of-excellence status, irrespective of the accrediting entity, had minimal independent association with outcome. A surgical residency program had a varying association with outcomes. Conclusions The hypothesized positive volume-outcome relationship of bariatric surgery is shown without arbitrarily categorizing hospitals to case volume groups, by analysis of volume as a continuous variable. Institutions with a dedicated fellowship training program have also been shown, in part, to be associated with improved outcomes. The concept of volume-dependent center-of-excellence programs is supported, though no independent association with the credentialing process is noted. PMID:20510799

The Effects of Pay-for-Performance Programs on Health, Health Care Use, and Processes of Care: A Systematic Review.

PubMed

Mendelson, Aaron; Kondo, Karli; Damberg, Cheryl; Low, Allison; Motúapuaka, Makalapua; Freeman, Michele; O'Neil, Maya; Relevo, Rose; Kansagara, Devan

2017-03-07

The benefits of pay-for-performance (P4P) programs are uncertain. To update and expand a prior review examining the effects of P4P programs targeted at the physician, group, managerial, or institutional level on process-of-care and patient outcomes in ambulatory and inpatient settings. PubMed from June 2007 to October 2016; MEDLINE, PsycINFO, CINAHL, Business Economics and Theory, Business Source Elite, Scopus, Faculty of 1000, and Gartner Research from June 2007 to February 2016. Trials and observational studies in ambulatory and inpatient settings reporting process-of-care, health, or utilization outcomes. Two investigators extracted data, assessed study quality, and graded the strength of the evidence. Among 69 studies, 58 were in ambulatory settings, 52 reported process-of-care outcomes, and 38 reported patient outcomes. Low-strength evidence suggested that P4P programs in ambulatory settings may improve process-of-care outcomes over the short term (2 to 3 years), whereas data on longer-term effects were limited. Many of the positive studies were conducted in the United Kingdom, where incentives were larger than in the United States. The largest improvements were seen in areas where baseline performance was poor. There was no consistent effect of P4P on intermediate health outcomes (low-strength evidence) and insufficient evidence to characterize any effect on patient health outcomes. In the hospital setting, there was low-strength evidence that P4P had little or no effect on patient health outcomes and a positive effect on reducing hospital readmissions. Few methodologically rigorous studies; heterogeneous population and program characteristics and incentive targets. Pay-for-performance programs may be associated with improved processes of care in ambulatory settings, but consistently positive associations with improved health outcomes have not been demonstrated in any setting. U.S. Department of Veterans Affairs.

Implementation and evaluation of a low health literacy and culturally sensitive diabetes education program.

PubMed

Swavely, Deborah; Vorderstrasse, Allison; Maldonado, Edgardo; Eid, Sherrine; Etchason, Jeff

2014-01-01

Low health literacy is more prevalent in persons with limited education, members of ethnic minorities, and those who speak English as a second language, and is associated with multiple adverse diabetes-related health outcomes. This study examined the effectiveness of a low health literacy and culturally sensitive diabetes education program for economically and socially disadvantaged adult patients with type 2 diabetes. A pre-post prospective study design was used to examine outcomes over 12 months. Outcome measures included diabetes knowledge, self-efficacy, and self-care, measured using reliable and valid survey tools, and A1C. Over this period of time 277 patients were enrolled in the program, with 106 participants completing survey data. At the completion of the program patients had significant improvements in diabetes knowledge (p < .001), self-efficacy (p < .001), and three domains of self-care including diet (p < .001), foot care (p < .001), and exercise (p < .001). There were no significant improvements in the frequency of blood glucose testing (p = .345). Additionally, A1C values significantly improved 3 months after completing the program (p = .007). In conclusion, a diabetes education program designed to be culturally sensitive and meet the needs of individuals with low health literacy improves short-term outcomes. © 2013 National Association for Healthcare Quality.

Improving the Transition Outcomes of Low-Income Minority Youth with Disabilities

ERIC Educational Resources Information Center

Balcazar, Fabricio E.; Taylor-Ritzler, Tina; Dimpfl, Shawn; Portillo-Pena, Nelson; Guzman, Alberto; Schiff, Rachel; Murvay, Michele

2012-01-01

This study describes the results of a program developed to improve the transition outcomes of low-income minority youth with disabilities. The program relies on case management support to facilitate interagency collaboration. The participants included 164 graduates from special education and 26 youth from an equivalent comparison group. Two case…

"More than Being in a Class": Adolescents' Ethnolinguistic Insights in a Two-Way Dual-Language Program

ERIC Educational Resources Information Center

Kibler, Amanda; Salerno, April; Hardigree, Christine

2014-01-01

Much of the debate regarding outcomes of various types of dual-language programs has focused on linguistic and academic results, and with good reason: improving the educational outcomes of language minorities and supporting societal multilingualism are vital goals. More rarely explored, however, are these programs' ethnolinguistic outcomes: the…

Effects of Admission and Treatment Strategies of DWI Courts on Offender Outcomes

PubMed Central

Sloan, Frank A.; Chepke, Lindsey M.; Davis, Dontrell V.; Acquah, Kofi; Zold-Kilbourne, Phyllis

2013-01-01

Purpose The purpose of this study is to classify DWI courts on the basis of the mix of difficult cases participating in the court (casemix severity) and the amount of involvement between the court and participant (service intensity). Using our classification typology, we assess how casemix severity and service intensity are associated with program outcomes. We expected that holding other factors constant, greater service intensity would improve program outcomes while a relatively severe casemix would result in worse program outcomes. Methods The study used data from 8 DWI courts, 7 from Michigan and 1 from North Carolina. Using a 2-way classification system based on court casemix severity and program intensity, we selected participants in 1 of the courts, and alternatively 2 courts as reference groups. Reference group courts had relatively severe casemixes and high service intensity. We used propensity score matching to match participants in the other courts to participants in the reference group court programs. Program outcome measures were the probabilities of participants’: failing to complete the court’s program; increasing educational attainment; participants improving employment from time of program enrollment; and re-arrest. Results For most outcomes, our main finding was that higher service intensity is associated with better outcomes for court participants, as anticipated, but a court’s casemix severity was unrelated to study outcomes. Conclusions Our results imply that devoting more resources to increasing duration of treatment is productive in terms of better outcomes, irrespective of the mix of participants in the court’s program PMID:23416679

Comparing effectiveness of generic and disease-specific self-management interventions for people with diabetes in a practice context.

PubMed

Ghahari, Setareh; Packer, Tanya; Boldy, Duncan; Melling, Lauren; Parsons, Richard

2015-10-01

The effectiveness of self-management interventions has been demonstrated. However, the benefits of generic vs. disease-specific programs are unclear, and their efficacy within a practice setting has yet to be fully explored. To compare the outcomes of the diabetes-specific self-management program (Diabetes) and the generic chronic disease Self-management Program (Chronic Condition) and to explore whether program characteristics, evaluated using the Quality Self-Management Assessment Framework (Q-SAF), provide insight into the results of the outcome evaluation. A pragmatic pretest, post-test design with 12-week follow up was used to compare the 2 self-management interventions. Outcomes were quality of life, self-efficacy, loneliness, self-management skills, depression, and health behaviours. People with diabetes self-selected attendance at the Diabetes or Chronic Condition program offered as part of routine practice. Participants with diabetes in the 2 programs (Diabetes=200; Chronic Condition=90) differed significantly in almost all demographic and clinical characteristics. Both programs yielded positive outcomes. Controlling for baseline and demographic characteristics, random effects modelling showed an interaction between time and program for 1 outcome: self-efficacy (p=0.029). Participants in the Chronic Condition group experienced greater improvements over time than did those in the Diabetes group. The Q-SAF analysis showed differences in program content, delivery and workforce capacity. People with diabetes benefited from both programs, but participation in the generic program resulted in greater improvements in self-efficacy for participants who had self-selected that program. Both programs in routine care led to health-related improvements. The Q-SAF can be used to assess the quality of programs. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

Out-of-School-Time Academic Programs to Improve School Achievement: A Community Guide Health Equity Systematic Review.

PubMed

Knopf, John A; Hahn, Robert A; Proia, Krista K; Truman, Benedict I; Johnson, Robert L; Muntaner, Carles; Fielding, Jonathan E; Jones, Camara Phyllis; Fullilove, Mindy T; Hunt, Pete C; Qu, Shuli; Chattopadhyay, Sajal K; Milstein, Bobby

2015-01-01

Low-income and minority status in the United States are associated with poor educational outcomes, which, in turn, reduce the long-term health benefits of education. This systematic review assessed the extent to which out-of-school-time academic (OSTA) programs for at-risk students, most of whom are from low-income and racial/ethnic minority families, can improve academic achievement. Because most OSTA programs serve low-income and ethnic/racial minority students, programs may improve health equity. Methods of the Guide to Community Preventive Services were used. An existing systematic review assessing the effects of OSTA programs on academic outcomes (Lauer et al 2006; search period 1985-2003) was supplemented with a Community Guide update (search period 2003-2011). Standardized mean difference. Thirty-two studies from the existing review and 25 studies from the update were combined and stratified by program focus (ie, reading-focused, math-focused, general academic programs, and programs with minimal academic focus). Focused programs were more effective than general or minimal academic programs. Reading-focused programs were effective only for students in grades K-3. There was insufficient evidence to determine effectiveness on behavioral outcomes and longer-term academic outcomes. OSTA programs, particularly focused programs, are effective in increasing academic achievement for at-risk students. Ongoing school and social environments that support learning and development may be essential to ensure the longer-term benefits of OSTA programs.

Nurse managed prenatal programs affect outcomes for corporations.

PubMed

Thompson, P E; Bitowski, B E; Bell, P L

1997-09-01

Faced with higher medical costs and increased insurance premiums, corporations are focusing on health promotion and wellness. With increasing numbers of women in the workforce, corporations have identified the need for prenatal programs. By developing, initiating, and evaluating outcome-based prenatal programs nurses can target the health care needs of this select population. One such program documented several outcomes including improved employee health and an 86% reduction in maternal/newborn costs.

Outcomes and lessons learned from evaluating TRICARE's disease management programs.

PubMed

Dall, Timothy M; Askarinam Wagner, Rachel C; Zhang, Yiduo; Yang, Wenya; Arday, David R; Gantt, Cynthia J

2010-06-01

To share outcomes and lessons learned from an evaluation of disease management (DM) programs for asthma, congestive heart failure (CHF), and diabetes for TRICARE patients. Multiyear evaluation of participants in voluntary, opt-out DM programs. Patient-centered programs, administered by 3 regional contractors, provide phone-based consultations with a care manager, educational materials, and newsletters. The study sample consisted of 23,793 asthma, 4092 CHF, and 29,604 diabetes patients with at least 6 months' tenure in the program. Medical claims were analyzed to quantify program effect on healthcare utilization, medical costs, and clinical outcomes. Multivariate regression analysis with an historical control group was used to predict patient outcomes in the absence of DM. The difference between actual and predicted DM patient outcomes was attributed to the program. A patient survey collected data on program satisfaction and perceived usefulness of program information and services. Modest improvements in patient outcomes included reduced inpatient days and medical costs, and (with few exceptions) increased percentages of patients receiving appropriate medications and tests. Annual per patient reductions in medical costs were $453, $371, and $783 for asthma, CHF, and diabetes program participants, respectively. The estimated return on investment was $1.26 per $1.00 spent on DM services. Findings suggest that the DM programs more than pay for themselves, in addition to improving patient health and quality of life. Lessons learned in program design, implementation, effectiveness, and evaluation may benefit employers contemplating DM, DM providers, and evaluators of DM programs.

Incentive Design and Quality Improvements: Evidence from State Medicaid Nursing Home Pay-for-Performance Programs.

PubMed

Konetzka, R Tamara; Skira, Meghan M; Werner, Rachel M

2018-01-01

Pay-for-performance (P4P) programs have become a popular policy tool aimed at improving health care quality. We analyze how incentive design affects quality improvements in the nursing home setting, where several state Medicaid agencies have implemented P4P programs that vary in incentive structure. Using the Minimum Data Set and the Online Survey, Certification, and Reporting data from 2001 to 2009, we examine how the weights put on various performance measures that are tied to P4P bonuses, such as clinical outcomes, inspection deficiencies, and staffing levels, affect improvements in those measures. We find larger weights on clinical outcomes often lead to larger improvements, but small weights can lead to no improvement or worsening of some clinical outcomes. We find a qualifier for P4P eligibility based on having few or no severe inspection deficiencies is more effective at decreasing inspection deficiencies than using weights, suggesting simple rules for participation may incent larger improvement.

Incentive Design and Quality Improvements: Evidence from State Medicaid Nursing Home Pay-for-Performance Programs

PubMed Central

Konetzka, R. Tamara; Skira, Meghan M.; Werner, Rachel M.

2017-01-01

Pay-for-performance (P4P) programs have become a popular policy tool aimed at improving health care quality. We analyze how incentive design affects quality improvements in the nursing home setting, where several state Medicaid agencies have implemented P4P programs that vary in incentive structure. Using the Minimum Data Set and the Online Survey, Certification, and Reporting data from 2001 to 2009, we examine how the weights put on various performance measures that are tied to P4P bonuses, such as clinical outcomes, inspection deficiencies, and staffing levels, affect improvements in those measures. We find larger weights on clinical outcomes often lead to larger improvements, but small weights can lead to no improvement or worsening of some clinical outcomes. We find a qualifier for P4P eligibility based on having few or no severe inspection deficiencies is more effective at decreasing inspection deficiencies than using weights, suggesting simple rules for participation may incent larger improvement. PMID:29594189

Post-Inpatient Brain Injury Rehabilitation Outcomes: Report from the National OutcomeInfo Database.

PubMed

Malec, James F; Kean, Jacob

2016-07-15

This study examined outcomes for intensive residential and outpatient/community-based post-inpatient brain injury rehabilitation (PBIR) programs compared with supported living programs. The goal of supported living programs was stable functioning (no change). Data were obtained for a large cohort of adults with acquired brain injury (ABI) from the OutcomeInfo national database, a web-based database system developed through National Institutes of Health (NIH) Small Business Technology Transfer (STTR) funding for monitoring progress and outcomes in PBIR programs primarily with the Mayo-Portland Adaptability Inventory (MPAI-4). Rasch-derived MPAI-4 measures for cases from 2008 to 2014 from 9 provider organizations offering programs in 23 facilities throughout the United States were examined. Controlling for age at injury, time in program, and time since injury on admission (chronicity), both intensive residential (n = 205) and outpatient/community-based (n = 2781) programs resulted in significant (approximately 1 standard deviation [SD]) functional improvement on the MPAI-4 Total Score compared with supported living (n = 101) programs (F = 18.184, p < 0.001). Intensive outpatient/community-based programs showed greater improvements on MPAI-4 Ability (F = 14.135, p < 0.001), Adjustment (F = 12.939, p < 0.001), and Participation (F = 16.679, p < 0.001) indices than supported living programs; whereas, intensive residential programs showed improvement primarily in Adjustment and Participation. Age at injury and time in program had small effects on outcome; the effect of chronicity was small to moderate. Examination of more chronic cases (>1 year post-injury) showed significant, but smaller (approximately 0.5 SD) change on the MPAI-4 relative to supported living programs (F = 17.562, p < 0.001). Results indicate that intensive residential and outpatient/community-based PIBR programs result in substantial positive functional changes moderated by chronicity.

Post-Inpatient Brain Injury Rehabilitation Outcomes: Report from the National OutcomeInfo Database

PubMed Central

Kean, Jacob

2016-01-01

Abstract This study examined outcomes for intensive residential and outpatient/community-based post-inpatient brain injury rehabilitation (PBIR) programs compared with supported living programs. The goal of supported living programs was stable functioning (no change). Data were obtained for a large cohort of adults with acquired brain injury (ABI) from the OutcomeInfo national database, a web-based database system developed through National Institutes of Health (NIH) Small Business Technology Transfer (STTR) funding for monitoring progress and outcomes in PBIR programs primarily with the Mayo-Portland Adaptability Inventory (MPAI-4). Rasch-derived MPAI-4 measures for cases from 2008 to 2014 from 9 provider organizations offering programs in 23 facilities throughout the United States were examined. Controlling for age at injury, time in program, and time since injury on admission (chronicity), both intensive residential (n = 205) and outpatient/community-based (n = 2781) programs resulted in significant (approximately 1 standard deviation [SD]) functional improvement on the MPAI-4 Total Score compared with supported living (n = 101) programs (F = 18.184, p < 0.001). Intensive outpatient/community-based programs showed greater improvements on MPAI-4 Ability (F = 14.135, p < 0.001), Adjustment (F = 12.939, p < 0.001), and Participation (F = 16.679, p < 0.001) indices than supported living programs; whereas, intensive residential programs showed improvement primarily in Adjustment and Participation. Age at injury and time in program had small effects on outcome; the effect of chronicity was small to moderate. Examination of more chronic cases (>1 year post-injury) showed significant, but smaller (approximately 0.5 SD) change on the MPAI-4 relative to supported living programs (F = 17.562, p < 0.001). Results indicate that intensive residential and outpatient/community-based PIBR programs result in substantial positive functional changes moderated by chronicity. PMID:26414433

Quality Improvement Initiatives in Inflammatory Bowel Disease.

PubMed

Berry, Sameer K; Siegel, Corey A; Melmed, Gil Y

2017-08-01

This article serves as an overview of several quality improvement initiatives in inflammatory bowel disease (IBD). IBD is associated with significant variation in care, suggesting poor quality of care. There have been several efforts to improve the quality of care for patients with IBD. Quality improvement (QI) initiatives in IBD are intended to be patient-centric, improve outcomes for individuals and populations, and reduce costs-all consistent with "the triple aim" put forth by the Institute for Healthcare Improvement (IHI). Current QI initiatives include the development of quality measure sets to standardize processes and outcomes, learning health systems to foster collaborative improvement, and patient-centered medical homes specific to patients with IBD in shared risk models of care. Some of these programs have demonstrated early success in improving patient outcomes, reducing costs, improving patient satisfaction, and facilitating patient engagement. However, further studies are needed to evaluate and compare the effects of these programs over time on clinical outcomes in order to demonstrate long-term value and sustainability.

Research Review: Harnessing the power of individual participant data in a meta-analysis of the benefits and harms of the Incredible Years parenting program.

PubMed

Leijten, Patty; Gardner, Frances; Landau, Sabine; Harris, Victoria; Mann, Joanna; Hutchings, Judy; Beecham, Jennifer; Bonin, Eva-Maria; Scott, Stephen

2018-02-01

Parenting programs aim to reduce children's conduct problems through improvement of family dynamics. To date, research on the precise benefits and possible harms of parenting programs on family well-being has been unsystematic and likely to be subject to selective outcome reporting and publication bias. Better understanding of program benefits and harms requires full disclosure by researchers of all included measures, and large enough numbers of participants to be able to detect small effects and estimate them precisely. We obtained individual participant data for 14 of 15 randomized controlled trials on the Incredible Years parenting program in Europe (total N = 1,799). We used multilevel modeling to estimate program effects on 13 parent-reported outcomes, including parenting practices, children's mental health, and parental mental health. Parental use of praise, corporal punishment, threats, and shouting improved, while parental use of tangible rewards, monitoring, or laxness did not. Children's conduct problems and attention deficit hyperactivity disorder (ADHD) symptoms improved, while emotional problems did not. Parental mental health (depressive symptoms, self-efficacy, and stress) did not improve. There was no evidence of harmful effects. The Incredible Years parenting program improves the aspects of family well-being that it is primarily designed to improve: parenting and children's conduct problems. It also improves parent-reported ADHD symptoms in children. Wider benefits are limited: the program does not improve children's emotional problems or parental mental health. There are no signs of harm on any of the target outcomes. © 2017 Association for Child and Adolescent Mental Health.

Career/Vocational Preparation for Students with Disabilities: A Program Improvement Guide.

ERIC Educational Resources Information Center

Stodden, Robert A.

This program improvement guide is designed to assist district and school level interdisciplinary planning teams to improve career/vocational programs for students with disabilities. Its focus is on the integration of best practices within the educational program continuum to achieve positive student outcomes. The guide includes three sections.…

Stroke Self-Management Support Improves Survivors' Self-Efficacy and Outcome Expectation of Self-Management Behaviors.

PubMed

Lo, Suzanne H S; Chang, Anne M; Chau, Janita P C

2018-03-01

Evidence shows self-management programs are associated with improved recovery outcomes. This article reports on the effectiveness of a new nurse-led self-efficacy-based stroke self-management program. A randomized controlled trial of participants recruited from 3 acute stroke units was conducted. The intervention group received the 4-week stroke self-management program. The control group received usual care. All participants were assessed at baseline and 8 weeks after randomization. Data were analyzed using generalized estimating equations. Outcomes included self-efficacy, outcome expectation, and satisfaction with performance of self-management behaviors. One hundred twenty-eight participants were randomized with mean age, 67.46 years (SD, 11.95); 59% men; and mean duration poststroke, 45 days (SD, 26.16). At 8 weeks of follow-up in the intention-to-treat population, the intervention group improved significantly in self-efficacy (95% confidence interval, 2.55-12.45; P <0.01), outcome expectation (95% confidence interval, 5.47-14.01; P <0.01), and satisfaction with performance of self-management behaviors (95% confidence interval, 3.38-13.87; P <0.01) compared with the control. Similar results were obtained at 8 weeks of follow-up in the per-protocol population. The stroke self-management program improved survivors' self-efficacy, outcome expectation, and satisfaction with performance of self-management behaviors. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02112955. © 2018 American Heart Association, Inc.

The Effects of Incentives on Families' Long-Term Outcome in a Parenting Program

ERIC Educational Resources Information Center

Heinrichs, Nina; Jensen-Doss, Amanda

2010-01-01

To examine the impact of paying for participation in a preventive parenting program on treatment outcomes, 197 families with preschool-aged children were randomized to paid or unpaid conditions. Although both groups improved on nearly all measures, paid families showed less improvement on 3 of 10 variables, including father-reported child…

NCME Award: University-Wide Utilization of Student Outcome Information in Assessing and Improving Academic Programs.

ERIC Educational Resources Information Center

Educational Measurement: Issues and Practice, 1984

1984-01-01

The University of Tennessee, Knoxville conducted a system-wide effort to increase use of student outcome information in assessing and improving academic programs. For this effort, the university received the National Council on Measurement in Education award for an outstanding example of an application of educational measurement technology. (EGS)

Recommendation for Center-Based Early Childhood Education to Promote Health Equity.

PubMed

2016-01-01

The Community Preventive Services Task Force recommends early childhood education programs based on strong evidence of effectiveness in improving educational outcomes associated with long-term health and sufficient evidence of effectiveness in improving social- and health-related outcomes. When provided to low-income or racial and ethnic minority communities, early childhood education programs are likely to reduce educational achievement gaps, improve the health of low-income student populations, and promote health equity.

The Perioperative Educational Program for Improving Upper Arm Dysfunction in Patients with Breast Cancer at 1-Year Follow-Up: A Prospective, Controlled Trial.

PubMed

Sato, Fumiko; Arinaga, Yoko; Sato, Naoko; Ishida, Takanori; Ohuchi, Noriaki

2016-03-01

The many women with breast cancer who underwent axillary lymph node dissection (ALND) suffer from the upper arm dysfunction. In this study, we investigated the effectiveness of a perioperative educational program for improving upper arm dysfunction in breast cancer patients following ALND. This study was a sub-analysis of a previous controlled trial with an educational program. The subjects of this analysis included 64 patients following ALND who completed measurements at 12 months. The perioperative educational program consisted of monitoring of arm dysfunction, exercises, massage, and lifestyle adjustments. The intervention group (37 patients) received this perioperative educational program over 12 months, while 27 patients in the control group received written information about shoulder exercise from on-site staff only before surgery. Primary outcomes were shoulder range of motion (ROM), arm girth, and grip strength. Secondary outcomes were evaluated with the Subjective Perception of Post-Operative Functional Impairment of the Arm (SPOFIA) scores, the Disabilities of the Arm, Shoulder and Hand (DASH) scores, and the Medical Outcome Study 36-Item Short-Form Health Survey v2 (SF-36v2). The SF-36v2 measures health-related quality of life (QOL). Primary and secondary outcomes were compared between groups at 1 week (after drainage tube removal) and 12 months after surgery, using the Mann-Whitney U test. The horizontal extension was significantly improved only in the intervention group. Moreover, the SPOFIA score was significantly improved in the intervention group, and other scores of the secondary outcomes were similar between the two groups. The perioperative educational program may improve postoperative upper arm dysfunction and symptoms.

Hospital-Based Comprehensive Care Programs for Children With Special Health Care Needs

PubMed Central

Cohen, Eyal; Jovcevska, Vesna; Kuo, Dennis Z.; Mahant, Sanjay

2014-01-01

Objective To examine the effectiveness of hospital-based comprehensive care programs in improving the quality of care for children with special health care needs. Data Sources A systematic review was conducted using Ovid MEDLINE, CINAHL, EMBASE, PsycINFO, Sociological Abstracts SocioFile, and Web of Science. Study Selection Evaluations of comprehensive care programs for categorical (those with single disease) and noncategorical groups of children with special health care needs were included. Selected articles were reviewed independently by 2 raters. Data Extraction Models of care focused on comprehensive care based at least partially in a hospital setting. The main outcome measures were the proportions of studies demonstrating improvement in the Institute of Medicine’s quality-of-care domains (effectiveness of care, efficiency of care, patient or family centeredness, patient safety, timeliness of care, and equity of care). Data Synthesis Thirty-three unique programs were included, 13 (39%) of which were randomized controlled trials. Improved outcomes most commonly reported were efficiency of care (64% [49 of 76 outcomes]), effectiveness of care (60% [57 of 95 outcomes]), and patient or family centeredness (53% [10 of 19 outcomes). Outcomes less commonly evaluated were patient safety (9% [3 of 33 programs]), timeliness of care (6% [2 of 33 programs]), and equity of care (0%). Randomized controlled trials occurred more frequently in studies evaluating categorical vs noncategorical disease populations (11 of 17 [65%] vs 2 of 16 [17%], P = .008). Conclusions Although positive, the evidence supporting comprehensive hospital-based programs for children with special health care needs is restricted primarily to nonexperimental studies of children with categorical diseases and is limited by inadequate outcome measures. Additional high-quality evidence with appropriate comparative groups and broad outcomes is necessary to justify continued development and growth of programs for broad groups of children with special health care needs. PMID:21646589

A model to begin to use clinical outcomes in medical education.

PubMed

Haan, Constance K; Edwards, Fred H; Poole, Betty; Godley, Melissa; Genuardi, Frank J; Zenni, Elisa A

2008-06-01

The latest phase of the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project challenges graduate medical education (GME) programs to select meaningful clinical quality indicators by which to measure trainee performance and progress, as well as to assess and improve educational effectiveness of programs. The authors describe efforts to measure educational quality, incorporating measurable patient-care outcomes to guide improvement. University of Florida College of Medicine-Jacksonville education leaders developed a tiered framework for selecting clinical indicators whose outcomes would illustrate integration of the ACGME competencies and their assessment with learning and clinical care. In order of preference, indicators selected should align with a specialty's (1) national benchmarked consensus standards, (2) national specialty society standards, (3) standards of local, institutional, or regional quality initiatives, or (4) top-priority diagnostic and/or therapeutic categories for the specialty, based on areas of high frequency, impact, or cost. All programs successfully applied the tiered process to clinical indicator selection and then identified data sources to track clinical outcomes. Using clinical outcomes in resident evaluation assesses the resident's performance as reflective of his or her participation in the health care delivery team. Programmatic improvements are driven by clinical outcomes that are shown to be below benchmark across the residents. Selecting appropriate clinical indicators-representative of quality of care and of graduate medical education-is the first step toward tracking educational outcomes using clinical data as the basis for evaluation and improvement. This effort is an important aspect of orienting trainees to using data for monitoring and improving care processes and outcomes throughout their careers.

Kenya's ICT Policy in Practice: The Effectiveness of Tablets and E-Readers in Improving Student Outcomes

ERIC Educational Resources Information Center

Piper, Benjamin; Jepkemei, Evelyn; Kwayumba, Dunston; Kibukho, Kennedy

2015-01-01

Kenya is investing in information and communication technology (ICT) to improve children's learning outcomes. However, the literature on ICT is pessimistic about the ability of ICT alone to improve outcomes, and few ICT programs have created the instructional change necessary to increase learning. The Primary Math and Reading (PRIMR) Initiative…

Embarking on performance improvement.

PubMed

Brown, Bobbi; Falk, Leslie Hough

2014-06-01

Healthcare organizations should approach performance improvement as a program, not a project. The program should be led by a guidance team that identifies goals, prioritizes work, and removes barriers to enable clinical improvement teams and work groups to realize performance improvements. A healthcare enterprise data warehouse can provide the initial foundation for the program analytics. Evidence-based best practices can help achieve improved outcomes and reduced costs.

A comment on Scherr et al. "A multicomponent, school-based intervention, the Shaping Healthy Choices Program, improves nutrition-related outcomes"

USDA-ARS?s Scientific Manuscript database

We write in response to the article by Scherr et al. entitled "A multicomponent, school-based intervention, the Shaping Healthy Choices Program, improves nutrition-related outcomes." We admire Scherr et al. for undertaking such a challenging study on so important a topic, and for wisely using a rand...

Improving Student Outcomes via Comprehensive Supports: Three-Year Outcomes from CUNY's Accelerated Study in Associate Programs (ASAP)

ERIC Educational Resources Information Center

Kolenovic, Zineta; Linderman, Donna; Karp, Melinda Mechur

2013-01-01

Community colleges are grappling with low rates of degree completion and transfer. The City University of New York's (CUNY) Accelerated Study in Associate Programs (ASAP) aims to improve graduation rates by providing a range of comprehensive support services to community college students in select majors. Using student-unit record data, we…

Does an outcome-based approach to continuing medical education improve physicians' competences in rational prescribing?

PubMed

Esmaily, Hamideh M; Savage, Carl; Vahidi, Rezagoli; Amini, Abolghasem; Dastgiri, Saeed; Hult, Hakan; Dahlgren, Lars Owe; Wahlstrom, Rolf

2009-11-01

Continuing medical education (CME) is compulsory in Iran, and traditionally it is lecture-based, which is mostly not successful. Outcome-based education has been proposed for CME programs. To evaluate the effectiveness of an outcome-based educational intervention with a new approach based on outcomes and aligned teaching methods, on knowledge and skills of general physicians (GPs) working in primary care compared with a concurrent CME program in the field of "Rational prescribing". The method used was cluster randomized controlled design. All GPs working in six cities in one province in Iran were invited to participate. The cities were matched and randomly divided into an intervention arm for education on rational prescribing with an outcome-based approach, and a control arm for a traditional program on the same topic. Knowledge and skills were assessed using a pre- and post-test, including case scenarios. In total, 112 GPs participated. There were significant improvements in knowledge and prescribing skills after the training in the intervention arm as well as in comparison with the changes in the control arm. The overall intervention effect was 26 percentage units. The introduction of an outcome-based approach in CME appears to be effective when creating programs to improve GPs' knowledge and skills.

The Medicare Health Outcomes Survey program: overview, context, and near-term prospects.

PubMed

Jones, Nathaniel; Jones, Stephanie L; Miller, Nancy A

2004-07-12

In 1996, the Centers for Medicare & Medicaid Services (CMS) initiated the Medicare Health Outcomes Survey (HOS). It is the first national survey to measure the quality of life and functional health status of Medicare beneficiaries enrolled in managed care. The program seeks to gather valid and reliable health status data in Medicare managed care for use in quality improvement activities, public reporting, plan accountability and improving health outcomes based on competition. The context that led to the development of the HOS was formed by the convergence of the following factors: 1) a recognized need to monitor the performance of managed care plans, 2) technical expertise and advancement in the areas of quality measurement and health outcomes assessment, 3) the existence of a tested functional health status assessment tool (SF-36)1, which was valid for an elderly population, 4) CMS leadership, and 5) political interest in quality improvement. Since 1998, there have been six baseline surveys and four follow up surveys. CMS, working with its partners, performs the following tasks as part of the HOS program: 1) Supports the technical/scientific development of the HOS measure, 2) Certifies survey vendors, 3) Collects Health Plan Employer Data and Information Set(HEDIS)2 HOS data, 4) Cleans, scores, and disseminates annual rounds of HOS data, public use files and reports to CMS, Quality Improvement Organizations (QIOs), Medicare+Choice Organizations (M+COs), and other stakeholders, 5) Trains M+COs and QIOs in the use of functional status measures and best practices for improving care, 6) Provides technical assistance to CMS, QIOs, M+COs and other data users, and 7) Conducts analyses using HOS data to support CMS and HHS priorities.CMS has recently sponsored an evaluation of the HOS program, which will provide the information necessary to enhance the future administration of the program. Information collected to date reveals that the HOS program is a valuable tool that provides a rich set of data that is useful for quality monitoring and improvement efforts. To enhance the future of the HOS program, many stakeholders recommend the implementation of incentives to encourage the use of the data, while others identify the need to monitor the health status of plan disenrollees.Overall, the HOS program represents an important vehicle for collecting outcomes data from Medicare beneficiaries. The new Medicare Prescription Drug, Improvement, and Modernization Act (2003) mandates the collection and use of data for outcomes measurement. Consequently, it is important to improve HOS to most effectively meet the mandate.

The components of action planning and their associations with behavior and health outcomes.

PubMed

Lorig, Kate; Laurent, Diana D; Plant, Kathryn; Krishnan, Eswar; Ritter, Philip L

2014-03-01

Based on the works of Kiesler and Bandura, action plans have become important tools in patient self-management programs. One such program, shown effective in randomized trials, is the Internet Chronic Disease Self-Management Program. An implementation of this program, Healthy Living Canada, included detailed information on action plans and health-related outcome measures. Action plans were coded by type, and associations between action plans, confidence in completion and completion were examined. Numbers of Action Plans attempted and competed and completion rates were calculated for participants and compared to six-month changes in outcomes using regression models. Five of seven outcome measures significantly improved at six-months. A total of 1136 action plans were posted by 254 participants in 12 workshops (mean 3.9 out of 5 possible); 59% of action plans involved exercise, 16% food, and 14% role management. Confidence of completion was associated with completion. Action plan completion measures were associated with improvements in activity limitation, aerobic exercise, and self-efficacy. Baseline self-efficacy was associated with at least partial completion of action plans. Action planning appears to be an important component of self-management interventions, with successful completion associated with improved health and self-efficacy outcomes.

Developing a Deep Brain Stimulation Neuromodulation Network for Parkinson Disease, Essential Tremor, and Dystonia: Report of a Quality Improvement Project

PubMed Central

O’Suilleabhain, Padraig E.; Sanghera, Manjit; Patel, Neepa; Khemani, Pravin; Lacritz, Laura H.; Chitnis, Shilpa; Whitworth, Louis A.; Dewey, Richard B.

2016-01-01

Objective To develop a process to improve patient outcomes from deep brain stimulation (DBS) surgery for Parkinson disease (PD), essential tremor (ET), and dystonia. Methods We employed standard quality improvement methodology using the Plan-Do-Study-Act process to improve patient selection, surgical DBS lead implantation, postoperative programming, and ongoing assessment of patient outcomes. Results The result of this quality improvement process was the development of a neuromodulation network. The key aspect of this program is rigorous patient assessment of both motor and non-motor outcomes tracked longitudinally using a REDCap database. We describe how this information is used to identify problems and to initiate Plan-Do-Study-Act cycles to address them. Preliminary outcomes data is presented for the cohort of PD and ET patients who have received surgery since the creation of the neuromodulation network. Conclusions Careful outcomes tracking is essential to ensure quality in a complex therapeutic endeavor like DBS surgery for movement disorders. The REDCap database system is well suited to store outcomes data for the purpose of ongoing quality assurance monitoring. PMID:27711133

Developing a Deep Brain Stimulation Neuromodulation Network for Parkinson Disease, Essential Tremor, and Dystonia: Report of a Quality Improvement Project.

PubMed

Dewey, Richard B; O'Suilleabhain, Padraig E; Sanghera, Manjit; Patel, Neepa; Khemani, Pravin; Lacritz, Laura H; Chitnis, Shilpa; Whitworth, Louis A; Dewey, Richard B

2016-01-01

To develop a process to improve patient outcomes from deep brain stimulation (DBS) surgery for Parkinson disease (PD), essential tremor (ET), and dystonia. We employed standard quality improvement methodology using the Plan-Do-Study-Act process to improve patient selection, surgical DBS lead implantation, postoperative programming, and ongoing assessment of patient outcomes. The result of this quality improvement process was the development of a neuromodulation network. The key aspect of this program is rigorous patient assessment of both motor and non-motor outcomes tracked longitudinally using a REDCap database. We describe how this information is used to identify problems and to initiate Plan-Do-Study-Act cycles to address them. Preliminary outcomes data is presented for the cohort of PD and ET patients who have received surgery since the creation of the neuromodulation network. Careful outcomes tracking is essential to ensure quality in a complex therapeutic endeavor like DBS surgery for movement disorders. The REDCap database system is well suited to store outcomes data for the purpose of ongoing quality assurance monitoring.

Development of the Veterans Healthcare Administration (VHA) Ophthalmic Surgical Outcome Database (OSOD) project and the role of ophthalmic nurse reviewers.

PubMed

Lara-Smalling, Agueda; Cakiner-Egilmez, Tulay; Miller, Dawn; Redshirt, Ella; Williams, Dale

2011-01-01

Currently, ophthalmic surgical cases are not included in the Veterans Administration Surgical Quality Improvement Project data collection. Furthermore, there is no comprehensive protocol in the health system for prospectively measuring outcomes for eye surgery in terms of safety and quality. There are 400,000 operative cases in the system per year. Of those, 48,000 (12%) are ophthalmic surgical cases, with 85% (41,000) of those being cataract cases. The Ophthalmic Surgical Outcome Database Pilot Project was developed to incorporate ophthalmology into VASQIP, thus evaluating risk factors and improving cataract surgical outcomes. Nurse reviewers facilitate the monitoring and measuring of these outcomes. Since its inception in 1778, the Veterans Administration (VA) Health System has provided comprehensive healthcare to millions of deserving veterans throughout the U.S. and its territories. Historically, the quality of healthcare provided by the VA has been the main focus of discussion because it did not meet a standard of care comparable to that of the private sector. Information regarding quality of healthcare services and outcomes data had been unavailable until 1986, when Congress mandated the VA to compare its surgical outcomes to those of the private sector (PL-99-166). 1 Risk adjustment of VA surgical outcomes began in 1987 with the Continuous Improvement in Cardiac Surgery Program (CICSP) in which cardiac surgical outcomes were reported and evaluated. 2 Between 1991 and 1993, the National VA Surgical Risk Study (NVASRS) initiated a validated risk-adjustment model for predicting surgical outcomes and comparative assessment of the quality of surgical care in 44 VA medical centers. 3 The success of NVASRS encouraged the VA to establish an ongoing program for monitoring and improving the quality of surgical care, thus developing the National Surgical Quality Improvement Program (NSQIP) in 1994. 4 According to a prospective study conducted between 1991-1997 in 123 VA medical centers by Khuri et al., the 30-day mortality and morbidity rates for major surgeries had decreased by 9% and 30%, respectively. 5 Recently renamed the VA Surgical Quality Improvement Program (VASQIP) in 2010, the quality of surgical outcomes has continued to improve among all documented surgical specialties. Ophthalmic surgery is presumed to have a very low mortality rate and therefore has not been included in the VASQIP database.

Youth empowerment solutions for violence prevention.

PubMed

Reischl, Thomas M; Zimmerman, Marc A; Morrel-Samuels, Susan; Franzen, Susan P; Faulk, Monique; Eisman, Andria B; Roberts, Everett

2011-12-01

The limited success of youth violence prevention interventions suggests that effective prevention needs to address causes at multiple levels of analysis and empower youth in developing and implementing prevention programs. In this article, we review published studies of youth violence prevention efforts that engage youth in developing or implementing violence prevention activities. The reviewed studies suggest the promise of youth empowerment strategies and the need for systematic outcome studies of empowerment programs. After reviewing empowerment theory applied to youth violence prevention programs, we present a case study of the Youth Empowerment Solutions (YES) for Peaceful Communities program. YES engages middle-school youth in an after-school and summer program that includes a culturally tailored character development curriculum and empowers the youth to plan and implement community improvement projects with assistance from adult neighborhood advocates. The case study focuses on outcome evaluation results and presents evidence of the YES program effects on community-level outcomes (eg, property improvements, violent crime incidents) and on individual-level outcomes (eg, conflict avoidance, victimization). The literature review and the case study suggest the promise of engaging and empowering youth to plan and implement youth violence prevention programs.

Driving Organizational Change From the Bedside: The AACN Clinical Scene Investigator Academy.

PubMed

Lacey, Susan R; Goodyear-Bruch, Caryl; Olney, Adrienne; Hanson, Dave; Altman, Marian S; Varn-Davis, Natasha S; Brinker, Debbie; Lavandero, Ramón; Cox, Karen S

2017-08-01

Staff nurses are pivotal in leading change related to quality improvement efforts, although many lack skills to steer change from the bedside. The American Association of Critical-Care Nurses (AACN) staff nurse leadership program, Clinical Scene Investigator (CSI) Academy, teaches and empowers staff nurses in leadership skills and change concepts to translate evidence into practice affecting patient outcomes. To describe the curriculum of the AACN CSI Academy that provides staff nurses with the leadership skills required to create unit-based change projects that positively impact patient/family outcomes. The curriculum of the Academy included leadership topics, communication, change concepts, quality improvement methods, project management, and data management and analysis. Each team of participants collected project data to show improvements in patient care. The program evaluation used many data sources to assess the program effectiveness, relating to the professional growth of the participant nurses. The participants assessed project patient outcomes, sustainability, and spread. The first cohort of CSI participants included 164 direct care nurses from 42 hospitals in 6 cities. They rated the Academy highly in the program evaluation, and they reported that the Academy contributed to their professional development. The individual hospital quality improvement projects resulted in positive patient and estimated fiscal outcomes that were generally sustained 1 year after the program. With the skills, tools, and support obtained from participation in the CSI Academy, staff nurses can make substantial contributions to their organizations in clinical and possibly fiscal outcomes. ©2017 American Association of Critical-Care Nurses.

Impact of the Siena College Tech Valley Scholars Program on Student Outcomes

ERIC Educational Resources Information Center

Medsker, Larry; Allard, Lee; Tucker, Lucas J.; O'Donnell, Jodi L.; Sterne-Marr, Rachel; Bannon, Jon; Finn, Rose; Weatherwax, Allan

2016-01-01

The Tech Valley Scholars (TVS) program included 38 students who joined this program over the course of three academic years, from 2009 to 2012. These students comprise the experimental group for this study to determine if participating in the NSF-funded Tech Valley Scholars program improved academic outcomes. The experimental group was compared to…

Can the national surgical quality improvement program provide surgeon-specific outcomes?

PubMed

Kuhnen, Angela H; Marcello, Peter W; Roberts, Patricia L; Read, Thomas E; Schoetz, David J; Rusin, Lawrence C; Hall, Jason F; Ricciardi, Rocco

2015-02-01

Efforts to improve the quality of surgical care and reduce morbidity and mortality have resulted in outcomes reporting at the service and institutional level. Surgeon-specific outcomes are not readily available. The aim of this study is to compare surgeon-specific outcomes from the National Surgical Quality Improvement Program and 100% capture institutional quality data. We conducted a cohort study evaluating institutional and surgeon-specific outcomes following colorectal surgery procedures at 1 institution over 5 years. All patients who underwent an operation by a colorectal surgeon at Lahey Hospital & Medical Center from January 1, 2008 through December 31, 2012 were identified. Thirty-day mortality, reoperation, urinary tract infection, deep vein thrombosis, pneumonia, superficial surgical site infection, and organ space infection were the primary outcomes measured. We compared annual and 5-year institutional and surgeon-specific adverse event rates between the data sets. In addition, we categorized individual surgeons as low-outlier, average, or high-outlier in relation to aggregate averages and determined the concordance between the data sets in identifying outliers. Concordance was designated if the 2 databases classified outlier status similarly for the same adverse event category. In the 100% capture institutional data, 6459 operative encounters were identified in comparison with 1786 National Surgical Quality Improvement Program encounters (28% sampled). Annual aggregate adverse event rates were similar between the institutional data and the National Surgical Quality Improvement Program. For annual surgeon-specific comparisons, concordance in identifying outliers between the 2 data sets was 51.4%, and gross discordance between outlier status was in 8.2%. Five-year surgeon-specific comparisons demonstrated 59% concordance in identifying outlier status with 8.2% gross discordance for the group. The inclusion of data from only 1 academic referral center is a limitation of this study. Each surgeon was identified as a "high outlier" in at least 1 adverse event category. Comparisons at the annual and 5-year points demonstrated poor concordance between our 100% capture institutional data and the National Surgical Quality Improvement Program data.

Assessment of Student Learning Outcomes in FCS Programs

ERIC Educational Resources Information Center

Weaver-Kaulis, Amy; Crutsinger, Christy

2006-01-01

Accreditation, budget, and accountability pressures at the institution and program levels lead to the involvement of faculty in assessment-based activities. Increasingly, programs are being expected to document student learning beyond traditional course grades. The use of outcomes as a tool to improve learning relies heavily on the active…

Changing Recruitment Outcomes: The "Why" and the "How"

ERIC Educational Resources Information Center

MacLean, Lisa; Pato, Michele T.

2011-01-01

Objective: Residency programs compete for applicants and commit extensive resources to the recruitment process. After failing to fill in the match for 5 years (1999-2004), this program decided to make changes in its recruitment process. The authors describe one program's experience in improving recruitment outcomes. Methods: The new training…

Revealing pathways from payments for ecosystem services to socioeconomic outcomes

PubMed Central

Zhang, Jindong

2018-01-01

Payments for ecosystem services (PES) programs have been widely implemented as a promising tool to conserve ecosystems while facilitating socioeconomic development. However, the underlying pathways (or processes) through which PES programs affect socioeconomic outcomes remain elusive, and existing literature provides little guidance to quantify them. By integrating linkages among PES programs, livelihood activities, and socioeconomic outcomes, we develop a framework to reveal pathways from PES programs to socioeconomic outcomes. We empirically demonstrate the framework’s operationalization and uncover the pathways that lead to unexpected negative effects of two important PES programs on participating households’ income. With improved understanding of the pathways (for example, the programs decreased income through reducing crop production), we provide recommendations to enhance the PES programs’ outcomes in our demonstration site and beyond. Our study highlights the finding that elucidating the pathways from PES programs to their outcomes can help identify specific strategies to achieve ecosystem conservation and socioeconomic development simultaneously. PMID:29750187

The Impact of a Civic Service Program on Biopsychosocial Outcomes of Post 9/11 U.S. Military Veterans

PubMed Central

Matthieu, Monica M.; Lawrence, Karen A.; Robertson-Blackmore, Emma

2017-01-01

Volunteering as a health promotion intervention, improves physical health, mental health, and social outcomes particularly in older adults, yet limited research exists for veterans. We conducted a preliminary study to explore whether volunteering impacts a variety of biopsychosocial outcomes, including symptoms of post-traumatic stress disorder (PTSD) and depression, among returning military veterans from Iraq and Afghanistan. A survey enrolling a prospective cohort of United States (U.S.) veterans who served in the military after 11 September 2001 and who participated in a national civic service program was conducted. A total of 346 veterans completed standardized health, mental health, and psychosocial self-report measures before and after the program. Statistically significant differences were detected in overall health rating, level of emotional difficulty, PTSD and depression symptoms, purpose in life, self-efficacy, social isolation, and the perceived availability of social support at program completion. Screening positive for probable PTSD predicted improved perceived self-efficacy while probable depression predicted a decrease in loneliness, an increase in purpose in life, and an increase in perceived social support, at program completion. Volunteering was associated with significant improvements in health, mental health and social outcomes in returning veterans. PMID:28039802

Improving the evidence base for services working with youth at-risk of involvement in the criminal justice system: developing a standardised program approach.

PubMed

Knight, Alice; Maple, Myfanwy; Shakeshaft, Anthony; Shakehsaft, Bernie; Pearce, Tania

2018-04-16

Young people who engage in multiple risk behaviour (high-risk young people) such as substance abuse, antisocial behaviour, low engagement in education and employment, self-harm or suicide ideation are more likely to experience serious harms later in life including homelessness, incarceration, violence and premature death. In addition to personal disadvantage, these harms represent an avoidable social and economic cost to society. Despite these harms, there is insufficient evidence about how to improve outcomes for high-risk young people. A key reason for this is a lack of standardisation in the way in which programs provided by services are defined and evaluated. This paper describes the development of a standardised intervention model for high-risk young people. The model can be used by service providers to achieve greater standardisation across their programs, outcomes and outcome measures. To demonstrate its feasibility, the model is applied to an existing program for high-risk young people. The development and uptake of a standardised intervention model for these programs will help to more rapidly develop a larger and more rigorous evidence-base to improve outcomes for high-risk young people.

Employing continuous quality improvement in community-based substance abuse programs.

PubMed

Chinman, Matthew; Hunter, Sarah B; Ebener, Patricia

2012-01-01

This article aims to describe continuous quality improvement (CQI) for substance abuse prevention and treatment programs in a community-based organization setting. CQI (e.g., plan-do-study-act cycles (PDSA)) applied in healthcare and industry was adapted for substance abuse prevention and treatment programs in a community setting. The authors assessed the resources needed, acceptability and CQI feasibility for ten programs by evaluating CQI training workshops with program staff and a series of three qualitative interviews over a nine-month implementation period with program participants. The CQI activities, PDSA cycle progress, effort, enthusiasm, benefits and challenges were examined. Results indicated that CQI was feasible and acceptable for community-based substance abuse prevention and treatment programs; however, some notable resource challenges remain. Future studies should examine CQI impact on service quality and intended program outcomes. The study was conducted on a small number of programs. It did not assess CQI impact on service quality and intended program outcomes. Practical implications- This project shows that it is feasible to adapt CQI techniques and processes for community-based programs substance abuse prevention and treatment programs. These techniques may help community-based program managers to improve service quality and achieve program outcomes. This is one of the first studies to adapt traditional CQI techniques for community-based settings delivering substance abuse prevention and treatment programs.

Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis.

PubMed

Montroy, Joshua; Breau, Rodney H; Cnossen, Sonya; Witiuk, Kelsey; Binette, Andrew; Ferrier, Taylor; Lavallée, Luke T; Fergusson, Dean A; Schramm, David

2016-01-01

The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) is the first nationally validated, risk-adjusted, outcomes-based program to measure and compare the quality of surgical care across North America. Participation in this program may provide an opportunity to reduce the incidence of adverse events related to surgery. A systematic review of the literature was performed. MedLine, EMBASE and PubMed were searched for studies relevant to NSQIP. Patient characteristics, intervention, and primary outcome measures were abstracted. The intervention was participation in NSQIP and monitoring of Individual Site Summary Reports with or without implementation of a quality improvement program. The outcomes of interest were change in peri-operative adverse events and mortality represented by pooled risk ratios (pRR) and 95% confidence intervals (CI). Eleven articles reporting on 35 health care institutions were included. Nine (82%) of the eleven studies implemented a quality improvement program. Minimal improvements in superficial (pRR 0.81; 95% CI 0.72-0.91), deep (pRR 0.82; 95% CI0.64-1.05) and organ space (pRR 1.15; 95% CI 0.96-1.37) infections were observed at centers that did not institute a quality improvement program. However, centers that reported formal interventions for the prevention and treatment of infections observed substantial improvements (superficial pRR 0.55, 95% CI 0.39-0.77; deep pRR 0.61, 95% CI 0.50-0.75, and organ space pRR 0.60, 95% CI 0.50-0.71). Studies evaluating other adverse events noted decreased incidence following NSQIP participation and implementation of a formal quality improvement program. These data suggest that NSQIP is effective in reducing surgical morbidity. Improvement in surgical quality appears to be more marked at centers that implemented a formal quality improvement program directed at the reduction of specific morbidities.

Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis

PubMed Central

Montroy, Joshua; Breau, Rodney H.; Cnossen, Sonya; Witiuk, Kelsey; Binette, Andrew; Ferrier, Taylor; Lavallée, Luke T.; Fergusson, Dean A.; Schramm, David

2016-01-01

Background The American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) is the first nationally validated, risk-adjusted, outcomes-based program to measure and compare the quality of surgical care across North America. Participation in this program may provide an opportunity to reduce the incidence of adverse events related to surgery. Study Design A systematic review of the literature was performed. MedLine, EMBASE and PubMed were searched for studies relevant to NSQIP. Patient characteristics, intervention, and primary outcome measures were abstracted. The intervention was participation in NSQIP and monitoring of Individual Site Summary Reports with or without implementation of a quality improvement program. The outcomes of interest were change in peri-operative adverse events and mortality represented by pooled risk ratios (pRR) and 95% confidence intervals (CI). Results Eleven articles reporting on 35 health care institutions were included. Nine (82%) of the eleven studies implemented a quality improvement program. Minimal improvements in superficial (pRR 0.81; 95% CI 0.72–0.91), deep (pRR 0.82; 95% CI0.64–1.05) and organ space (pRR 1.15; 95% CI 0.96–1.37) infections were observed at centers that did not institute a quality improvement program. However, centers that reported formal interventions for the prevention and treatment of infections observed substantial improvements (superficial pRR 0.55, 95% CI 0.39–0.77; deep pRR 0.61, 95% CI 0.50–0.75, and organ space pRR 0.60, 95% CI 0.50–0.71). Studies evaluating other adverse events noted decreased incidence following NSQIP participation and implementation of a formal quality improvement program. Conclusions These data suggest that NSQIP is effective in reducing surgical morbidity. Improvement in surgical quality appears to be more marked at centers that implemented a formal quality improvement program directed at the reduction of specific morbidities. PMID:26812596

A Diabetes Self-Management Program: 12-Month Outcome Sustainability From a Nonreinforced Pragmatic Trial.

PubMed

Lorig, Kate; Ritter, Philip L; Turner, Ralph M; English, Kathleen; Laurent, Diana D; Greenberg, Jay

2016-12-15

Diabetes self-management education has been shown to be effective in controlled trials. The 6-week Better Choices, Better Health-Diabetes (BCBH-D) self-management program was also associated with an improvement in health outcomes in a 6-month translation study. The objective of this study was to determine whether a national translation of the BCBH-D self-management program, offered both Web-based and face-to-face, was associated with improvements in health outcomes (including HbA1c) and health behaviors (including recommended medical tests) 1 year after intervention. Web-based programs were administered nationally, whereas face-to-face workshops took place in Atlanta, Indianapolis, and St Louis. Self-report questionnaires were either Web-based or administered by mail, at baseline and 1 year, and collected health and health-behavior measures. HbA1c blood samples were collected via mailed kits. A previous 6-month study found statistically significant improvements in 13 of 14 outcome measures, including HbA1c. For this study, paired t test compared baseline with 1-year outcomes. Subgroup analyses determined whether participants with specific conditions improved (high HbA1c, depression, hypoglycemia, nonadherence to medication, no aerobic exercise). The percentage of participants with improvements in effect size of at least 0.4 in at least 1 of the 5 measures was calculated. A total of 857 participants with 1-year data (69.7% of baseline participants) demonstrated statistically significant 1-year improvements in 13 of 15 outcome measures; 79.9% (685/857) of participants showed improvements in effect size of 0.4 or greater in at least 1 of the 5 criterial measures. Participants had small but significant benefits in multiple measures. Improvements previously noted at 6 months were maintained or amplified at 1 year. ©Kate Lorig, Philip L Ritter, Ralph M Turner, Kathleen English, Diana D Laurent, Jay Greenberg. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 15.12.2016.

Innovating for quality and value: Utilizing national quality improvement programs to identify opportunities for responsible surgical innovation.

PubMed

Woo, Russell K; Skarsgard, Erik D

2015-06-01

Innovation in surgical techniques, technology, and care processes are essential for improving the care and outcomes of surgical patients, including children. The time and cost associated with surgical innovation can be significant, and unless it leads to improvements in outcome at equivalent or lower costs, it adds little or no value from the perspective of the patients, and decreases the overall resources available to our already financially constrained healthcare system. The emergence of a safety and quality mandate in surgery, and the development of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) allow needs-based surgical care innovation which leads to value-based improvement in care. In addition to general and procedure-specific clinical outcomes, surgeons should consider the measurement of quality from the patients' perspective. To this end, the integration of validated Patient Reported Outcome Measures (PROMs) into actionable, benchmarked institutional outcomes reporting has the potential to facilitate quality improvement in process, treatment and technology that optimizes value for our patients and health system. Copyright © 2015 Elsevier Inc. All rights reserved.

Focus Group Outcomes of the Happy Kids Program

ERIC Educational Resources Information Center

Anderson, Karen; Ferguson, Neil; Partington, Gary; Byrne, Matt

2015-01-01

In this article, the outcomes of The Happy Kids project, a strategy to improve the social and emotional well-being of primary school students, were examined. Results indicated that the Happy Kids program had demonstrated positive social and emotional outcomes for students in all schools, in particular, a positive impact upon students' confidence,…

Association of hospital participation in a quality reporting program with surgical outcomes and expenditures for Medicare beneficiaries.

PubMed

Osborne, Nicholas H; Nicholas, Lauren H; Ryan, Andrew M; Thumma, Jyothi R; Dimick, Justin B

2015-02-03

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) provides feedback to hospitals on risk-adjusted outcomes. It is not known if participation in the program improves outcomes and reduces costs relative to nonparticipating hospitals. To evaluate the association of enrollment and participation in the ACS NSQIP with outcomes and Medicare payments compared with control hospitals that did not participate in the program. Quasi-experimental study using national Medicare data (2003-2012) for a total of 1,226,479 patients undergoing general and vascular surgery at 263 hospitals participating in ACS NSQIP and 526 nonparticipating hospitals. A difference-in-differences analytic approach was used to evaluate whether participation in ACS NSQIP was associated with improved outcomes and reduced Medicare payments compared with nonparticipating hospitals that were otherwise similar. Control hospitals were selected using propensity score matching (2 control hospitals for each ACS NSQIP hospital). Thirty-day mortality, serious complications (eg, pneumonia, myocardial infarction, or acute renal failure and a length of stay >75th percentile), reoperation, and readmission within 30 days. Hospital costs were assessed using price-standardized Medicare payments during hospitalization and 30 days after discharge. After accounting for patient factors and preexisting time trends toward improved outcomes, there were no statistically significant improvements in outcomes at 1, 2, or 3 years after (vs before) enrollment in ACS NSQIP. For example, in analyses comparing outcomes at 3 years after (vs before) enrollment, there were no statistically significant differences in risk-adjusted 30-day mortality (4.3% after enrollment vs 4.5% before enrollment; relative risk [RR], 0.96 [95% CI, 0.89 to 1.03]), serious complications (11.1% after enrollment vs 11.0% before enrollment; RR, 0.96 [95% CI, 0.91 to 1.00]), reoperations (0.49% after enrollment vs 0.45% before enrollment; RR, 0.97 [95% CI, 0.77 to 1.16]), or readmissions (13.3% after enrollment vs 12.8% before enrollment; RR, 0.99 [95% CI, 0.96 to 1.03]). There were also no differences at 3 years after (vs before) enrollment in mean total Medicare payments ($40 [95% CI, -$268 to $348]), or payments for the index admission (-$11 [95% CI, -$278 to $257]), hospital readmission ($245 [95% CI, -$231 to $721]), or outliers (-$86 [95% CI, -$1666 to $1495]). With time, hospitals had progressively better surgical outcomes but enrollment in a national quality reporting program was not associated with the improved outcomes or lower Medicare payments among surgical patients. Feedback on outcomes alone may not be sufficient to improve surgical outcomes.

MyPOD: an EMR-Based Tool that Facilitates Quality Improvement and Maintenance of Certification.

PubMed

Berman, Loren; Duffy, Brian; Randall Brenn, B; Vinocur, Charles

2017-03-01

Maintenance of Certification (MOC) was designed to assess physician competencies including operative case volume and outcomes. This information, if collected consistently and systematically, can be used to facilitate quality improvement. Information automatically extracted from the electronic medical record (EMR) can be used as a prompt to compile these data. We developed an EMR-based program called MyPOD (My Personal Outcomes Data) to track surgical outcomes at our institution. We compared occurrences reported in the first 18 months to those captured in the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-P) over the same time period. During the first 18 months of using MyPOD, 691 cases were captured in both MyPOD and NSQIP-P. There were 48 cases with occurrences in NSQIP-P (6.9% occurrence rate). MyPOD captured 33% of the occurrences and 83% of the deaths reported in NSQIP-P. Use of the MyPOD program helped to identify series of complications and facilitated systematic change to improve outcomes. MyPOD provides comparative data that is essential in performance evaluation and facilitates quality improvement in surgery. This program and similar EMR-driven tools are becoming essential components of the MOC process. Our initial review has revealed opportunities for improvement in self-reporting which we can continue to measure by comparison to NSQIP-P. In addition, it has identified systems issues that have led to hospital-wide improvements.

Review of Strategies to Enhance Outcomes for Patients with Type 2 Diabetes: Payers' Perspective

PubMed Central

Greenapple, Rhonda

2011-01-01

Background Diabetes and its clinical consequences exact a great toll on patients and on society in terms of its effects on morbidity and mortality and its staggering economic impact. Objective To review various programs and strategies that aim at enhancing adherence to antihyperglycemic therapy and suggest the best approach to improving patient outcomes and reducing healthcare costs. Discussion Treatment goals for patients with diabetes have been defined, and multiple safe and effective medications are available. Nevertheless, the majority of patients with diabetes fail to achieve treatment goals, because of difficulty with adherence to medication regimens and lifestyle modifications, and because of economic barriers. This article discusses various initiatives developed to improve patient outcomes, including consumer-driven health plans and wellness and prevention programs. Furthermore, economic incentives to patients, such as value-based insurance design, may increase adherence; nevertheless, evidence suggests that such programs alone provide only modest gains. Primary providers in disease management programs can include nurses, case managers, or pharmacists. Supportive interventions across several modalities have been shown to be effective. Conclusion An approach that uses a combination of strategies designed to impact patients' health-related behaviors across a variety of modalities may help to improve outcomes and reduce costs. Additional novel, innovative interdisciplinary initiatives are necessary to effect meaningful change that can facilitate improved health outcomes for patients with diabetes and maximize cost-effectiveness approaches for payers. PMID:25126364

Clinical performance improvement series. Classic CQI integrated with comprehensive disease management as a model for performance improvement.

PubMed

Joshi, M S; Bernard, D B

1999-08-01

In recent years, health and disease management has emerged as an effective means of delivering, integrating, and improving care through a population-based approach. Since 1997 the University of Pennsylvania Health System (UPHS) has utilized the key principles and components of continuous quality improvement (CQI) and disease management to form a model for health care improvement that focuses on designing best practices, using best practices to influence clinical decision making, changing processes and systems to deploy and deliver best practices, and measuring outcomes to improve the process. Experience with 28 programs and more than 14,000 patients indicates significant improvement in outcomes, including high physician satisfaction, increased patient satisfaction, reduced costs, and improved clinical process and outcome measures across multiple diseases. DIABETES DISEASE MANAGEMENT: In three months a UPHS multidisciplinary diabetes disease management team developed a best practice approach for the treatment of all patients with diabetes in the UPHS. After the program was pilot tested in three primary care physician sites, it was then introduced progressively to additional practice sites throughout the health system. The establishment of the role of the diabetes nurse care managers (certified diabetes educators) was central to successful program deployment. Office-based coordinators ensure incorporation of the best practice protocols into routine flow processes. A disease management intranet disseminates programs electronically. Outcomes of the UPHS health and disease management programs so far demonstrate success across multiple dimensions of performance-service, clinical quality, access, and value. The task of health care leadership today is to remove barriers and enable effective implementation of key strategies, such as health and disease management. Substantial effort and resources must be dedicated to gain physician buy-in and achieve compliance. The challenge is to provide leadership support, to reward and recognize best practice performers, and to emphasize the use of data for feedback and improvement. As these processes are implemented successfully, and evidence of improved outcomes is documented, it is likely that this approach will be more widely embraced and that organizationwide performance improvement will increase significantly. Health care has traditionally invested extraordinary resources in developing best practice approaches, including guidelines, education programs, or other tangible products and services. Comparatively little time, effort, and resources have been targeted to implementation and use, the stage at which most efforts fail. CQI's emphasis on data, rapid diffusion of innovative programs, and rapid cycle improvements enhance the implementation and effectiveness of disease management.

The power of the National Surgical Quality Improvement Program--achieving a zero pneumonia rate in general surgery patients.

PubMed

Fuchshuber, Pascal R; Greif, William; Tidwell, Chantal R; Klemm, Michael S; Frydel, Cheryl; Wali, Abdul; Rosas, Efren; Clopp, Molly P

2012-01-01

The National Surgical Quality Improvement Program (NSQIP) of the American College of Surgeons provides risk-adjusted surgical outcome measures for participating hospitals that can be used for performance improvement of surgical mortality and morbidity. A surgical clinical nurse reviewer collects 135 clinical variables including preoperative risk factors, intraoperative variables, and 30-day postoperative mortality and morbidity outcomes for patients undergoing major surgical procedures. A report on mortality and complications is prepared twice a year. This article summarizes briefly the history of NSQIP and how its report on surgical outcomes can be used for performance improvement within a hospital system. In particular, it describes how to drive performance improvement with NSQIP data using the example of postoperative respiratory complications--a major factor of postoperative mortality. In addition, this article explains the benefit of a collaborative of several participating NSQIP hospitals and describes how to develop a "playbook" on the basis of an outcome improvement project.

Community-based walking exercise for peripheral artery disease: An exploratory pilot study

PubMed Central

Mays, Ryan J; Hiatt, William R; Casserly, Ivan P; Rogers, R Kevin; Main, Deborah S; Kohrt, Wendy M; Ho, P Michael; Regensteiner, Judith G

2016-01-01

Supervised walking exercise is an effective treatment to improve walking ability of patients with peripheral artery disease (PAD), but few exercise programs in community settings have been effective. The aim of this study was to determine the efficacy of a community-based walking exercise program with training, monitoring, and coaching (TMC) components to improve exercise performance and patient-reported outcomes in PAD patients. This was a randomized, controlled trial including PAD patients who previously received peripheral endovascular therapy or presented with stable claudication. Patients randomized (n=25) to the intervention group received a comprehensive community-based walking exercise program with elements of TMC over 14 weeks. Patients in the control group did not receive treatment beyond standard advice to walk. The primary outcome in the intent-to-treat (ITT) analyses was peak walking time (PWT) on a graded treadmill. Secondary outcomes included claudication onset time (COT) and patient-reported outcomes assessed via the Walking Impairment Questionnaire (WIQ). Intervention group patients (n=10) did not significantly improve PWT when compared with the control group patients (n=10) (mean±standard error: +2.1±0.7 vs. 0.0±0.7 min, p=0.052). Changes in COT and WIQ scores were greater for intervention patients compared with control patients (COT: +1.6±0.8 vs. −0.6±0.7 min, p=0.045; WIQ: +18.3±4.2 vs. −4.6±4.2%, p=0.001). This pilot using a walking program with TMC and an ITT analyses did not improve the primary outcome in PAD patients. Other walking performance and patient self-reported outcomes were improved following exercise in community settings. Further study is needed to determine whether this intervention improves outcomes in a trial employing a larger sample size. PMID:25755148

Effects of a Summer Treatment Program on Functional Sports Outcomes in Young Children with ADHD

PubMed Central

Fabiano, Gregory A.; Waschbusch, Daniel A.; Belin, Peter J.; Gnagy, Elizabeth M.; Pelham, William E.; Greiner, Andrew R.; Roemmich, James N.

2015-01-01

Participation in youth sports can be very beneficial, but children with Attention Deficit Hyperactivity Disorder (ADHD) may participate less often and less successfully. The current study evaluated functional sports outcomes for children with ADHD who attended an intensive behavioral treatment program that included a sports training component, and it compared outcomes to children with ADHD who did not attend the program. Results suggest that treatment resulted in significant improvements in many aspects of children’s sports functioning, including knowledge of game rules, in vivo game performance, and fundamental skill tasks (motor proficiency, ability to trap a soccer ball appropriately, reduced handball penalties in soccer, and improved ability to catch a baseball). Parents also reported improved sports skills and good sportsmanship in the treatment group. No differences between groups were evident on additional skill tasks evaluating accurately kicking a soccer ball, throwing a baseball, or hitting a baseball off a tee. These results suggest intensive behavioral intervention that includes sports training can significantly improve functional sports outcomes for young children with ADHD. PMID:24362766

Caregiver stress and outcomes of children with pediatric feeding disorders treated in an intensive interdisciplinary program.

PubMed

Greer, Ashley J; Gulotta, Charles S; Masler, Elizabeth A; Laud, Rinita B

2008-07-01

This study investigated the impact of an intensive interdisciplinary feeding program on caregiver stress and child outcomes of children with feeding disorders across three categories. Children were categorized into either tube dependent, liquid dependent, or food selective groups. Outcomes for caregiver stress levels, child mealtime behaviors, weight, and calories were examined at admission and discharge for 121 children. Repeated measures ANOVAs were used to examine differences pre- and post-treatment and across feeding categories. Caregiver stress, child mealtime behaviors, weight, and caloric intake improved significantly following treatment in the intensive feeding program, regardless of category placement. Few studies have examined the impact of an intensive interdisciplinary approach on caregiver stress, as well as on child outcome variables with such a diverse population. This study provides support that regardless of a child's medical and feeding history, an intensive interdisciplinary approach significantly improves caregiver stress and child outcomes.

Leadership development programs for physicians: a systematic review.

PubMed

Frich, Jan C; Brewster, Amanda L; Cherlin, Emily J; Bradley, Elizabeth H

2015-05-01

Physician leadership development programs typically aim to strengthen physicians' leadership competencies and improve organizational performance. We conducted a systematic review of medical literature on physician leadership development programs in order to characterize the setting, educational content, teaching methods, and learning outcomes achieved. Articles were identified through a search in Ovid MEDLINE from 1950 through November 2013. We included articles that described programs designed to expose physicians to leadership concepts, outlined teaching methods, and reported evaluation outcomes. A thematic analysis was conducted using a structured data entry form with categories for setting/target group, educational content, format, type of evaluation and outcomes. We identified 45 studies that met eligibility criteria, of which 35 reported on programs exclusively targeting physicians. The majority of programs focused on skills training and technical and conceptual knowledge, while fewer programs focused on personal growth and awareness. Half of the studies used pre/post intervention designs, and four studies used a comparison group. Positive outcomes were reported in all studies, although the majority of studies relied on learner satisfaction scores and self-assessed knowledge or behavioral change. Only six studies documented favorable organizational outcomes, such as improvement in quality indicators for disease management. The leadership programs examined in these studies were characterized by the use of multiple learning methods, including lectures, seminars, group work, and action learning projects in multidisciplinary teams. Physician leadership development programs are associated with increased self-assessed knowledge and expertise; however, few studies have examined outcomes at a system level. Our synthesis of the literature suggests important gaps, including a lack of programs that integrate non-physician and physician professionals, limited use of more interactive learning and feedback to develop greater self-awareness, and an overly narrow focus on individual-level rather than system-level outcomes.

A pragmatic randomized controlled trial of the Flinders Program of chronic condition management in community health care services.

PubMed

Battersby, Malcolm; Harris, Melanie; Smith, David; Reed, Richard; Woodman, Richard

2015-11-01

To evaluate the Flinders Program in improving self-management in common chronic conditions. To examine properties of the Partners in Health scale (PIH). Participants were randomized to usual care or Flinders Program plus usual care. Self-management competency, quality of life, and other outcomes were measured at baseline, 6 months, and 12 months. Of 231 participants, 172 provided data at 6 months and 61 at 12 months. At 6 months, intention-to-treat outcomes favoured the intervention group for SF-12 physical health (p=0.043). Other pre-determined outcomes did not show significance. At 6 months intervention participants' problem severity scores reduced (p<0.001) and goal achievement scores increased (p<0.001). Only 55% of the intervention group received a Flinders Program, compromising study power. The PIH was associated with other measures at baseline and for change over time. In a pragmatic community trial, the Flinders Program improved quality of life at 6 months. Incomplete in-practice intervention delivery limited trial power. Studies are now needed on improving delivery. The PIH has potential as a generic risk screening tool and predictive measure of change in self-management and chronic condition outcomes over time. Better implementation including service integration is required for improved chronic disease management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Outcomes of an enhancement study with additional psychoeducational sessions for healthy siblings of a child with cancer during inpatient family-oriented rehabilitation.

PubMed

Niemitz, Mandy; Goldbeck, Lutz

2018-03-01

Chronic illness of a child puts healthy children of the family at risk of distress. Previous studies have demonstrated that healthy children's psychological symptoms can be reduced when the child knows more about the disease. So far, there is limited evidence of the effectiveness of psychoeducational interventions for healthy children. To compare the effectiveness of an inpatient family-oriented rehabilitation program with vs without additional psychoeducational sessions for healthy children of families with children with cancer. We performed a controlled study in 4 German family-oriented rehabilitation clinics. The outcomes of n = 73 healthy children (mean age: M = 9.55; SD = 3.14; range: 4-18), who participated in 5 additional psychoeducational sessions, were compared with the outcomes of n = 111 healthy children (mean age: M = 8.85; SD = 3.28; range: 4-17), who underwent the usual inpatient rehabilitation program. Primary outcomes were the healthy children's cancer-specific knowledge and their emotional symptoms. Secondary outcomes were family satisfaction and quality of life. Intention-to-treat analyses showed that both groups improved significantly from preintervention to postintervention. Improvements comprised knowledge about cancer (F(1,174) = 11.03, p < 0.001), self-reported emotional symptoms (F(1,135) = 31.68, p < 0.001), and parent-proxy-reported emotional symptoms (F(1,179) = 37.07, p < 0.001). The additional psycho-educational program did not significantly enhance the outcomes. The same pattern of significant improvement in both conditions emerged for all secondary outcomes. The immediate effects of the intervention persisted until 2 months after discharge from the rehabilitation program. Inpatient family-oriented rehabilitation is effective in improving multiple psychosocial outcomes of healthy children in families which have a child with cancer. Additional psycho-educational sessions did not show any substantial additional improvement. Copyright © 2017 John Wiley & Sons, Ltd.

Preventing falls in assisted living: Results of a quality improvement pilot study.

PubMed

Zimmerman, Sheryl; Greene, Angela; Sloane, Philip D; Mitchell, Madeline; Giuliani, Carol; Nyrop, Kirsten; Walsh, Edith

Residents of assisted living (AL) communities are at high risk for falls, which result in negative outcomes and high health care costs. Adapting effective falls prevention programs for AL quality improvement (QI) has the potential to reduce falls, improve resident quality of life, and reduce costs. This project tested the feasibility and outcomes of an evidence-based multi-component QI program, the Assisted Living Falls Prevention and Monitoring Program (AL-FPMP). Resident posture and gait improved, likely due to exercise and/or physical therapy. Effective falls prevention QI programs can be implemented in AL, and are advised to (1) establish and maintain a falls team to create a culture focused on the reduction of falls risk; (2) teach staff to assess residents using the Morse Falls Scale to increase their awareness of residents' falls risk and improvement; and (3) modify existing exercise programs to address balance and lower body strength. Copyright © 2016 Elsevier Inc. All rights reserved.

Randomized Trial of Healthy Families Arizona: Quantitative and Qualitative Outcomes

ERIC Educational Resources Information Center

LeCroy, Craig Winston; Davis, Melinda F.

2017-01-01

Home visitation has the potential to improve parent, child, and maternal outcomes and has become a widely implemented prevention program across the United States. The purpose of this research was to use a randomized controlled trial to assess the short-term effectiveness of the Arizona Healthy Families program across a range of outcomes. Two…

Can Rational Prescribing Be Improved by an Outcome-Based Educational Approach? A Randomized Trial Completed in Iran

ERIC Educational Resources Information Center

Esmaily, Hamideh M.; Silver, Ivan; Shiva, Shadi; Gargani, Alireza; Maleki-Dizaji, Nasrin; Al-Maniri, Abdullah; Wahlstrom, Rolf

2010-01-01

Introduction: An outcome-based education approach has been proposed to develop more effective continuing medical education (CME) programs. We have used this approach in developing an outcome-based educational intervention for general physicians working in primary care (GPs) and evaluated its effectiveness compared with a concurrent CME program in…

Improving vocational rehabilitation services for injured workers in Washington State.

PubMed

Sears, Jeanne M; Wickizer, Thomas M; Schulman, Beryl A

2014-06-01

Workers who incur permanent impairments or have ongoing medical restrictions due to injuries or illnesses sustained at work may require support from vocational rehabilitation programs in order to return to work. Vocational rehabilitation programs implemented within workers' compensation settings are costly, and effective service delivery has proven challenging. The Vocational Improvement Project, a 5.5-year pilot program beginning in 2008, introduced major changes to the Washington State workers' compensation-based vocational rehabilitation program. In the evaluation of this pilot program, set within a large complex system characterized by competing stakeholder interests, we assessed effects on system efficiency and employment outcomes for injured workers. While descriptive in nature, this evaluation provided evidence that several of the intended outcomes were attained, including: (1) fewer repeat referrals, (2) fewer delays, (3) increased choice for workers, and (4) establishment of statewide partnerships to improve worker outcomes. There remains substantial room for further improvement. Retraining plan completion rates remain under 60% and only half of workers earned any wages within two years of completing their retraining plan. Ongoing communication with stakeholders was critical to the successful conduct and policy impact of this evaluation, which culminated in a 3-year extension of the pilot program through June 2016. Copyright © 2013 Elsevier Ltd. All rights reserved.

A systematic review of internet-based worksite wellness approaches for cardiovascular disease risk management: outcomes, challenges & opportunities.

PubMed

Aneni, Ehimen C; Roberson, Lara L; Maziak, Wasim; Agatston, Arthur S; Feldman, Theodore; Rouseff, Maribeth; Tran, Thinh H; Blumenthal, Roger S; Blaha, Michael J; Blankstein, Ron; Al-Mallah, Mouaz H; Budoff, Matthew J; Nasir, Khurram

2014-01-01

The internet is gaining popularity as a means of delivering employee-based cardiovascular (CV) wellness interventions though little is known about the cardiovascular health outcomes of these programs. In this review, we examined the effectiveness of internet-based employee cardiovascular wellness and prevention programs. We conducted a systematic review by searching PubMed, Web of Science and Cochrane library for all published studies on internet-based programs aimed at improving CV health among employees up to November 2012. We grouped the outcomes according to the American Heart Association (AHA) indicators of cardiovascular wellbeing--weight, BP, lipids, smoking, physical activity, diet, and blood glucose. A total of 18 randomized trials and 11 follow-up studies met our inclusion/exclusion criteria. Follow-up duration ranged from 6-24 months. There were significant differences in intervention types and number of components in each intervention. Modest improvements were observed in more than half of the studies with weight related outcomes while no improvement was seen in virtually all the studies with physical activity outcome. In general, internet-based programs were more successful if the interventions also included some physical contact and environmental modification, and if they were targeted at specific disease entities such as hypertension. Only a few of the studies were conducted in persons at-risk for CVD, none in blue-collar workers or low-income earners. Internet based programs hold promise for improving the cardiovascular wellness among employees however much work is required to fully understand its utility and long term impact especially in special/at-risk populations.

Assessing the impact of a remote digital coaching engagement program on patient-reported outcomes in asthma.

PubMed

Rasulnia, Mazi; Burton, Billy Stephen; Ginter, Robert P; Wang, Tracy Y; Pleasants, Roy Alton; Green, Cynthia L; Lugogo, Njira

2017-08-11

Low adherence and poor outcomes provide opportunity for digital coaching to engage patients with uncontrolled asthma in their care to improve outcomes. To examine the impact of a remote digital coaching program on asthma control and patient experience. We recruited 51 adults with uncontrolled asthma, denoted by albuterol use of >2 times per week and/or exacerbations requiring corticosteroids, and applied a 12-week patient-centered remote digital coaching program using a combination of educational pamphlets, symptom trackers, best peak flow establishment, physical activity, and dietary counseling, as well as coaches who implemented emotional enforcement to motivate disease self-management through telephone, text, and email. Baseline and post-intervention measures were quality of life (QOL), spirometry, Asthma Control Test (ACT), Asthma Symptom Utility Index (ASUI), rescue albuterol use, and exacerbation history. Among 51 patients recruited, 40 completed the study. Eight subjects required assistance reading medical materials. Significant improvements from baseline were observed for Patient-Reported Outcomes Measurement Information System mental status (p = 0.010), body weight, and outpatient exacerbation frequency (p = 0.028). The changes from baseline in ACT (p = 0.005) were statistically significant but did not achieve the pre-specified minimum clinically important difference (MCID), whereas for ASUI, the MCID and statistical significance were achieved. Spirometry and rescue albuterol use were no different. A patient-oriented, remote digital coaching program that utilized trained health coaches and digital materials led to statistically significant improvement in mental status, outpatient exacerbations, body weight, and ASUI. Digital coaching programs may improve some outcomes in adults with uncontrolled asthma.

2011 John M. Eisenberg Patient Safety and Quality Awards. Mentored implementation: building leaders and achieving results through a collaborative improvement model. Innovation in patient safety and quality at the national level.

PubMed

Maynard, Gregory A; Budnitz, Tina L; Nickel, Wendy K; Greenwald, Jeffrey L; Kerr, Kathleen M; Miller, Joseph A; Resnic, JoAnne N; Rogers, Kendall M; Schnipper, Jeffrey L; Stein, Jason M; Whitcomb, Winthrop F; Williams, Mark V

2012-07-01

The Society of Hospital Medicine (SHM) created "Mentored Implementation" (MI) programs with the dual aims of educating and mentoring hospitalists and their quality improvement (QI) teams and accelerating improvement in the inpatient setting in three signature programs: Venous Thromboembolism (VTE) Prevention, Glycemic Control, and Project BOOST (Better Outcomes for Older adults through Safe Transitions). More than 300 hospital improvement teams were enrolled in SHM MI programs in a series of cohorts. Hospitalist mentors worked with individual hospitals/health systems to guide local teams through the life cycle of a QI project. Implementation Guides and comprehensive Web-based "Resource Rooms," as well as the mentor's own experience, provided best-practice definitions, practical implementation tips, measurement strategies, and other tools. E-mail interactions and mentoring were augmented by regularly scheduled teleconferences; group webinars; and, in some instances, a site visit. Performance was tracked in a centralized data tracking center. Preliminary data on all three MI programs show significant improvement in patient outcomes, as well as enhancements of communication and leadership skills of the hospitalists and their QI teams. Although objective data on outcomes and process measures for the MI program's efficacy remain preliminary at this time, the maturing data tracking system, multiple awards, and early results indicate that the MI programs are successful in providing QI training and accelerating improvement efforts.

Programs to improve adolescent sexual and reproductive health in the US: a review of the evidence.

PubMed

Manlove, Jennifer; Fish, Heather; Moore, Kristin Anderson

2015-01-01

US adolescents have high rates of teen pregnancy, childbearing, and sexually transmitted infections (STIs), highlighting the need to identify and implement effective programs that will help improve teen sexual and reproductive health. This review identified 103 random-assignment evaluations of 85 programs that incorporated intent-to-treat analyses and assessed impacts on pregnancy, childbearing, STIs, and their key determinants - sexual activity, number of sexual partners, condom use, and other contraceptive use - among teens. This review describes the evidence base for five broad program approaches, including abstinence education, comprehensive sex education, clinic-based programs, youth development programs, and parent-youth relationship programs. We also describe programs with impacts on key outcomes, including pregnancy/childbearing, STIs, and those that found impacts on both sexual activity and contraceptive use. Our review identified 52 effective programs: 38 with consistent impacts on reproductive health outcomes, and 14 with mixed findings (across subpopulations, follow-ups, or multiple measures of a single outcome). We found that a variety of program approaches produced impacts on sexual and reproductive health outcomes. Parent-youth relationship programs and clinic-based program evaluations more frequently showed impacts than other program approaches, although we also identified a number of abstinence-education, comprehensive sex education, and youth-development programs with impacts on sexual and reproductive health outcomes. Overall, we identified nine program evaluations with impacts on teen pregnancies or births, five with impacts on reducing STIs, and 15 with impacts on both delaying/reducing sexual activity and increasing contraceptive use (including condom use). Future efforts should conduct replications of existing program evaluations, identify implementation components linked to impacts, rigorously evaluate programs that appear promising, and expand the evidence base on programs that impact hormonal and long-acting contraceptive method use.

Outcomes of home-based employment service programs for people with disabilities and their related factors--a preliminary study in Taiwan.

PubMed

Lin, Yi-Jiun; Huang, I-Chun; Wang, Yun-Tung

2014-01-01

The aim of this exploratory study is to gain an understanding of the outcomes of home-based employment service programs for people with disabilities and their related factors in Taiwan. This study used survey method to collect 132 questionnaires. Descriptive and two-variable statistics including chi-square (χ(2)), independent sample t-test and analysis of variance were employed. The results found that 36.5% of the subjects improved their employment status and 75.8% of them improved in employability. Educational level and and vocational categories including "web page production", "e-commerce", "internet marketing", "on-line store" and "website set-up and management" were significantly "positively" associated with either of the two outcome indicators - change of employment status and employability. This study is the first evidence-based study about the outcomes of home-based employment service programs and their related factors for people with disabilities in Taiwan. The outcomes of the home-based employment service programs for people with disabilities were presented. Implications for Rehabilitation Home-based rehabilitation for people with disabilities can be effective. A programme of this kind supports participants in improving or gaining employment status as well as developing employability skills. Further consideration should be given to developing cost-effective home-based programmes and evaluating their effectiveness.

Comparing maternal child health problems and outcomes across public health nursing agencies.

PubMed

Monsen, Karen A; Fulkerson, Jayne A; Lytton, Amy B; Taft, Lila L; Schwichtenberg, Linda D; Martin, Karen S

2010-05-01

To use aggregated data from health informatics systems to identify needs of maternal and child health (MCH) clients served by county public health agencies and to demonstrate outcomes of services provided. Participating agencies developed and implemented a formal standardized classification data comparison process using structured Omaha System data. An exploratory descriptive analysis of the data was performed. Summary reports of aggregated and analyzed data from records of clients served and discharged in 2005 were compared. Client problems and outcomes were found to be similar across agencies, with behavioral, psychosocial, environmental and physiological problems identified and addressed. Differential improvement was noted by problem, outcome measure, and agency; and areas for enhancing intervention strategies were prioritized. Problems with greatest improvement across agencies were Antepartum/postpartum and Family planning, and least improvement across agencies were Neglect and Substance use. Findings demonstrated that public health nurses address many serious health-related problems with low-income high-risk MCH clients. MCH client needs were found to be similar across agencies. Public health nurse home visiting services addressed important health issues with MCH clients, and statistically significant improvement in client health problems occurred consistently across agencies. The data comparison processes developed in this project were useful for MCH programs, and may be applicable to other program areas using structured client data for evaluation purposes. Using informatics tools and data facilitated needs assessment, program evaluation, and outcomes management processes for the agencies, and will continue to play an integral role in directing practice and improving client outcomes.

Patient perceptions of a remote monitoring intervention for chronic disease management.

PubMed

Wakefield, Bonnie J; Holman, John E; Ray, Annette; Scherubel, Melody

2011-04-01

Use of telecommunications technology to provide remote monitoring for people with chronic disease is becoming increasingly accepted as a means to improve patient outcomes and reduce resource use. The purpose of this project was to evaluate patient perceptions of a nurse-managed remote monitoring intervention to improve outcomes in veterans with comorbid diabetes and hypertension. Postintervention evaluation data were collected using a 12-item questionnaire and an open-ended question. Participants rated the program as generally positive on the questionnaire, but responses to the open-ended question revealed criticisms and suggestions for improvement not captured on the questionnaire. Interviewing participants in these programs may offer richer data for identifying areas for program improvement. Copyright 2011, SLACK Incorporated.

Evaluating the Effectiveness of Self-Created Student Screencasts as a Tool to Increase Student Learning Outcomes in a Hands-On Computer Programming Course

ERIC Educational Resources Information Center

Powell, Loreen M.; Wimmer, Hayden

2015-01-01

Computer programming is challenging to teach and difficult for students to learn. Instructors have searched for ways to improve student learning in programming courses. In an attempt to foster hands-on learning and to increase student learning outcomes in a programming course, the authors conducted an exploratory study to examine student created…

The nurse-family partnership: An evidence-based preventive intervention.

PubMed

Olds, David L

2006-01-01

Pregnancy and the early years of the child's life offer an opportune time to prevent a host of adverse maternal, child, and family outcomes that are important in their own right, but that also reflect biological, behavioral, and social substrates in the child and family that affect family formation and future life trajectories. This article summarizes a 27-year program of research that has attempted to improve early maternal and child health and future life options with prenatal and infancy home visiting by nurses. The program is designed for low-income mothers who have had no previous live births. The home-visiting nurses have three major goals: to improve the outcomes of pregnancy by helping women improve their prenatal health, to improve the child's health and development by helping parents provide more sensitive and competent care of the child, and to improve parental life course by helping parents plan future pregnancies, complete their education, and find work. The program has been tested in three separate large-scale, randomized controlled trials with different populations living in different contexts. Results from these trials indicate that the program has been successful in achieving two of its most important goals: (a) the improvement of parental care of the child as reflected in fewer injuries and ingestions that may be associated with child abuse and neglect and better infant emotional and language development; and (b) the improvement of maternal life course, reflected in fewer subsequent pregnancies, greater work-force participation, and reduced dependence on public assistance and food stamps. The impact on pregnancy outcomes is equivocal. In the first trial, the program also produced long-term effects on the number of arrests, convictions, emergent substance use, and promiscuous sexual activity of 15-year-old children whose nurse-visited mothers were low-income and unmarried when they registered in the study during pregnancy. In general, the impact of the program was greater on those segments of the population at greater risk for the particular outcome domain under examination. Since 1996, the program has been offered for public investment outside of research contexts. Careful attention has been given to ensuring that organizational and community contexts are favorable for development of the program, to providing excellent training and guidance to the nurses in their use of the program's visit-by-visit guidelines, to monitoring the functioning of the program with a comprehensive clinical information system, and to improving the performance of the programs over time with continuous improvement strategies. Copyright © 2006 Michigan Association for Infant Mental Health.

Evaluating Principal-Preparation Programs Based on Placement Rates: Problems and Prospects for Policymakers

ERIC Educational Resources Information Center

Fuller, Edward J.; Hollingworth, Liz

2016-01-01

Recent calls to hold preparation programs accountable for outcomes have led states to develop and adopt preparation program accountability systems. A primary feature of these systems is a focus on outcomes such as placement rates, retention rates, and graduates' effectiveness in improving K-12 student achievement. Yet, little research has examined…

Improving the power of an efficacy study of a social and emotional learning program: application of generalizability theory to the measurement of classroom-level outcomes.

PubMed

Mashburn, Andrew J; Downer, Jason T; Rivers, Susan E; Brackett, Marc A; Martinez, Andres

2014-04-01

Social and emotional learning programs are designed to improve the quality of social interactions in schools and classrooms in order to positively affect students' social, emotional, and academic development. The statistical power of group randomized trials to detect effects of social and emotional learning programs and other preventive interventions on setting-level outcomes is influenced by the reliability of the outcome measure. In this paper, we apply generalizability theory to an observational measure of the quality of classroom interactions that is an outcome in a study of the efficacy of a social and emotional learning program called The Recognizing, Understanding, Labeling, Expressing, and Regulating emotions Approach. We estimate multiple sources of error variance in the setting-level outcome and identify observation procedures to use in the efficacy study that most efficiently reduce these sources of error. We then discuss the implications of using different observation procedures on both the statistical power and the monetary costs of conducting the efficacy study.

Comparison of manual therapy and exercise therapy in osteoarthritis of the hip: a randomized clinical trial.

PubMed

Hoeksma, Hugo L; Dekker, Joost; Ronday, H Karel; Heering, Annet; van der Lubbe, Nico; Vel, Cees; Breedveld, Ferdinand C; van den Ende, Cornelia H M

2004-10-15

To determine the effectiveness of a manual therapy program compared with an exercise therapy program in patients with osteoarthritis (OA) of the hip. A single-blind, randomized clinical trial of 109 hip OA patients was carried out in the outpatient clinic for physical therapy of a large hospital. The manual therapy program focused on specific manipulations and mobilization of the hip joint. The exercise therapy program focused on active exercises to improve muscle function and joint motion. The treatment period was 5 weeks (9 sessions). The primary outcome was general perceived improvement after treatment. Secondary outcomes included pain, hip function, walking speed, range of motion, and quality of life. Of 109 patients included in the study, 56 were allocated to manual therapy and 53 to exercise therapy. No major differences were found on baseline characteristics between groups. Success rates (primary outcome) after 5 weeks were 81% in the manual therapy group and 50% in the exercise group (odds ratio 1.92, 95% confidence interval 1.30, 2.60). Furthermore, patients in the manual therapy group had significantly better outcomes on pain, stiffness, hip function, and range of motion. Effects of manual therapy on the improvement of pain, hip function, and range of motion endured after 29 weeks. The effect of the manual therapy program on hip function is superior to the exercise therapy program in patients with OA of the hip.

Evaluating the social and economic impact of community-based prenatal care.

PubMed

Cramer, Mary E; Chen, Li-Wu; Roberts, Sara; Clute, Dorothea

2007-01-01

This article describes the evaluation and findings of a community-based prenatal care program, Omaha Healthy Start (OHS), designed to reduce local racial disparities in birth outcomes. This evaluative study used a comparative descriptive design, and Targeting Outcomes of Programs was the conceptual framework for evaluation. The evaluation followed 3 groups for 2 years: OHS birth mothers (N=79; N=157); non-OHS participant birth mothers (N=746; N=774); and Douglas County birth mothers (N=7,962; N=7,987). OHS provided case management, home visits, screening, referral, transportation, and health education to participants. Program outcome measures included low birth weight, infant mortality, adequacy of care, trimester of care, and costs of care. OHS birth outcomes improved during year 2, and there was a 31% cost saving in the average hospital expenditure compared with the nonparticipant groups. Preliminary evaluative analysis indicates that prenatal case management and community outreach can improve birth outcomes for minority women, while producing cost savings. Further prospective study is needed to document trends over a longer period of time regarding the relationship between community-based case management programs for minority populations, birth outcomes, and costs of care.

Provider and Patient Directed Financial Incentives to Improve Care and Outcomes for Patients with Diabetes

PubMed Central

Lorincz, Ilona S.; Lawson, Brittany C. T.

2012-01-01

Incentive programs directed at both providers and patients have become increasingly widespread. Pay-for-performance (P4P) where providers receive financial incentives to carry out specific care or improve clinical outcomes has been widely implemented. The existing literature indicates they probably spur initial gains which then level off or partially revert if incentives are withdrawn. The literature also indicates that process measures are easier to influence through P4P programs but that intermediate outcomes such as glucose, blood pressure, and cholesterol control are harder to influence, and the long term impact of P4P programs on health is largely unknown. Programs directed at patients show greater promise as a means to influence patient behavior and intermediate outcomes such as weight loss; however, the evidence for long term effects are lacking. In combination, both patient and provider incentives are potentially powerful tools but whether they are cost-effective has yet to be determined. PMID:23225214

The impact of patient support programs on adherence, clinical, humanistic, and economic patient outcomes: a targeted systematic review

PubMed Central

Ganguli, Arijit; Clewell, Jerry; Shillington, Alicia C

2016-01-01

Background Patient support programs (PSPs), including medication management and counseling, have the potential to improve care in chronic disease states with complex therapies. Little is known about the program’s effects on improving clinical, adherence, humanistic, and cost outcomes. Purpose To conduct a targeted review describing medical conditions in which PSPs have been implemented; support delivery components (eg, face-to-face, phone, mail, and internet); and outcomes associated with implementation. Data sources MEDLINE – 10 years through March 2015 with supplemental handsearching of reference lists. Study selection English-language trials and observational studies of PSPs providing at minimum, counseling for medication management, measurement of ≥1 clinical outcome, and a 3-month follow-up period during which outcomes were measured. Data extraction Program characteristics and related clinical, adherence, humanistic, and cost outcomes were abstracted. Study quality and the overall strength of evidence were reviewed using standard criteria. Data synthesis Of 2,239 citations, 64 studies met inclusion criteria. All targeted chronic disease processes and the majority (48 [75%]) of programs offered in-clinic, face-to-face support. All but 9 (14.1%) were overseen by allied health care professionals (eg, nurses, pharmacists, paraprofessionals). Forty-one (64.1%) reported at least one significantly positive clinical outcome. The most frequent clinical outcome impacted was adherence, where 27 of 41 (66%) reported a positive outcome. Of 42 studies measuring humanistic outcomes (eg, quality of life, functional status), 27 (64%) reported significantly positive outcomes. Only 15 (23.4%) programs reported cost or utilization-related outcomes, and, of these, 12 reported positive impacts. Conclusion The preponderance of evidence suggests a positive impact of PSPs on adherence, clinical and humanistic outcomes. Although less often measured, health care utilization and costs are also reduced following PSP implementation. Further research is needed to better quantify which support programs, delivery methods, and components offer the greatest value for any particular medical condition. PMID:27175071

Experimental impacts of a teacher professional development program in Chile on preschool classroom quality and child outcomes.

PubMed

Yoshikawa, Hirokazu; Leyva, Diana; Snow, Catherine E; Treviño, Ernesto; Barata, M Clara; Weiland, Christina; Gomez, Celia J; Moreno, Lorenzo; Rolla, Andrea; D'Sa, Nikhit; Arbour, Mary Catherine

2015-03-01

We assessed impacts on classroom quality and on 5 child language and behavioral outcomes of a 2-year teacher professional-development program for publicly funded prekindergarten and kindergarten in Chile. This cluster-randomized trial included 64 schools (child N = 1,876). The program incorporated workshops and in-classroom coaching. We found moderate to large positive impacts on observed emotional and instructional support as well as classroom organization in prekindergarten classrooms after 1 year of the program. After 2 years of the program, moderate positive impacts were observed on emotional support and classroom organization. No significant program impacts on child outcomes were detected at posttest (1 marginal effect, an increase in a composite of self-regulation and low problem behaviors, was observed). Professional development for preschool teachers in Chile can improve classroom quality. More intensive curricular approaches are needed for these improvements to translate into effects on children. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Preventing alcohol and drug exposed births in Washington state: intervention findings from three parent-child assistance program sites.

PubMed

Grant, Therese M; Ernst, Cara C; Streissguth, Ann; Stark, Kenneth

2005-01-01

Home visitation interventions show promise for helping at-risk mothers, yet few programs have been developed and evaluated specifically for alcohol and drug-abusing pregnant women. This study examines outcomes among 216 women enrolled in the Washington State Parent-Child Assistance Program, a three-year intervention program for women who abuse alcohol and drugs during an index pregnancy. Pretest-posttest comparison was made across three sites: the original demonstration (1991-1995), and the Seattle and Tacoma replications (1996-2003). In the original demonstration, the client group performed significantly better than controls. Compared to the original demonstration, outcomes at replication sites were maintained (for regular use of contraception and use of reliable method; and number of subsequent deliveries), or improved (for alcohol/drug treatment completed; alcohol/ drug abstinence; subsequent delivery unexposed to alcohol/drugs). Improved outcomes at replication sites are not attributable to enrolling lower-risk women. Public policies and programs initiated over the study period may have had a positive effect on outcomes. Study findings suggest that this community-based intervention model is effective over time and across venues.

Implementation of a drug-use and disease-state management program.

PubMed

Skledar, S J; Hess, M M

2000-12-15

A drug-use and disease-state management (DUDSM) program was instituted in 1996 at a teaching hospital associated with a large nonprofit health care system. The program's goals are to optimize pharmacotherapeutic regimens, evaluate health outcomes of identified disease states, and evaluate the economic impact of pharmacotherapeutic options for given disease states by developing practice guidelines. Through a re-engineering process, resources within the pharmacy department were identified that could be devoted to the DUDSM program, including the use of clinical pharmacy specialists, promotion of staff pharmacists into the DUDSM program, a pharmacy technician, and information systems support. A strength of the program is its systematic approach for developing and implementing new initiatives, as well as monitoring compliance with all initiatives on an ongoing basis. The initiative-design process incorporates continuous quality improvement principles, outcome design and evaluation, competency assessment for all pharmacists, multidisciplinary collaboration, and sophisticated information systems. Seventy-five initiatives have been implemented, ranging from simple dose-optimization strategies for specific drugs to complicated practice guidelines for managing specific disease states. Improved patient outcomes have been documented, including reduced length of stay, postsurgical wound infection, adverse drug reactions, and medication errors. Documented cost savings exceeded $4 million annually for fiscal years 1996-97 through 1999-2000. Overall compliance with DUDSM initiatives exceeds 80%, and physician service profiling has been initiated to monitor variant prescribing. The DUDSM program has successfully integrated practice guidelines into therapeutic decision-making, resulting in improved patient-care outcomes and cost savings.

Leveraging Competency Framework to Improve Teaching and Learning: A Methodological Approach

ERIC Educational Resources Information Center

Shankararaman, Venky; Ducrot, Joelle

2016-01-01

A number of engineering education programs have defined learning outcomes and course-level competencies, and conducted assessments at the program level to determine areas for continuous improvement. However, many of these programs have not implemented a comprehensive competency framework to support the actual delivery and assessment of an…

Wisconsin Farm to School Programs: Dietary Outcomes in Elementary Students

ERIC Educational Resources Information Center

Bontrager Yoder, Andrea Beth H.

2014-01-01

Background. High overweight and obesity prevalence has instigated many programs to improve children's health. Farm to School (F2S) is a grassroots-organized program that seeks to improve children's dietary habits, especially fruit and vegetable (FV) consumption, through various educational activities. Long-term goals include reducing obesity…

Process and Outcome Evaluation of an Art Therapy Program for People Living with HIV/AIDS

ERIC Educational Resources Information Center

Feldman, Matthew B.; Betts, Donna J.; Blausey, Daniel

2014-01-01

Program evaluation offers an opportunity for improving the implementation and impact of art therapy. This article describes a process and outcomes evaluation of an art therapy program within the mental health services unit of a community-based organization for people living with HIV/AIDS. The aims were to assess utilization patterns and program…

Effect of special diabetes program for Indians funding on system changes in diabetes care and outcomes among American Indian/Alaska Native people 1994-2004.

PubMed

Ramesh, Meera; Schraer, Cynthia; Mayer, Ann Marie; Asay, Elvin; Koller, Kathryn

2008-06-01

The Alaska Native Medical Center diabetes program analysed Diabetes Care and Outcomes Audit data from 1994-2004 to evaluate the impact of the Special Diabetes Program for Indians (SDPI) funding on process and intermediate outcomes. We conducted a retrospective analysis of data from standardized medical records reviews conducted between 1994 and 2004 from regional sites in Alaska. We analysed 7,735 randomly selected records for trends over three time periods (pre-SDPI, transition and SDPI). Hemoglobin A1c, total and LDL cholesterol, triglycerides and blood pressure significantly improved from the pre-SDPI to the SDPI period. However, as the number of people with diabetes increased, the percentage of patients receiving foot, eye and dental exams decreased, as did the percentage receiving nutrition, exercise and diabetes education. SDPI funding provided resources for interventions necessary to improve the effectiveness of diabetes care. This was associated with improved intermediate outcomes in American Indian/Alaska Native patients with diabetes. Further observations are needed to evaluate whether or not intermediate outcomes result in decreased cardiovascular disease, amputations, dialysis and retinopathy.

Student Development in an Experiential Learning Program

ERIC Educational Resources Information Center

Gilbert, Brandi L.; Banks, Julianna; Houser, John H. W.; Rhodes, Simon J.; Lees, N. Douglas

2014-01-01

This study is an outcomes assessment of an experiential learning program for undergraduate students interested in life and health sciences careers enrolled at a public urban research institution. The year-long research and professional experience internships were projected to improve learning outcomes in undergraduates. The study included an…

Motor Retraining (MoRe) for Functional Movement Disorders: Outcomes From a 1-Week Multidisciplinary Rehabilitation Program.

PubMed

Jacob, Alexandra; Kaelin, Darryl; Roach, Abbey; Ziegler, Craig; LaFaver, Kathrin

2018-05-18

Functional movement disorders (FMDs) are conditions of abnormal motor control thought to be caused by psychological factors. These disorders are commonly seen in neurologic practice, and prognosis is often poor. No consensus treatment guidelines have been established; however, the role of physical therapy in addition to psychotherapy has increasingly been recognized. This study reports patient outcomes from a multidisciplinary FMD treatment program using motor retraining (MoRe) strategies. To assess outcomes of FMD patients undergoing a multidisciplinary treatment program and determine factors predictive of treatment success. Retrospective chart review. University-affiliated rehabilitation institute. Thirty-two consecutive FMD patients admitted to the MoRe program from July 2014-July 2016. Patients participated in a 1-week, multidisciplinary inpatient treatment program with daily physical, occupational, speech therapy, and psychotherapy interventions. Primary outcome measures were changes in the patient-rated Clinical Global Impression Scale (CGI) and the physician-rated Psychogenic Movement Disorder Rating Scale (PMDRS) based on review of standardized patient videos. Measurements were taken as part of the clinical evaluation of the program. Twenty-four of the 32 patients were female with a mean age of 49.1 (±14.2) years and mean symptom duration of 7.4 (±10.8) years. Most common movement phenomenologies were abnormal gait (31.2%), hyperkinetic movements (31.2%), and dystonia (31.2%). At discharge, 86.7% of patients reported symptom improvement on the CGI, and self-reported improvement was maintained in 69.2% at the 6-month follow-up. PMDRS scores improved by 59.1% from baseline to discharge. Longer duration of symptoms, history of abuse, and comorbid psychiatric disorders were not significant predictors of treatment outcomes. The majority of FMD patients experienced improvement from a 1-week multidisciplinary inpatient rehabilitation program. Treatment outcomes were not negatively correlated with longer disease duration or psychiatric comorbidities. The results from our study are encouraging, although further long-term prospective randomized studies are needed. Level III. Copyright © 2018 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Factors Associated with Effective Nutrition Interventions for Pregnant Indigenous Women: A Systematic Review.

PubMed

Ashman, Amy M; Brown, Leanne J; Collins, Clare E; Rollo, Megan E; Rae, Kym M

2017-08-01

Indigenous people continue to experience health disparities relative to non-Indigenous populations. Interventions to improve nutrition during pregnancy in these groups may improve health outcomes for mothers and their infants. The effectiveness of existing nutrition intervention programs has not been reviewed previously. The objective was to identify interventions targeting improving nutrition-related outcomes for pregnant Indigenous women residing in Organisation for Economic Co-operation and Development countries, and to identify positive factors contributing to successful programs. Thirteen electronic databases were searched up until October 2015. Key words identified studies intervening to improve nutrition-related outcomes for pregnant Indigenous women. Two reviewers assessed articles for inclusion and study quality and extracted data. Only studies published in English were included. Data were summarized narratively. Abstracts and titles were screened (n=2,566) and 315 full texts were reviewed for eligibility. This review included 27 articles from 20 intervention programs from Australia, Canada, and the United States. The most prevalent measurable outcomes were birth weight (n=9) and breastfeeding initiation/duration (n=11). Programs with statistically significant results for these outcomes employed the following nutrition activities: individual counseling/education (n=8); delivery by senior Indigenous woman (n=2), peer counselor (n=3), or other Indigenous health worker (n=4); community-wide interventions (n=2); media campaigns (n=2); delivery by non-Indigenous health professional (n=3); and home visits (n=3). Heterogeneity of included studies made it challenging to make firm recommendations regarding program success. Authors of included studies recommended community consultation be included when designing studies and working with communities at all stages of the research process. Individualized counseling/education can contribute to successful program outcomes, as can the use of Indigenous workers to deliver program content. Limitations of some studies included a lack of details on interventions and the use of nonrandom control groups. Future studies should include detailed descriptions of intervention components and include appropriate evaluation protocols. Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Effects of the Family Bereavement Program on Academic Outcomes, Educational Expectations and Job Aspirations 6 Years Later: The Mediating Role of Parenting and Youth Mental Health Problems

PubMed Central

Schoenfelder, Erin N.; Tein, Jenn-Yun; Wolchik, Sharlene; Sandler, Irwin N.

2014-01-01

Experiencing the death of a parent during childhood is associated with a variety of difficulties, including lower academic achievement, that have implications for functioning in childhood and adulthood. This study examines effects of the Family Bereavement Program (FBP), a preventive intervention for parentally-bereaved youth and their caregivers, on grade point averages (GPA), educational expectations and job aspirations of youths 6 years after the intervention. A total of 244 bereaved youths ages 8-16 and their caregivers were randomized to either the FBP or a comparison group that received books about bereavement. Assessments occurred at pretest, post-test, and 11-month and 6-year follow-ups. Direct program effects on educational outcomes and job aspirations 6 years later were non-significant, although the program improved educational expectations for children with fewer behavior problems at program entry, and GPA for younger children. Mediational pathways for program effects on educational outcomes were also tested. Program-induced improvements in effective parenting at 11-month follow-up were associated with higher GPAs at 6-year follow-up for youth who were younger or for whom more time had passed since the loss. Program-induced improvements in parenting and teacher-rated youth mental health problems at the 6-year follow-up mediated program effects on youths’ educational expectations for those with fewer behavior problems at program entry. The implications of these findings for understanding processes related to academic and educational outcomes following the death of a parent and for prevention efforts to help bereaved and other high-risk children succeed in school are discussed. PMID:25052624

Improving child welfare performance through supervisory use of client outcome data.

PubMed

Moore, T D; Rapp, C A; Roberts, B

2000-01-01

Despite their benefits, there is little evidence that outcome data are being widely used by program managers or field level supervisors. Three interdependent factors that facilitate the use of outcome data are well-constructed reports, and organizational culture that supports learning and outcome achievement, and managerial skills in interpreting data and taking relevant action. This article describes an outcome reporting package and training oriented toward frontline supervisors to help them use outcome data, shape a learning culture, interpret data, and take focused action toward improving outcomes for children and families.

Predictors of Program Use and Child and Parent Outcomes of A Brief Online Parenting Intervention.

PubMed

Baker, Sabine; Sanders, Matthew R

2017-10-01

Web-based parenting interventions have the potential to increase the currently low reach of parenting programs, but few evidence-based online programs are available, and little is known about who benefits from this delivery format. This study investigated if improvements in child behavior and parenting, following participation in a brief online parenting program (Triple P Online Brief), can be predicted by family and program-related factors. Participants were 100 parents of 2-9-year-old children displaying disruptive behavior problems. Regression analyses showed that higher baseline levels of child behavior problems, older parental age and more intense conflict over parenting pre-intervention predicted greater improvement in child behavior at 9-month follow-up. Improvement in parenting was predicted by higher pre-intervention levels of ineffective parenting. Family demographics, parental adjustment and program related factors did not predict treatment outcomes. Younger child age and lower disagreement over parenting pre-intervention predicted completion of the recommended minimum dose of the program.

A Systematic Review of Internet-Based Worksite Wellness Approaches for Cardiovascular Disease Risk Management: Outcomes, Challenges & Opportunities

PubMed Central

Aneni, Ehimen C.; Roberson, Lara L.; Maziak, Wasim; Agatston, Arthur S.; Feldman, Theodore; Rouseff, Maribeth; Tran, Thinh H.; Blumenthal, Roger S.; Blaha, Michael J.; Blankstein, Ron; Al-Mallah, Mouaz H.; Budoff, Matthew J.; Nasir, Khurram

2014-01-01

Context The internet is gaining popularity as a means of delivering employee-based cardiovascular (CV) wellness interventions though little is known about the cardiovascular health outcomes of these programs. In this review, we examined the effectiveness of internet-based employee cardiovascular wellness and prevention programs. Evidence Acquisition We conducted a systematic review by searching PubMed, Web of Science and Cochrane library for all published studies on internet-based programs aimed at improving CV health among employees up to November 2012. We grouped the outcomes according to the American Heart Association (AHA) indicators of cardiovascular wellbeing – weight, BP, lipids, smoking, physical activity, diet, and blood glucose. Evidence Synthesis A total of 18 randomized trials and 11 follow-up studies met our inclusion/exclusion criteria. Follow-up duration ranged from 6 – 24 months. There were significant differences in intervention types and number of components in each intervention. Modest improvements were observed in more than half of the studies with weight related outcomes while no improvement was seen in virtually all the studies with physical activity outcome. In general, internet-based programs were more successful if the interventions also included some physical contact and environmental modification, and if they were targeted at specific disease entities such as hypertension. Only a few of the studies were conducted in persons at-risk for CVD, none in blue-collar workers or low-income earners. Conclusion Internet based programs hold promise for improving the cardiovascular wellness among employees however much work is required to fully understand its utility and long term impact especially in special/at-risk populations. PMID:24421894

Service system integration, access to services, and housing outcomes in a program for homeless persons with severe mental illness.

PubMed

Rosenheck, R; Morrissey, J; Lam, J; Calloway, M; Johnsen, M; Goldman, H; Randolph, F; Blasinsky, M; Fontana, A; Calsyn, R; Teague, G

1998-11-01

This study evaluated the hypothesis that greater integration and coordination between agencies within service systems is associated with greater accessibility of services and improved client housing outcomes. As part of the Access to Community Care and Effective Services and Supports program, data were obtained on baseline client characteristics, service use, and 3-month and 12-month outcomes from 1832 clients seen at 18 sites during the first year of program operation. Data on interorganizational relationships were obtained from structured interviews with key informants from relevant organizations in each community (n = 32-82 at each site). Complete follow-up data were obtained from 1340 clients (73%). After control for baseline characteristics, service system integration was associated with superior housing outcomes at 12 months, and this relationship was mediated through greater access to housing agencies. Service system integration is related to improved access to housing services and better housing outcomes among homeless people with mental illness.

42 CFR 416.43 - Conditions for coverage-Quality assessment and performance improvement.

Code of Federal Regulations, 2011 CFR

2011-10-01

... outcomes, patient safety, and quality of care. (2) Performance improvement activities must track adverse... patient safety by using quality indicators or performance measures associated with improved health... that includes care and services furnished in the ASC. (b) Standard: Program data. (1) The program must...

A Peer-to-Peer Mentoring Program for In-Center Hemodialysis: A Patient-Centered Quality Improvement Program.

PubMed

St Clair Russell, Jennifer; Southerland, Shiree; Huff, Edwin D; Thomson, Maria; Meyer, Klemens B; Lynch, Janet R

2017-01-01

A patient-centered quality improvement program implemented in one Virginia hemodialysis facility sought to determine if peer-to-peer (P2P) programs can assist patients on in-center hemodialysis with self-management and improve outcomes. Using a single-arm, repeatedmeasurement, quasi-experimental design, 46 patients participated in a four-month P2P intervention. Outcomes include knowledge, self-management behaviors, and psychosocial health indicators: self-efficacy, perceived social support, hemodialysis social support, and healthrelated quality of life (HRQoL). Physiological health indicators included missed and shortened treatments, arteriovenous fistula placement, interdialytic weight gain, serum phosphorus, and hospitalizations. Mentees demonstrated increased knowledge, self-efficacy, perceived social support, hemodialysis social support, and HRQoL. Missed treatments decreased. Mentors experienced increases in knowledge, self-management, and social support. A P2P mentoring program for in-center hemodialysis can benefit both mentees and mentors. Copyright© by the American Nephrology Nurses Association.

Using Social-Emotional and Character Development to Improve Academic Outcomes: A Matched-Pair, Cluster-Randomized Controlled Trial in Low-Income, Urban Schools

ERIC Educational Resources Information Center

Bavarian, Niloofar; Lewis, Kendra M.; DuBois, David L.; Acock, Alan; Vuchinich, Samuel; Silverthorn, Naida; Snyder, Frank J.; Day, Joseph; Ji, Peter; Flay, Brian R.

2013-01-01

Background: School-based social-emotional and character development (SECD) programs can influence not only SECD but also academic-related outcomes. This study evaluated the impact of one SECD program, Positive Action (PA), on educational outcomes among low-income, urban youth. Methods: The longitudinal study used a matched-pair, cluster-randomized…

Evidence-based perianesthesia care: accelerated postoperative recovery programs.

PubMed

Pasero, Chris; Belden, Jan

2006-06-01

Prolonged stress response after surgery can cause numerous adverse effects, including gastrointestinal dysfunction, muscle wasting, impaired cognition, and cardiopulmonary, infectious, and thromboembolic complications. These events can delay hospital discharge, extend convalescence, and negatively impact long-term prognosis. Recent advances in perioperative management practices have allowed better control of the stress response and improved outcomes for patients undergoing surgery. At the center of the current focus on improved outcomes are evidence-based fast-track surgical techniques and what is commonly referred to as "accelerated postoperative recovery programs." These programs require a multidisciplinary, coordinated effort, and nurses are essential to their successful implementation.

Elbow ulnar collateral ligament injuries in athletes: Can we improve our outcomes?

PubMed Central

Redler, Lauren H; Degen, Ryan M; McDonald, Lucas S; Altchek, David W; Dines, Joshua S

2016-01-01

Injury to the ulnar collateral ligament (UCL) most commonly occurs in the overhead throwing athlete. Knowledge surrounding UCL injury pathomechanics continues to improve, leading to better preventative treatment strategies and rehabilitation programs. Conservative treatment strategies for partial injuries, improved operative techniques for reconstruction in complete tears, adjunctive treatments, as well as structured sport specific rehabilitation programs including resistive exercises for the entire upper extremity kinetic chain are all important factors in allowing for a return to throwing in competitive environments. In this review, we explore each of these factors and provide recommendations based on the available literature to improve outcomes in UCL injuries in athletes. PMID:27114930

Eight Weeks of Strength and Power Training Improves Club Head Speed in Collegiate Golfers.

PubMed

Oranchuk, Dustin J; Mannerberg, Jason M; Robinson, Tracey L; Nelson, Megan C

2018-02-14

Club head speed (CHS) is a major determinant of drive distance, a key component of golf performance. The purpose of this study was to determine the indirect effects of an eight-week strength and power program on CHS. Twelve (6 male, 6 female) NCAA Division II golfers (20.3±1.5 years) randomly assigned to an intervention or control group, underwent either a periodized strength and power program consisting of high-load barbell movements or a bodyweight and rotational movement focused resistance training program. Outcomes were CHS, countermovement jump (CMJ) height, and 1RM back squat (BS), power clean (PC), and deadlift (DL). Dependent t-tests were utilized to assess differences in outcome variables pre-to-post for each group, independent t-tests were utilized to assess differences between groups, and Pearson correlations were utilized to assess associations between CHS and outcome variables. On average, the intervention group experienced improvements in all outcome variables except peak CHS (p=0.60); the control group displayed no changes in any outcome variable except a decrease in average CHS (p=0.028). Compared to the control group, the intervention group experienced greater improvements in average CHS, BS, PC, and average and peak CMJ height (p<0.05). Additionally, CHS had large associations with PC (r=0.70, p=0.012), BS (r=0.64, p=0.025), DL (r=0.54, p=0.068) and CMJ (r=0.73, p=0.007). These results suggest improving muscular strength and power by increasing PC, BS, and CMJ is associated with increased CHS in collegiate golfers. Integrating a high-load, barbell-focused strength and power program may be beneficial for improving CHS and indirectly, golf performance.

Evaluation of a Postdischarge Call System Using the Logic Model.

PubMed

Frye, Timothy C; Poe, Terri L; Wilson, Marisa L; Milligan, Gary

2018-02-01

This mixed-method study was conducted to evaluate a postdischarge call program for congestive heart failure patients at a major teaching hospital in the southeastern United States. The program was implemented based on the premise that it would improve patient outcomes and overall quality of life, but it had never been evaluated for effectiveness. The Logic Model was used to evaluate the input of key staff members to determine whether the outputs and results of the program matched the expectations of the organization. Interviews, online surveys, reviews of existing patient outcome data, and reviews of publicly available program marketing materials were used to ascertain current program output. After analyzing both qualitative and quantitative data from the evaluation, recommendations were made to the organization to improve the effectiveness of the program.

Technical Assistance and Changes in Nutrition and Physical Activity Practices in the National Early Care and Education Learning Collaboratives Project, 2015-2016.

PubMed

Chiappone, Alethea; Smith, Teresa M; Estabrooks, Paul A; Rasmussen, Cristy Geno; Blaser, Casey; Yaroch, Amy L

2018-04-26

The National Early Care and Education Learning Collaboratives Project (ECELC) aims to improve best practices in early care and education (ECE) programs in topic areas of the Nutrition and Physical Activity Self-Assessment in Child Care (NAP SACC). Technical assistance is a component of the ECELC, yet its effect on outcomes is unclear. Beyond dose and duration of technical assistance, limited research exists on characteristics of technical assistance that contribute to outcomes. The objective of this study was to identify and describe technical assistance characteristics and explore associations with NAP SACC outcomes. We collected data from 10 collaboratives comprising 84 ECE programs in 2 states in 2015-2016. The objective of technical assistance was to support programs in improving best practices. Technical assistance was provided to programs via on-site, telephone, or email and was tailored to program needs. We used a mixed-methods design to examine associations between technical assistance and NAP SACC outcomes. We used multiple regression analysis to assess quantitative data and qualitative comparative analysis to determine necessary and sufficient technical assistance conditions supporting NAP SACC outcomes. We also conducted a document review to describe technical assistance that referred conditions identified by the qualitative comparative analysis. Regression analyses detected an inverse relationship between changes in NAP SACC scores and hours of technical assistance. No clear pattern emerged in the qualitative comparative analysis, leaving no necessary and sufficient conditions. However, the qualitative comparative analysis identified feedback as a potentially important component of technical assistance, whereas resource sharing and frequent email were characteristics that seemed to reduce the likelihood of improved outcomes. Email and resource sharing were considered primarily general information rather than tailored technical assistance. Technical assistance may be used in programs and made adaptable to program needs. The inclusion and evaluation of technical assistance, especially tailored approaches, is warranted for environmental interventions, including ECE settings.

Predicting Employment Outcomes for Consumers in Community College Short-Term Training Programs

ERIC Educational Resources Information Center

Flannery, K. Brigid; Benz, Michael R.; Yovanoff, Paul; Kato, Mary McGrath; Lindstrom, Lauren

2011-01-01

Postsecondary education has been linked to improved access to employment opportunities for individuals with and without disabilities. The purpose of this study was to determine factors associated with increased employment outcomes for Vocational Rehabilitation consumers enrolled in community college short term occupational skill training programs.…

Lessons learned from the American College of Surgeons National Surgical Quality Improvement Program Database: has centralized data collection improved immediate breast reconstruction outcomes and safety?

PubMed

Wang, Frederick; Koltz, Peter F; Sbitany, Hani

2014-11-01

The American College of Surgeons National Surgical Quality Improvement Program database was implemented to longitudinally track surgical 30-day surgical outcomes and complications. The authors analyze the program-reported outcomes for immediate breast reconstruction from 2007 to 2011, to assess whether longitudinal data collection has improved national outcomes and to highlight areas in need of continued improvement. The authors reviewed the database from 2007 to 2011 and identified encounters for immediate breast reconstruction using Current Procedural Terminology codes for prosthetic and autologous reconstruction. Demographics and comorbidities were tabulated for all patients. Postoperative complications analyzed included surgical-site infection, wound dehiscence, implant or flap loss, pulmonary embolism, and respiratory infections. A total of 15,978 patients underwent mastectomy and immediate reconstruction. Fewer smokers underwent immediate reconstruction over time (p=0.126), whereas more obese patients (p=0.001) and American Society of Anesthesiologists class 3 and 4 patients (p<0.001) underwent surgery. An overall increase in superficial surgical-site infection was noted, from 1.7 percent to 2.3 percent (p=0.214). Wound dehiscence (p=0.036) increased over time, whereas implant loss (p=0.015) and flap loss (p=0.012) decreased over time. Mean operative times increased over the analyzed years, as did all complications for prosthetic and autologous reconstruction. The American College of Surgeons National Surgical Quality Improvement Program data set has shown an increase in complications for immediate breast reconstruction over time, because of a longitudinally higher number of comorbid patients and longer operative times. This knowledge allows plastic surgeons the unique opportunity to improve patient selection criteria and efficiency. Therapeutic, III.

Introducing quality improvement methods into local public health departments: structured evaluation of a statewide pilot project.

PubMed

Riley, William; Parsons, Helen; McCoy, Kim; Burns, Debra; Anderson, Donna; Lee, Suhna; Sainfort, François

2009-10-01

To test the feasibility and assess the preliminary impact of a unique statewide quality improvement (QI) training program designed for public health departments. One hundred and ninety-five public health employees/managers from 38 local health departments throughout Minnesota were selected to participate in a newly developed QI training program and 65 of those engaged in and completed eight expert-supported QI projects over a period of 10 months from June 2007 through March 2008. As part of the Minnesota Quality Improvement Initiative, a structured distance education QI training program was designed and deployed in a first large-scale pilot. To evaluate the preliminary impact of the program, a mixed-method evaluation design was used based on four dimensions: learner reaction, knowledge, intention to apply, and preliminary outcomes. Subjective ratings of three dimensions of training quality were collected from participants after each of the scheduled learning sessions. Pre- and post-QI project surveys were administered to collect participant reactions, knowledge, future intention to apply learning, and perceived outcomes. Monthly and final QI project reports were collected to further inform success and preliminary outcomes of the projects. The participants reported (1) high levels of satisfaction with the training sessions, (2) increased perception of the relevance of the QI techniques, (3) increased perceived knowledge of all specific QI methods and techniques, (4) increased confidence in applying QI techniques on future projects, (5) increased intention to apply techniques on future QI projects, and (6) high perceived success of, and satisfaction with, the projects. Finally, preliminary outcomes data show moderate to large improvements in quality and/or efficiency for six out of eight projects. QI methods and techniques can be successfully implemented in local public health agencies on a statewide basis using the collaborative model through distance training and expert facilitation. This unique training can improve both core and support processes and lead to favorable staff reactions, increased knowledge, and improved health outcomes. The program can be further improved and deployed and holds great promise to facilitate the successful dissemination of proven QI methods throughout local public health departments.

Sobriety as an admission criterion for transitional housing: a multi-site comparison of programs with a sobriety requirement to programs with no sobriety requirement.

PubMed

Tsai, Jack; Rosenheck, Robert A; Kasprow, Wesley J; McGuire, James F

2012-10-01

This study examined whether homeless clients enrolled in transitional housing programs that required sobriety (SR) as an admission criterion have outcomes comparable to clients enrolled in programs that did not require sobriety (NSR) as an admission criterion. A total of 1062 military veterans in 40 transitional housing programs funded by the United States Department of Veterans Affairs were grouped based on whether they were in SR or NSR programs and followed over a one-year period after program discharge. Participants in SR and NSR programs were compared on their ratings of the social climate of the program, and housing and psychosocial outcomes. Participants in SR programs reported more days housed and better psychosocial outcomes than participants in NSR programs, although the differences were small and there were no differences in ratings of their social climate. Both participants in SR and NSR programs showed improvements on most outcomes after discharge from transitional housing. There were no significant differences in outcomes between participants actively abusing substances at program entry compared to those who were not. Requiring sobriety as an admission criterion in transitional housing made only a small difference in housing outcomes post-discharge. Further study is needed to determine whether requiring sobriety at admission in transitional housing is necessary for successful client outcomes. Published by Elsevier Ireland Ltd.

Cost-Effectiveness of a Community Exercise and Nutrition Program for Older Adults: Texercise Select

PubMed Central

Akanni, Olufolake (Odufuwa); Smith, Matthew Lee; Ory, Marcia G.

2017-01-01

The wide-spread dissemination of evidence-based programs that can improve health outcomes among older populations often requires an understanding of factors influencing community adoption of such programs. One such program is Texercise Select, a community-based health promotion program previously shown to improve functional health, physical activity, nutritional habits and quality of the life among older adults. This paper assesses the cost-effectiveness of Texercise Select in the context of supportive environments to facilitate its delivery and statewide sustainability. Participants were surveyed using self-reported instruments distributed at program baseline and conclusion. Program costs were based on actual direct costs of program implementation and included costs of recruitment and outreach, personnel costs and participant incentives. Program effectiveness was measured using quality-adjusted life year (QALY) gained, as well as health outcomes, such as healthy days, weekly physical activity and Timed Up-and-Go (TUG) test scores. Preference-based EuroQol (EQ-5D) scores were estimated from the number of healthy days reported by participants and converted into QALYs. There was a significant increase in the number of healthy days (p < 0.05) over the 12-week program. Cost-effectiveness ratios ranged from $1374 to $1452 per QALY gained. The reported cost-effective ratios are well within the common cost-effectiveness threshold of $50,000 for a gained QALY. Some sociodemographic differences were also observed in program impact and cost. Non-Hispanic whites experienced significant improvements in healthy days from baseline to the follow-up period and had higher cost-effectiveness ratios. Results indicate that the Texercise Select program is a cost-effective strategy for increasing physical activity and improving healthy dietary practices among older adults as compared to similar health promotion interventions. In line with the significant improvement in healthy days, physical activity and nutrition-related outcomes among participants, this study supports the use of Texercise Select as an intervention with substantial health and cost benefits. PMID:28531094

Influence of Students' Feedback on the Quality of Adult Higher Distance Education Service Delivery

ERIC Educational Resources Information Center

Oduaran, Akpovire

2017-01-01

The evaluation of a program's compliance with service delivery and features necessary for the attainment of the program's educational objectives, student outcomes and continuous improvement is an important element in program accreditation and continuous improvement process. The study reported in this paper investigated the possible effects of…

A Progressive, Collaborative Process to Improve a Curriculum and Define an Assessment Program.

PubMed

Letassy, Nancy A; Medina, Melissa S; Britton, Mark L; Dennis, Vince; Draugalis, JoLaine R

2015-05-25

To revise the University of Oklahoma College of Pharmacy's professional program outcomes and create an assessment map using results from previous peer review and mapping of all professional courses and curricular streams of knowledge, skills, and attitudes (KSAs). After consolidating 15 original program outcomes into 11 more precise outcome statements, defining KSAs for each, and getting faculty approval of them, the committee detailed measurable program expectations upon graduation for each outcome and created an assessment map identifying where KSAs were taught, how they were to be assessed, and the expected ability level (novice, competent, proficient) for each across the curriculum. The committee's work identified deficits, inconsistencies, and disproportionalities in professional program assessment. It recommended assessments to capture student achievement of each outcome, identified performance levels and criteria to measure outcomes progressively in each professional year, and outlined a process to provide students periodic reports on their progress in achieving each outcome. This work establishes a firm foundation for ongoing efforts to measure effectiveness of the professional program, especially in light of Accreditation Council for Pharmacy Education's (ACPE) revised accreditation standards.

Budget Impact of a Comprehensive Nutrition-Focused Quality Improvement Program for Malnourished Hospitalized Patients

PubMed Central

Sulo, Suela; Feldstein, Josh; Partridge, Jamie; Schwander, Bjoern; Sriram, Krishnan; Summerfelt, Wm. Thomas

2017-01-01

Background Nutrition interventions can alleviate the burden of malnutrition by improving patient outcomes; however, evidence on the economic impact of medical nutrition intervention remains limited. A previously published nutrition-focused quality improvement program targeting malnourished hospitalized patients showed that screening patients with a validated screening tool at admission, rapidly administering oral nutritional supplements, and educating patients on supplement adherence result in significant reductions in 30-day unplanned readmissions and hospital length of stay. Objectives To assess the potential cost-savings associated with decreased 30-day readmissions and hospital length of stay in malnourished inpatients through a nutrition-focused quality improvement program using a web-based budget impact model, and to demonstrate the clinical and fiscal value of the intervention. Methods The reduction in readmission rate and length of stay for 1269 patients enrolled in the quality improvement program (between October 13, 2014, and April 2, 2015) were compared with the pre–quality improvement program baseline and validation cohorts (4611 patients vs 1319 patients, respectively) to calculate potential cost-savings as well as to inform the design of the budget impact model. Readmission rate and length-of-stay reductions were calculated by determining the change from baseline to post–quality improvement program as well as the difference between the validation cohort and the post–quality improvement program, respectively. Results As a result of improved health outcomes for the treated patients, the nutrition-focused quality improvement program led to a reduction in 30-day hospital readmissions and length of stay. The avoided hospital readmissions and reduced number of days in the hospital for the patients in the quality improvement program resulted in cost-savings of $1,902,933 versus the pre–quality improvement program baseline cohort, and $4,896,758 versus the pre–quality improvement program in the validation cohort. When these costs were assessed across the entire patient population enrolled in the quality improvement program, per-patient net savings of $1499 when using the baseline cohort as the comparator and savings per patient treated of $3858 when using the validated cohort as the comparator were achieved. Conclusion The nutrition-focused quality improvement program reduced the per-patient healthcare costs by avoiding 30-day readmissions and through reduced length of hospital stay. These clinical and economic outcomes provide a rationale for merging patient care and financial modeling to advance the delivery of value-based medicine in a malnourished hospitalized population. The use of a novel web-based budget impact model supports the integration of comparative effectiveness analytics and healthcare resource management in the hospital setting to provide optimal quality of care at a reduced overall cost. PMID:28975010

Budget Impact of a Comprehensive Nutrition-Focused Quality Improvement Program for Malnourished Hospitalized Patients.

PubMed

Sulo, Suela; Feldstein, Josh; Partridge, Jamie; Schwander, Bjoern; Sriram, Krishnan; Summerfelt, Wm Thomas

2017-07-01

Nutrition interventions can alleviate the burden of malnutrition by improving patient outcomes; however, evidence on the economic impact of medical nutrition intervention remains limited. A previously published nutrition-focused quality improvement program targeting malnourished hospitalized patients showed that screening patients with a validated screening tool at admission, rapidly administering oral nutritional supplements, and educating patients on supplement adherence result in significant reductions in 30-day unplanned readmissions and hospital length of stay. To assess the potential cost-savings associated with decreased 30-day readmissions and hospital length of stay in malnourished inpatients through a nutrition-focused quality improvement program using a web-based budget impact model, and to demonstrate the clinical and fiscal value of the intervention. The reduction in readmission rate and length of stay for 1269 patients enrolled in the quality improvement program (between October 13, 2014, and April 2, 2015) were compared with the pre-quality improvement program baseline and validation cohorts (4611 patients vs 1319 patients, respectively) to calculate potential cost-savings as well as to inform the design of the budget impact model. Readmission rate and length-of-stay reductions were calculated by determining the change from baseline to post-quality improvement program as well as the difference between the validation cohort and the post-quality improvement program, respectively. As a result of improved health outcomes for the treated patients, the nutrition-focused quality improvement program led to a reduction in 30-day hospital readmissions and length of stay. The avoided hospital readmissions and reduced number of days in the hospital for the patients in the quality improvement program resulted in cost-savings of $1,902,933 versus the pre-quality improvement program baseline cohort, and $4,896,758 versus the pre-quality improvement program in the validation cohort. When these costs were assessed across the entire patient population enrolled in the quality improvement program, per-patient net savings of $1499 when using the baseline cohort as the comparator and savings per patient treated of $3858 when using the validated cohort as the comparator were achieved. The nutrition-focused quality improvement program reduced the per-patient healthcare costs by avoiding 30-day readmissions and through reduced length of hospital stay. These clinical and economic outcomes provide a rationale for merging patient care and financial modeling to advance the delivery of value-based medicine in a malnourished hospitalized population. The use of a novel web-based budget impact model supports the integration of comparative effectiveness analytics and healthcare resource management in the hospital setting to provide optimal quality of care at a reduced overall cost.

Feasibility study of a family-focused intervention to improve outcomes for children with FASD.

PubMed

Reid, Natasha; Dawe, Sharon; Harnett, Paul; Shelton, Doug; Hutton, Lauren; O'Callaghan, Frances

2017-08-01

Growing evidence shows that children with fetal alcohol spectrum disorder (FASD) can benefit from interventions, and specifically interventions focused on improving self-regulation. However, novel ways of improving outcomes for children with FASD need further investigation so that programs target not only the individual child but also the family context, which includes the parent-child relationship. The current study aimed to evaluate the feasibility of an adapted version of the Parents under Pressure (PuP) program that addresses self-regulatory processes, through improving the parent-child relationship and the use of mindfulness-based strategies for both children and parents. This was a mixed methods study. Feasibility was examined by evaluating recruitment, data collection/outcome measures, and intervention procedures. The study used a phenomenological approach to obtain qualitative information from caregivers and a single-case experimental design to evaluate the preliminary participant responses to the intervention. Two out of three families completed treatment. The recruitment and intervention procedures were found to be suitable for and acceptable to the families involved. Some concerns were identified regarding the outcome measures that would need to be addressed in future research. Quantitative and qualitative outcomes were positive. The results provide preliminary support for the feasibility of an adapted version of the PuP program. Thus, offering a potential multi-component option, that aims to improve self-regulatory skills for children with FASD, through focusing on improving the parent-child relationship and incorporating mindfulness-based techniques for both parents and children. Copyright © 2017 Elsevier Ltd. All rights reserved.

Drug utilization review: mechanisms to improve its effectiveness and broaden its scope. The U.S. Pharmacopeia Drug Utilization Review Advisory Panel.

PubMed

2000-01-01

To address important problems and needed changes in online and retrospective drug utilization review (DUR) programs. Emphasis is placed on reliability of DUR criteria and the shift of traditional retrospective DUR programs toward disease management and health care outcomes. Published literature evaluating the role of online and retrospective DUR programs. Particular attention was given to studies assessing DUR criteria reliability and new interventions with retrospective DUR programs. A literature review was conducted along with an expert summary from the U.S. Pharmacopeia Drug Utilization Review Advisory Panel. Studies have revealed variations in DUR criteria that could be affecting clinical practice and patient care. Appropriate formal methodologies and use of consistent procedures in developing online prospective DUR programs and systems could help resolve these problems. Traditional retrospective DUR is also shifting to incorporate disease management and methodologies from health outcomes and pharmacoeconomics studies. Refinements are needed to improve the reliability and validity of online DUR criteria and to minimize false positive messages. Databases created as a result of DUR efforts have been used in new and innovative ways to incorporate health outcomes data and disease management interventions. Additional outcomes data, combined with quality assurance efforts, should increase the utility of DUR/disease management efforts in evaluating health systems while improving the effectiveness and efficiency of pharmacists' health care interventions.

Using social-emotional and character development to improve academic outcomes: a matched-pair, cluster-randomized controlled trial in low-income, urban schools

PubMed Central

Lewis, Kendra M.; DuBois, David L.; Acock, Alan; Vuchinich, Samuel; Silverthorn, Naida; Snyder, Frank J.; Day, Joseph; Ji, Peter; Flay, Brian R.

2013-01-01

BACKGROUND School-based social-emotional and character development (SECD) programs can influence not only SECD, but also academic-related outcomes. This study evaluated the impact of one SECD program, Positive Action (PA), on educational outcomes among low-income, urban youth. METHODS The longitudinal study used a matched-pair, cluster-randomized controlled design. Student-reported disaffection with learning and academic grades, and teacher ratings of academic ability and motivation were assessed for a cohort followed from grades 3 to 8. Aggregate school records were used to assess standardized test performance (for entire school, cohort, and demographic subgroups) and absenteeism (entire school). Multilevel growth-curve analyses tested program effects. RESULTS PA significantly improved growth in academic motivation and mitigated disaffection with learning. There was a positive impact of PA on absenteeism and marginally significant impact on math performance of all students. There were favorable program effects on reading for African American boys and cohort students transitioning between grades 7 and 8, and on math for girls and low-income students. CONCLUSIONS A school-based SECD program was found to influence academic outcomes among students living in low-income, urban communities. Future research should examine mechanisms by which changes in SECD influence changes in academic outcomes. PMID:24138347

Using social-emotional and character development to improve academic outcomes: a matched-pair, cluster-randomized controlled trial in low-income, urban schools.

PubMed

Bavarian, Niloofar; Lewis, Kendra M; Dubois, David L; Acock, Alan; Vuchinich, Samuel; Silverthorn, Naida; Snyder, Frank J; Day, Joseph; Ji, Peter; Flay, Brian R

2013-11-01

School-based social-emotional and character development (SECD) programs can influence not only SECD but also academic-related outcomes. This study evaluated the impact of one SECD program, Positive Action (PA), on educational outcomes among low-income, urban youth. The longitudinal study used a matched-pair, cluster-randomized controlled design. Student-reported disaffection with learning and academic grades, and teacher ratings of academic ability and motivation were assessed for a cohort followed from grades 3 to 8. Aggregate school records were used to assess standardized test performance (for entire school, cohort, and demographic subgroups) and absenteeism (entire school). Multilevel growth-curve analyses tested program effects. PA significantly improved growth in academic motivation and mitigated disaffection with learning. There was a positive impact of PA on absenteeism and marginally significant impact on math performance of all students. There were favorable program effects on reading for African American boys and cohort students transitioning between grades 7 and 8, and on math for girls and low-income students. A school-based SECD program was found to influence academic outcomes among students living in low-income, urban communities. Future research should examine mechanisms by which changes in SECD influence changes in academic outcomes. © 2013, American School Health Association.

Evaluation of the 'Fitting to Outcomes eXpert' (FOX®) with established cochlear implant users.

PubMed

Buechner, Andreas; Vaerenberg, Bart; Gazibegovic, Dzemal; Brendel, Martina; De Ceulaer, Geert; Govaerts, Paul; Lenarz, Thomas

2015-01-01

To evaluate the possible impact of 'Fitting to Outcomes eXpert (FOX(®))' on cochlear implant (CI) fitting in a clinic with extensive experience of fitting a range of CI systems, as a way to assess whether a software tool such as FOX is able to complement standard clinical procedures. Ten adult post-lingually deafened and unilateral long-term users of the Advanced Bionics(TM) CI system (Clarion CII or HiRes 90K(TM)) underwent speech perception assessment with their current clinical program. One cycle 'iteration' of FOX optimization was performed and the program adjusted accordingly. After a month of using both clinical and FOX programs, a second iteration of FOX optimization was performed. Following this, the assessments were repeated without further acclimatization. FOX prescribed programming modifications in all subjects. Soundfield-aided thresholds were significantly lower for FOX than the clinical program. Group speech scores in noise were not significantly different between the two programs but three individual subjects had improved speech scores with the FOX MAP, two had worse speech scores, and five were the same. FOX provided a standardized approach to fitting based on outcome measures rather than comfort alone. The results indicated that for this group of well-fitted patients, FOX improved outcomes in some individuals. There were significant changes, both better and worse, in individual speech perception scores but median scores remained unchanged. Soundfield-aided thresholds were significantly improved for the FOX group.

A Model for Using a Capstone Experience as One Method of Assessment of an Information Systems Degree Program

ERIC Educational Resources Information Center

Murray, Meg; Perez, Jorge; Guimaraes, Mario

2008-01-01

Student attainment of educational outcomes is a core purpose of any institution of higher education and assessment provides a vehicle through which a program of study is able to ascertain how well it is achieving its stated learning outcomes and how program improvement might be achieved. Assessment of student learning begins with the clear…

Assessing Impact of Technology Based Digital Equalizer Programme on Improving Student Learning Outcomes

ERIC Educational Resources Information Center

Sarkar, Subrata; Mohapatra, Sanjay; Sundarakrishnan, J.

2017-01-01

The objective of this research was to assess the impact of the Digital Equalizer program (DE Program) in terms of student learning outcomes of students in subjects like science, mathematics and geography after 8 months of implementing the DE program in 283 schools across 30 districts of Odisha, India. This study was a inter group and intra group…

Anterior cruciate ligament- specialized post-operative return-to-sports (ACL-SPORTS) training: a randomized control trial

PubMed Central

2013-01-01

Background Anterior cruciate ligament reconstruction (ACLR) is standard practice for athletes that wish to return to high-level activities; however functional outcomes after ACLR are poor. Quadriceps strength weakness, abnormal movement patterns and below normal knee function is reported in the months and years after ACLR. Second ACL injuries are common with even worse outcomes than primary ACLR. Modifiable limb-to-limb asymmetries have been identified in individuals who re-injure after primary ACLR, suggesting a neuromuscular training program is needed to improve post-operative outcomes. Pre-operative perturbation training, a neuromuscular training program, has been successful at improving limb symmetry prior to surgery, though benefits are not lasting after surgery. Implementing perturbation training after surgery may be successful in addressing post-operative deficits that contribute to poor functional outcomes and second ACL injury risk. Methods/Design 80 athletes that have undergone a unilateral ACLR and wish to return to level 1 or 2 activities will be recruited for this study and randomized to one of two treatment groups. A standard care group will receive prevention exercises, quadriceps strengthening and agility exercises, while the perturbation group will receive the same exercise program with the addition of perturbation training. The primary outcomes measures will include gait biomechanics, clinical and functional measures, and knee joint loading. Return to sport rates, return to pre-injury level of activity rates, and second injury rates will be secondary measures. Discussion The results of this ACL-Specialized Post-Operative Return To Sports (ACL-SPORTS) Training program will help clinicians to better determine an effective post-operative treatment program that will improve modifiable impairments that influence outcomes after ACLR. Trial registration Randomized Control Trial NIH 5R01AR048212-07. ClinicalTrials.gov: NCT01773317 PMID:23522373

An Investigation of Teaching and Learning Programs in Pharmacy Education

PubMed Central

Baia, Patricia

2016-01-01

Objective. To investigate published, peer-reviewed literature on pharmacy teaching and learning development programs and to synthesize existing data, examine reported efficacy and identify future areas for research. Methods. Medline and ERIC databases were searched for studies on teaching development programs published between 2001 and 2015. Results. Nineteen publications were included, representing 21 programs. Twenty programs were resident teaching programs, one program described faculty development. The majority of programs spanned one year and delivered instruction on teaching methodologies and assessment measures. All except one program included experiential components. Thirteen publications presented outcomes data; most measured satisfaction and self-perceived improvement. Conclusion. Published literature on teacher development in pharmacy is focused more on training residents than on developing faculty members. Although programs are considered important and highly valued by program directors and participants, little data substantiates that these programs improve teaching. Future research could focus on measurement of program outcomes and documentation of teaching development for existing faculty members. PMID:27293226

An Investigation of Teaching and Learning Programs in Pharmacy Education.

PubMed

Strang, Aimee F; Baia, Patricia

2016-05-25

Objective. To investigate published, peer-reviewed literature on pharmacy teaching and learning development programs and to synthesize existing data, examine reported efficacy and identify future areas for research. Methods. Medline and ERIC databases were searched for studies on teaching development programs published between 2001 and 2015. Results. Nineteen publications were included, representing 21 programs. Twenty programs were resident teaching programs, one program described faculty development. The majority of programs spanned one year and delivered instruction on teaching methodologies and assessment measures. All except one program included experiential components. Thirteen publications presented outcomes data; most measured satisfaction and self-perceived improvement. Conclusion. Published literature on teacher development in pharmacy is focused more on training residents than on developing faculty members. Although programs are considered important and highly valued by program directors and participants, little data substantiates that these programs improve teaching. Future research could focus on measurement of program outcomes and documentation of teaching development for existing faculty members.

Child Health Partnerships: a review of program characteristics, outcomes and their relationship.

PubMed

Jayaratne, Kapila; Kelaher, Margaret; Dunt, David

2010-06-17

Novel approaches are increasingly employed to address the social determinants of health of children world-wide. Such approaches have included complex social programs involving multiple stakeholders from different sectors jointly working together (hereafter Child Health Partnerships). Previous reviews have questioned whether these programs have led to significant improvements in child health and related outcomes. We aim to provide definitive answers to this question as well as identifying the characteristics of successful partnerships. A comprehensive literature search identified 11 major Child Health Partnerships in four comparable developed countries. A critical review is focused on various aspects of these including their target groups, program mechanics and outcomes. There was evidence of success in several major areas from the formation of effective joint operations of partners in different partnership models to improvement in both child wellbeing and parenting. There is emerging evidence that Child Health Partnerships are cost-effective. Population characteristics and local contexts need to be taken into account in the introduction and implementation of these programs.

Integrated programs for mothers with substance abuse issues and their children: a systematic review of studies reporting on child outcomes.

PubMed

Niccols, Alison; Milligan, Karen; Smith, Ainsley; Sword, Wendy; Thabane, Lehana; Henderson, Joanna

2012-04-01

Integrated treatment programs (those that include on-site pregnancy-, parenting-, or child-related services with addiction services) were developed to break the intergenerational cycle of addiction, potential child maltreatment, and poor outcomes for children. To examine the impact and effects of integrated programs for women with substance abuse issues and their children, we performed a systematic review of studies published from 1990 to 2011. Literature search strategies included online bibliographic database searches, checking printed sources, and requests to researchers. Studies were included if all participants were mothers with substance abuse problems at baseline; the treatment program included at least 1 specific substance use treatment and at least 1 parenting or child treatment service; the study design was randomized, quasi-experimental, or cohort; and there were quantitative data on child outcomes. We summarized data on child development, growth, and emotional and behavioral outcomes. Thirteen studies (2 randomized trials, 3 quasi-experimental studies, 8 cohort studies; N=775 children) were included in the review. Most studies using pre-post design indicated improvements in child development (with small to large effects, ds=0.007-1.132) and emotional and behavioral functioning (with most available effect sizes being large, ds=0.652-1.132). Comparison group studies revealed higher scores for infants of women in integrated programs than those not in treatment, with regard to development and most growth parameters (length, weight, and head circumference; with all available effect sizes being large, ds=1.16-2.48). In studies comparing integrated to non-integrated programs, most improvements in emotional and behavioral functioning favored integrated programs and, where available, most effect sizes indicated that this advantage was small (ds=0.22-0.45). Available evidence supports integrated programs, as findings suggest that they are associated with improvements in child development, growth, and emotional and behavioral functioning. More research is required comparing integrated to non-integrated programs. This review highlights the need for improved methodology, study quality, and reporting to improve our understanding of how best to meet the needs of children of women with substance abuse issues. Copyright © 2012 Elsevier Ltd. All rights reserved.

Brief report: Moving prevention into schools: The impact of a trauma-informed school-based intervention.

PubMed

Mendelson, Tamar; Tandon, S Darius; O'Brennan, Lindsey; Leaf, Philip J; Ialongo, Nicholas S

2015-08-01

Adolescents in disadvantaged communities have high rates of exposure to stress and trauma, which can negatively impact emotion regulation and executive functioning, increasing likelihood of school problems. This pilot study evaluated RAP Club, a 12-session school-based trauma-informed group intervention co-facilitated by a mental health counselor and young adult community member that utilizes evidence-based cognitive-behavioral and mindfulness strategies. Seventh and eighth graders at two urban public schools serving low-income communities were assigned to receive RAP Club (n = 29) or regular school programming (n = 20). RAP Club improved teacher-rated emotion regulation, social and academic competence, classroom behavior, and discipline. Higher program dose predicted improvements in several teacher-rated outcomes. Student self-report outcomes, however, did not vary by study group or dose. Even students with low baseline depression showed improvement in teacher-rated outcomes following program participation, supporting a model of universal program delivery to all students. Findings suggest RAP Club merits further study. Copyright © 2015 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Exploring psychological mechanisms of clinical response to an internet-delivered psychological pain management program.

PubMed

Gandy, M; Karin, E; Jones, M P; McDonald, S; Sharpe, L; Titov, N; Dear, B F

2018-05-13

The evidence for Internet-delivered pain management programs for chronic pain is growing, but there is little empirical understanding of how they effect change. Understanding mechanisms of clinical response to these programs could inform their effective development and delivery. A large sample (n = 396) from a previous randomized controlled trial of a validated internet-delivered psychological pain management program, the Pain Course, was used to examine the influence of three potential psychological mechanisms (pain acceptance, pain self-efficacy, fear of movement/re-injury) on treatment-related change in disability, depression, anxiety and average pain. Analyses involved generalized estimating equation models for clinical outcomes that adjusted for co-occurring change in psychological variables. This was paired with cross-lagged analysis to assess for evidence of causality. Analyses involved two time points, pre-treatment and post-treatment. Changes in pain-acceptance were strongly associated with changes in three (depression, anxiety and average pain) of the four clinical outcomes. Changes in self-efficacy were also strongly associated with two (anxiety and average pain) clinical outcomes. These findings suggest that participants were unlikely to improve in these clinical outcomes without also experiencing increases in their pain self-efficacy and pain acceptance. However, there was no clear evidence from cross-lagged analyses to currently support these psychological variables as direct mechanisms of clinical improvements. There was only statistical evidence to suggest higher levels of self-efficacy moderated improvements in depression. The findings suggest that, while clinical improvements are closely associated with improvements in pain acceptance and self-efficacy, these psychological variables may not drive the treatment effects observed. This study employed robust statistical techniques to assess the psychological mechanisms of an established internet-delivered pain management program. While clinical improvements (e.g. depression, anxiety, pain) were closely associated with improvements in psychological variables (e.g. pain self-efficacy and pain acceptance), these variables do not appear to be treatment mechanisms. © 2018 European Pain Federation - EFIC®.

Factors Influencing Job Satisfaction of New Graduate Nurses Participating in Nurse Residency Programs: A Systematic Review

PubMed Central

Lin, Patrice S.; Viscardi, Molly Kreider; McHugh, Matthew D.

2016-01-01

Nurse residency programs are designed to increase competence and skill, and ease the transition from student to new graduate nurse. These programs also offer the possibility to positively influence the job satisfaction of new graduate nurses, which could decrease poor nursing outcomes. However, little is known about the impact of participation in a nurse residency program on new graduate nurses’ satisfaction. This review examines factors that influence job satisfaction of nurse residency program participants. Eleven studies were selected for inclusion, and seven domains influencing new graduate nurses’ satisfaction during participation in nurse residency programs were identified: extrinsic rewards, scheduling, interactions and support, praise and recognition, professional opportunities, work environment, and hospital system. Within these domains, the evidence for improved satisfaction with nurse residency program participation was mixed. Further research is necessary to understand how nurse residency programs can be designed to improve satisfaction and increase positive nurse outcomes. PMID:25280192

Programs to improve adolescent sexual and reproductive health in the US: a review of the evidence

PubMed Central

Manlove, Jennifer; Fish, Heather; Moore, Kristin Anderson

2015-01-01

Background US adolescents have high rates of teen pregnancy, childbearing, and sexually transmitted infections (STIs), highlighting the need to identify and implement effective programs that will help improve teen sexual and reproductive health. Materials and methods This review identified 103 random-assignment evaluations of 85 programs that incorporated intent-to-treat analyses and assessed impacts on pregnancy, childbearing, STIs, and their key determinants – sexual activity, number of sexual partners, condom use, and other contraceptive use – among teens. This review describes the evidence base for five broad program approaches, including abstinence education, comprehensive sex education, clinic-based programs, youth development programs, and parent–youth relationship programs. We also describe programs with impacts on key outcomes, including pregnancy/childbearing, STIs, and those that found impacts on both sexual activity and contraceptive use. Results Our review identified 52 effective programs: 38 with consistent impacts on reproductive health outcomes, and 14 with mixed findings (across subpopulations, follow-ups, or multiple measures of a single outcome). We found that a variety of program approaches produced impacts on sexual and reproductive health outcomes. Parent–youth relationship programs and clinic-based program evaluations more frequently showed impacts than other program approaches, although we also identified a number of abstinence-education, comprehensive sex education, and youth-development programs with impacts on sexual and reproductive health outcomes. Overall, we identified nine program evaluations with impacts on teen pregnancies or births, five with impacts on reducing STIs, and 15 with impacts on both delaying/reducing sexual activity and increasing contraceptive use (including condom use). Conclusion Future efforts should conduct replications of existing program evaluations, identify implementation components linked to impacts, rigorously evaluate programs that appear promising, and expand the evidence base on programs that impact hormonal and long-acting contraceptive method use. PMID:25897271

A call for new standard of care in perioperative gynecologic oncology practice: Impact of enhanced recovery after surgery (ERAS) programs.

PubMed

Miralpeix, Ester; Nick, Alpa M; Meyer, Larissa A; Cata, Juan; Lasala, Javier; Mena, Gabriel E; Gottumukkala, Vijaya; Iniesta-Donate, Maria; Salvo, Gloria; Ramirez, Pedro T

2016-05-01

Enhanced recovery after surgery (ERAS) programs aim to hasten functional recovery and improve postoperative outcomes. However, there is a paucity of data on ERAS programs in gynecologic surgery. We reviewed the published literature on ERAS programs in colorectal surgery, general gynecologic surgery, and gynecologic oncology surgery to evaluate the impact of such programs on outcomes, and to identify key elements in establishing a successful ERAS program. ERAS programs are associated with shorter length of hospital stay, a reduction in overall health care costs, and improvements in patient satisfaction. We suggest an ERAS program for gynecologic oncology practice involving preoperative, intraoperative, and postoperative strategies including; preadmission counseling, avoidance of preoperative bowel preparation, use of opioid-sparing multimodal perioperative analgesia (including loco-regional analgesia), intraoperative goal-directed fluid therapy (GDT), and use of minimally invasive surgical techniques with avoidance of routine use of nasogastric tube, drains and/or catheters. Postoperatively, it is important to encourage early feeding, early mobilization, timely removal of tubes and drains, if present, and function oriented multimodal analgesia regimens. Successful implementation of an ERAS program requires a multidisciplinary team effort and active participation of the patient in their goal-oriented functional recovery program. However, future outcome studies should evaluate the efficacy of an intervention within the pathway, include objective measures of symptom burden and control, study measures of functional recovery, and quantify outcomes of the program in relation to the rates of adherence to the key elements of care in gynecologic oncology such as oncologic outcomes and return to intended oncologic therapy (RIOT). Copyright © 2016 Elsevier Inc. All rights reserved.

Outcomes at 18 Months From a Community Health Worker and Peer Leader Diabetes Self-Management Program for Latino Adults.

PubMed

Spencer, Michael S; Kieffer, Edith C; Sinco, Brandy; Piatt, Gretchen; Palmisano, Gloria; Hawkins, Jaclynn; Lebron, Alana; Espitia, Nicolaus; Tang, Tricia; Funnell, Martha; Heisler, Michele

2018-04-27

This study evaluated the effectiveness of a community health worker (CHW) diabetes self-management education (DSME) program, followed by two different approaches to maintain improvements in HbA 1c and other clinical and patient-centered outcomes over 18 months. The study randomized 222 Latino adults with type 2 diabetes and poor glycemic control from a federally qualified health center to 1 ) a CHW-led, 6-month DSME program or 2 ) enhanced usual care (EUC). After the 6-month program, participants randomized to the CHW-led DSME were further randomized to 1 ) 12 months of CHW-delivered monthly telephone outreach (CHW-only) or 2 ) 12 months of weekly group sessions delivered by peer leaders (PLs) with telephone outreach to those unable to attend (CHW+PL). The primary outcome was HbA 1c . Secondary outcomes were blood pressure, lipid levels, diabetes distress, depressive symptoms, understanding of diabetes self-management, and diabetes social support. Assessments were conducted at baseline and at 6, 12, and 18 months. Participants in the CHW intervention at the 6-month follow-up had greater decreases in HbA 1c (-0.45; 95% CI -0.87, -0.03; P < 0.05) and in diabetes distress (-0.3; 95% CI -0.6, -0.03; P < 0.05) compared with EUC. CHW+PL participants maintained HbA 1c improvements at 12 and 18 months, and CHW-only participants maintained improvements in diabetes distress at 12 and 18 months. CHW+PL participants also had significantly fewer depressive symptoms at 18 months compared with EUC (-2.2; 95% CI -4.1, -0.3; P < 0.05). Participants in CHW-led DSME had significant improvements in diabetes social support and in understanding of diabetes self-management at 6 months relative to EUC, but these intervention effects were not sustained at 18 months. This study demonstrates the effectiveness of a 6-month CHW intervention on key diabetes outcomes and of a volunteer PL program in sustaining key achieved gains. These are scalable models for health care centers in low-resource settings for achieving and maintaining improvements in key diabetes outcomes. © 2018 by the American Diabetes Association.

Improved self-management skills predict improvements in quality of life and depression in patients with chronic disorders.

PubMed

Musekamp, Gunda; Bengel, Jürgen; Schuler, Michael; Faller, Hermann

2016-08-01

Self-management programs aim to improve patients' skills to manage their chronic condition in everyday life. Improvement in self-management is assumed to bring about improvements in more distal outcomes, such as quality of life. This study aimed to test the hypothesis that changes in self-reported self-management skills observed after participation in self-management programs predict changes in both quality of life and depressive symptoms three months later. Using latent change modeling, the relationship between changes in latent variables over three time points (start and end of rehabilitation, after three months) was analysed. The sample comprised 580 patients with different chronic conditions treated in inpatient rehabilitation clinics. The influence of additional predictor variables (age, sex, perceived social support) and type of disorder as a moderator variable was also tested. Changes in self-reported self-management skills after rehabilitation predicted changes in both quality of life and depressive symptoms at the end of rehabilitation and the 3 months follow-up. These relationships remained significant after the inclusion of other predictor variables and were similar across disorders. The findings provide support for the hypothesis that improvements in proximal outcomes of self-management programs may foster improvements in distal outcomes. Further studies should investigate treatment mechanisms. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Participation in Training for Depression Care Quality Improvement: A Randomized Trial of Community Engagement or Technical Support.

PubMed

Chung, Bowen; Ngo, Victoria K; Ong, Michael K; Pulido, Esmeralda; Jones, Felica; Gilmore, James; Stoker-Mtume, Norma; Johnson, Megan; Tang, Lingqi; Wells, Kenneth Brooks; Sherbourne, Cathy; Miranda, Jeanne

2015-08-01

Community engagement and planning (CEP) could improve dissemination of depression care quality improvement in underresourced communities, but whether its effects on provider training participation differ from those of standard technical assistance, or resources for services (RS), is unknown. This study compared program- and staff-level participation in depression care quality improvement training among programs enrolled in CEP, which trained networks of health care and social-community agencies jointly, and RS, which provided technical support to individual programs. Matched programs from health care and social-community service sectors in two communities were randomly assigned to RS or CEP. Data were from 1,622 eligible staff members from 95 enrolled programs. Primary outcomes were any staff trained (for programs) and total hours of training (for staff). Secondary staff-level outcomes were hours of training in specific depression collaborative care components. CEP programs were more likely than RS programs to participate in any training (p=.006). Within health care sectors, CEP programs were more likely than RS programs to participate in training (p=.016), but within social-community sectors, there was no difference in training by intervention. Among staff who participated in training, mean training hours were greater among CEP programs versus RS programs for any type of training (p<.001) and for training related to each component of depression care (p<.001) except medication management. CEP may be an effective strategy to promote staff participation in depression care improvement efforts in underresourced communities.

Maintenance of a smoking cessation program in public health clinics beyond the experimental evaluation period.

PubMed Central

Manfredi, C.; Crittenden, K.; Cho, Y. I.; Engler, J.; Warnecke, R.

2001-01-01

OBJECTIVES: As phase 3 of a study to evaluate a smoking cessation program in public health practice, the authors assess the maintenance and impact of the It's Time smoking cessation program in seven public maternal and child health clinics in Chicago. METHODS: The authors interviewed 404 clinic patients in the study's baseline phase (prior to introduction of the It's Time intervention program), and 610 in the program maintenance phase (in the year after experimental evaluation had ended) to assess exposure to smoking cessation interventions offered at the clinic, and smoking cessation outcomes (quit, actions toward quitting, scores on action, motivation, readiness, and confidence scales). The authors controlled for clustering of smokers within clinics, smokers' characteristics prior to clinic visit, and type of clinic service. They compared outcomes by study group (control or intervention) to which each clinic had been assigned in the earlier experimental phase. RESULTS: Compared to baseline, smokers in the maintenance phase had greater exposure to posters, provider advice and booklet, and better outcomes on seven of eight smoking cessation measures, including quitting. These improvements were larger for clinics with prior experience implementing It's Time. CONCLUSION: Participation in the experimental evaluation of the It's Time program prepared and possibly motivated the clinics to continue the program. Continuing the program resulted in greater delivery of interventions and improved smoking cessation outcomes for smokers in the clinics. PMID:11889280

Improving HIV outcomes in resource-limited countries: the importance of quality indicators.

PubMed

Ahonkhai, Aima A; Bassett, Ingrid V; Ferris, Timothy G; Freedberg, Kenneth A

2012-11-24

Resource-limited countries increasingly depend on quality indicators to improve outcomes within HIV treatment programs, but indicators of program performance suitable for use at the local program level remain underdeveloped. Using the existing literature as a guide, we applied standard quality improvement (QI) concepts to the continuum of HIV care from HIV diagnosis, to enrollment and retention in care, and highlighted critical service delivery process steps to identify opportunities for performance indicator development. We then identified existing indicators to measure program performance, citing examples used by pivotal donor agencies, and assessed their feasibility for use in surveying local program performance. Clinical delivery steps without existing performance measures were identified as opportunities for measure development. Using National Quality Forum (NQF) criteria as a guide, we developed measurement concepts suitable for use at the local program level that address existing gaps in program performance assessment. This analysis of the HIV continuum of care identified seven critical process steps providing numerous opportunities for performance measurement. Analysis of care delivery process steps and the application of NQF criteria identified 24 new measure concepts that are potentially useful for improving operational performance in HIV care at the local level. An evidence-based set of program-level quality indicators is critical for the improvement of HIV care in resource-limited settings. These performance indicators should be utilized as treatment programs continue to grow.

Getting Back to Living: Further Evidence for the Efficacy of an Interdisciplinary Pediatric Pain Treatment Program.

PubMed

Bruce, Barbara K; Ale, Chelsea M; Harrison, Tracy E; Bee, Susan; Luedtke, Connie; Geske, Jennifer; Weiss, Karen E

2017-06-01

This study examined key functional outcomes following a 3-week interdisciplinary pediatric pain rehabilitation program for adolescents with chronic pain. Maintenance of gains was evaluated at 3-month follow-up. Participants included 171 adolescents (12 to 18 y of age) with chronic pain who completed a hospital-based outpatient pediatric pain rehabilitation program. Participants completed measures of functional disability, depressive symptoms, pain catastrophizing, opioid use, school attendance, and pain severity at admission, discharge, and at 3-month follow-up. Similar to other interdisciplinary pediatric pain rehabilitation program outcome studies, significant improvements were observed at the end of the program. These improvements appeared to be maintained or further improved at 3-month follow-up. Nearly 14% of the patients were taking daily opioid medication at admission to the program. All adolescents were completely tapered off of these medications at the end of the 3-week program and remained abstinent at 3-month follow-up. This study adds to the available data supporting interdisciplinary pediatric pain rehabilitation as effective in improving functioning and psychological distress even when discontinuing opioids. Implications for future research and limitations of the study are discussed.

Outcomes of Community-Based Prenatal Education Programs for Pregnant Women in Rural Texas.

PubMed

Ramsey, Joseph; Mayes, Brandii

A prenatal, evidenced-based education program was implemented in 7 rural counties and provided by trained staff at the Texas Department of State Health Services. This was implemented to address health disparities, in regard to birth outcomes, in rural minorities of Southeast Texas. The participants were given a preassessment (N = 382) and a postassessment (N = 326) of relevant health knowledge and a follow-up assessment (N = 149) to document the outcomes of their birth as well as health practices they were employing as new parents. The assessment results were analyzed to determine the effectiveness of the programs on improving health outcomes and knowledge.

Translating Addictions Research into Evidence-based Practice: the Polaris CD Outcomes Management System

PubMed Central

Toche-Manley, L.; Grissom, G.; Dietzen, L.; Sangsland, S.

2011-01-01

Converting the findings from addictions studies into information actionable by (non-research) treatment programs is important to improving program outcomes. This paper describes the translation of the findings of studies on Patient-Services matching, prediction of patient response to treatment (Expected Treatment Response) and prediction of dropout to provide evidence-based decision support in routine treatment. The findings of the studies and their application to the development of an outcomes management system are described. Implementation issues in a network of addictions treatment programs are discussed. The work illustrates how outcomes management systems can play an important role in translating research into practice. PMID:21324606

Questioning the Use of Outcome Measures to Evaluate Principal Preparation Programs

ERIC Educational Resources Information Center

Fuller, Ed; Hollingworth, Liz

2018-01-01

Policymakers are proposing the use of outcome measures as indicators of effective principal preparation programs. The three most common metrics recommended are: (1) graduates' effectiveness in improving student achievement test scores, (2) graduate job placement rates, and (3) principal job retention once employed. This article explores the use of…

Combining the Tasks of Grading Individual Assignments and Assessing Student Outcomes in Project-Based Courses

ERIC Educational Resources Information Center

Dahm, Kevin

2014-01-01

ABET requires that engineering programs demonstrate continuous assessment and continuous improvement in order to be accredited. Central to the process is establishing and assessing measurable "student outcomes" that reflect whether the goals and objectives of the program are being met. This paper examines effective strategies for…

Children's Program Outcome Review Team: 2001 Evaluation Results.

ERIC Educational Resources Information Center

Wade, Patricia C.

In its eighth year of evaluating children's services in the state, the Children's Program Outcome Review Team (CPORT), under the direction of the Tennessee Commission on Children and Youth, continued to collect and analyze data to improve service delivery to children and families involved in state custody. Using the Quality Service Review…

Wave of the Future?: Integrating IR, Outcomes Assessment, Planning, Program Review, and Accreditation

ERIC Educational Resources Information Center

Leimer, Christina

2010-01-01

Integrating institutional research, outcomes assessment, program review, strategic planning, and accreditation can be a powerful means of creating a culture of evidence-based decision making and continuous improvement. This study examined how this "integrated" model is organized in practice, how such offices began, why this approach was chosen,…

Identifying Elementary School Student Opinion Leaders for Engagement in Evidence-Based Program Adaptation and Implementation

ERIC Educational Resources Information Center

Reiger, Christopher J.; Gibson, Jennifer E.; Passarelli, Rebecca E.; Flaspohler, Paul D.

2017-01-01

Evidence-based programs, such as bullying prevention, often demonstrate disappointing outcomes when widely disseminated. Engaging opinion leaders--those individuals whom others emulate and go to for advice--in the process of adaptation and implementation may improve outcomes. However, opinion leaders have the most influence on individuals who are…

An intervention to improve program implementation: findings from a two-year cluster randomized trial of Assets-Getting To Outcomes

PubMed Central

2013-01-01

Background Studies have shown that communities have not always been able to implement evidence-based prevention programs with quality and achieve outcomes demonstrated by prevention science. Implementation support interventions are needed to bridge this gap between science and practice. The purpose of this article is to present two-year outcomes from an evaluation of the Assets Getting To Outcomes (AGTO) intervention in 12 Maine communities engaged in promoting Developmental Assets, a positive youth development approach to prevention. AGTO is an implementation support intervention that consists of: a manual of text and tools; face-to-face training, and onsite technical assistance, focused on activities shown to be associated with obtaining positive results across any prevention program. Methods This study uses a nested and cross-sectional, cluster randomized controlled design. Participants were coalition members and program staff from 12 communities in Maine. Each coalition nominated up to five prevention programs to participate. At random, six coalitions and their respective 30 programs received the two-year AGTO intervention and the other six maintained routine operations. The study assessed prevention practitioner capacity (efficacy and behaviors), practitioner exposure to and use of AGTO, practitioner perceptions of AGTO, and prevention program performance. Capacity of coalition members and performance of their programs were compared between the two groups across the baseline, one-, and two-year time points. Results We found no significant differences between AGTO and control group’s prevention capacity. However, within the AGTO group, significant differences were found between those with greater exposure to and use of AGTO. Programs that received the highest number of technical assistance hours showed the most program improvement. Conclusions This study is the first of its kind to show that use of an implementation support intervention-AGTO -yielded improvements in practitioner capacity and consequently in program performance on a large sample of practitioners and programs using a randomized controlled design. ClinicalTrials.gov identifier NCT00780338 PMID:23924279

Evaluation of chronic disease management on outcomes and cost of care for Medicaid beneficiaries.

PubMed

Zhang, Ning Jackie; Wan, Thomas T H; Rossiter, Louis F; Murawski, Matthew M; Patel, Urvashi B

2008-05-01

To evaluate the impacts of the chronic disease management program on the outcomes and cost of care for Virginia Medicaid beneficiaries. A total of 35,628 patients and their physicians and pharmacists received interventions for five chronic diseases and comorbidities from 1999 to 2001. Comparisons of medical utilization and clinical outcomes between experimental groups and control group were conducted using ANOVA and ANCOVA analyses. Findings indicate that the disease state management (DSM) program statistically significantly improved patient's drug compliance and quality of life while reducing (ER), hospital, and physician office visits and adverse events. The average cost per hospitalization would have been $42 higher without the interventions. A coordinated disease management program designed for Medicaid patients experiencing significant chronic diseases can substantially improve clinical outcomes and reduce unnecessary medical utilization, while lowering costs, although these results were not observed across all disease groups. The DSM model may be potentially useful for Medicaid programs in states or other countries. If the adoption of the DSM model is to be promoted, evidence of its effectiveness should be tested in broader settings and best practice standards are expected.

A systems approach for implementing practice-based learning and improvement and systems-based practice in graduate medical education.

PubMed

Varkey, Prathibha; Karlapudi, Sudhakar; Rose, Steven; Nelson, Roger; Warner, Mark

2009-03-01

The Accreditation Council for Graduate Medical Education (ACGME) initiated its Outcome Project to better prepare physicians-in-training to practice in the rapidly changing medical environment and mandated assessment of competency in six outcomes, including Practice-Based Learning and Improvement (PBLI) and Systems-Based Practice (SBP). Before the initiation of the Outcome Project, these competencies were not an explicit element of most graduate medical education training programs. Since 1999, directors of ACGME-accredited programs nationwide have been challenged to teach and assess these competencies. The authors describe an institution-wide curriculum intended to facilitate the teaching and assessment of PBLI and SBP competencies in the 115 ACGME-accredited residency and fellowship programs (serving 1,327 trainees) sponsored by Mayo School of Graduate Medical Education. Strategies to establish the curriculum in 2005 included development of a Quality Improvement (QI) curriculum Web site, one-on-one consultations with program directors, a three-hour program director workshop, and didactic sessions for residents and fellows on core topics. An interim program director self-assessment survey revealed a 13% increase in perceived ability to measure competency in SBP, no change in their perceived ability to measure competence in PBLI, a 15% increase in their ability to provide written documentation of competence in PBLI, and a 35% increase in their ability to provide written documentation of competence in SBP between 2005 and 2007. Nearly 70% of the programs had trainees participating in QI projects. Further research is needed to evaluate the cost-effectiveness of such a program and to measure its impact on learner knowledge, skills, and attitudes and, ultimately, on patient outcomes.

Improving Attitudes toward Elderly People: Evaluation of an Intervention Program for Adolescents.

ERIC Educational Resources Information Center

Dooley, Stephen; Frankel, B. Gail

1990-01-01

In an experimental evaluation of a "friendly visitor" type of program in which adolescents visited senior citizens, it was found that general attitudes toward elderly people improved following weekly contact with specific elderly persons. Two outcomes of these programs were found: the provision of service to the elderly and the change of negative…

Outcomes of Teaching Improvement Programs for Faculty. ASHE Annual Meeting Paper.

ERIC Educational Resources Information Center

Ramirez, Jose-Luis

This study explored the impact of teaching improvement programs on university faculty participants in Mexico, as well as the factors that have affected the success of these programs. A total of 80 professors from the University of Sonora in Hermosillo, Mexico, completed a questionnaire on current teaching practices. The group included 40 former…

Active Implementation Frameworks for Program Success: How to Use Implementation Science to Improve Outcomes for Children

ERIC Educational Resources Information Center

Metz, Allison; Bartley, Leah

2012-01-01

Over the past decade the science related to developing and identifying evidence-based programs and practices for children and families has improved significantly. However, the science related to implementing these programs in early childhood settings has lagged far behind. In this article, the authors outline how the science of implementation and…

Improvements in Negative Symptoms and Functional Outcome After a New Generation Cognitive Remediation Program: A Randomized Controlled Trial

PubMed Central

Ojeda, Natalia

2014-01-01

Cognitive remediation improves cognition in patients with schizophrenia, but its effect on other relevant factors such as negative symptoms and functional outcome has not been extensively studied. In this hospital-based study, 84 inpatients with chronic schizophrenia were recruited from Alava Hospital (Spain). All of the subjects underwent a baseline and a 3-month assessment that examined neurocognition, clinical symptoms, insight, and functional outcome according to the Global Assessment of Functioning (GAF) scale and Disability Assessment Schedule from World Health Organization (DAS-WHO). In addition to receiving standard treatment, patients were randomly assigned either to receive neuropsychological rehabilitation (REHACOP) or to a control group. REHACOP is an integrative program that taps all basic cognitive functions. The program included experts’ latest suggestions about positive feedback and activities of daily living in the patients’ environment. The REHACOP group showed significantly greater improvements at 3 months in the areas of neurocognition, negative symptoms, disorganization, and emotional distress compared with the control group (Cohen’s effect size for these changes ranged from d = 0.47 for emotional distress to d = 0.58 for disorganization symptoms). The REHACOP group also improved significantly in both the GAF (d = 0.61) and DAS-WHO total scores (d = 0.57). Specifically, the patients showed significant improvement in vocational outcomes (d = 0.47), family contact (d = 0.50), and social competence (d = 0.56). In conclusion, neuropsychological rehabilitation may be useful for the reduction of negative symptoms and functional disability in schizophrenia. These findings support the integration of neuropsychological rehabilitation into standard treatment programs for patients with schizophrenia. PMID:23686130

Oregon Pre-Engineering Learning Outcomes Study: Final Report

ERIC Educational Resources Information Center

Conley, David T.; Langan, Holly; Veach, Darya; Farkas, Virginia

2007-01-01

The Oregon Pre-engineering Learning Outcomes Project was conducted by the Educational Policy Improvement Center (EPIC) with grant funding from the Engineering and Technology Industry Council (ETIC). The study sought to improve student preparation and success in pre-engineering programs through the development of the Oregon Pre-engineering Learning…

Mental health predicts better academic outcomes: a longitudinal study of elementary school students in Chile.

PubMed

Murphy, J Michael; Guzmán, Javier; McCarthy, Alyssa E; Squicciarini, Ana María; George, Myriam; Canenguez, Katia M; Dunn, Erin C; Baer, Lee; Simonsohn, Ariela; Smoller, Jordan W; Jellinek, Michael S

2015-04-01

The world's largest school-based mental health program, Habilidades para la Vida [Skills for Life (SFL)], has been operating on a national scale in Chile for 15 years. SFL's activities include using standardized measures to screen elementary school students and providing preventive workshops to students at risk for mental health problems. This paper used SFL's data on 37,397 students who were in first grade in 2009 and third grade in 2011 to ascertain whether first grade mental health predicted subsequent academic achievement and whether remission of mental health problems predicted improved academic outcomes. Results showed that mental health was a significant predictor of future academic performance and that, overall, students whose mental health improved between first and third grade made better academic progress than students whose mental health did not improve or worsened. Our findings suggest that school-based mental health programs like SFL may help improve students' academic outcomes.

Outcome-based and Participation-based Wellness Incentives

PubMed Central

Barleen, Nathan A.; Marzec, Mary L.; Boerger, Nicholas L.; Moloney, Daniel P.; Zimmerman, Eric M.; Dobro, Jeff

2017-01-01

Objective: This study examined whether worksite wellness program participation or achievement of health improvement targets differed according to four incentive types (participation-based, hybrid, outcome-based, and no incentive). Methods: The study included individuals who completed biometric health screenings in both 2013 and 2014 and had elevated metrics in 2013 (baseline year). Multivariate logistic regression modeling tested for differences in odds of participation and achievement of health improvement targets between incentive groups; controlling for demographics, employer characteristics, incentive amounts, and other factors. Results: No statistically significant differences between incentive groups occurred for odds of participation or achievement of health improvement target related to body mass index, blood pressure, or nonhigh-density lipoprotein cholesterol. Conclusions: Given the null findings of this study, employers cannot assume that outcome-based incentives will result in either increased program participation or greater achievement of health improvement targets than participation-based incentives. PMID:28146041

Does improvement of cognitive functioning by cognitive remediation therapy effect work outcomes in severe mental illness? A secondary analysis of a randomized controlled trial.

PubMed

Ikebuchi, Emi; Sato, Sayaka; Yamaguchi, Sosei; Shimodaira, Michiyo; Taneda, Ayano; Hatsuse, Norifumi; Watanabe, Yukako; Sakata, Masuhiro; Satake, Naoko; Nishio, Masaaki; Ito, Jun-Ichiro

2017-05-01

The aim of this study was to clarify whether improvement of cognitive functioning by cognitive remediation therapy can improve work outcome in schizophrenia and other severe mental illnesses when combined with supported employment. The subjects of this study were persons with severe mental illness diagnosed with schizophrenia, major depression, or bipolar disorder (ICD-10) and cognitive dysfunction who participated in both cognitive remediation using the Thinking Skills for Work program and a supported employment program in a multisite, randomized controlled study. Logistic and multiple linear regression analyses were performed to clarify the influence of cognitive functioning on vocational outcomes, adjusting for demographic and clinical variables. Improvement of cognitive functioning with cognitive remediation significantly contributed to the total days employed and total earnings of competitive employment in supported employment service during the study period. Any baseline demographic and clinical variables did not significantly contribute to the work-related outcomes. A cognitive remediation program transferring learning skills into the real world is useful to increase the quality of working life in supported employment services for persons with severe mental illness and cognitive dysfunction who want to work competitively. © 2016 The Authors. Psychiatry and Clinical Neurosciences © 2016 Japanese Society of Psychiatry and Neurology.

Initial Weight Loss Response as an Indicator for Providing Early Rescue Efforts to Improve Long-term Treatment Outcomes.

PubMed

Unick, Jessica L; Pellegrini, Christine A; Demos, Kathryn E; Dorfman, Leah

2017-09-01

There is a large variability in response to behavioral weight loss (WL) programs. Reducing rates of obesity and diabetes may require more individuals to achieve clinically significant WL post-treatment. Given that WL within the first 1-2 months of a WL program is associated with long-term WL, it may be possible to improve treatment outcomes by identifying and providing additional intervention to those with poor initial success (i.e., "early non-responders"). We review the current literature regarding early non-response to WL programs and discuss how adaptive interventions can be leveraged as a strategy to "rescue" early non-responders. Preliminary findings suggest that adaptive interventions, specifically stepped care approaches, offer promise for improving outcomes among early non-responders. Future studies need to determine the optimal time point and threshold for intervening and the type of early intervention to employ. Clinicians and researchers should consider the discussed factors when making treatment decisions.

Trends in Biometric Health Indices Within an Employer-Sponsored Wellness Program With Outcome-Based Incentives.

PubMed

Fu, Patricia Lin; Bradley, Kent L; Viswanathan, Sheila; Chan, June M; Stampfer, Meir

2016-07-01

To evaluate changes in employees' biometrics over time relative to outcome-based incentive thresholds. Retrospective cohort analysis of biometric screening participants (n = 26 388). Large employer primarily in Western United States. Office, retail, and distribution workforce. A voluntary outcome-based biometric screening program, incentivized with health insurance premium discounts. Body mass index (BMI), cholesterol, blood glucose, blood pressure, and nicotine. Followed were participants from their first year of participation, evaluating changes in measures. On average, participants who did not meet the incentive threshold at baseline decreased their BMI (1%), glucose (8%), blood pressure (systolic 9%, diastolic 8%), and total cholesterol (8%) by year 2 with improvements generally sustained or continued during each additional year of participation. On average, individuals at high health risk who participated in a financially incentivized biometric assessment program improved their health indices over time. Further research is needed to understand key determinants that drive health improvement indicated here. © The Author(s) 2016.

Ready for Fall? Near-Term Effects of Voluntary Summer Learning Programs on Low-Income Students' Learning Opportunities and Outcomes. Technical Appendixes

ERIC Educational Resources Information Center

McCombs, Jennifer Sloan; Pane, John F.; Augustine, Catherine H.; Schwartz, Heather L.; Martorell, Paco; Zakaras, Laura

2014-01-01

Prior research has determined that low-income students lose more ground over the summer than their higher-income peers. Prior research has also shown that some summer learning programs can stem this loss, but we do not know whether large, district-run, voluntary programs can improve students' outcomes. To fill this gap, The Wallace Foundation…

Evaluating employee assistance programs. A review of methods, outcomes, and future directions.

PubMed

Jerrell, J M; Rightmyer, J F

1982-01-01

Renewed interest in assisting troubled employees has led to an upsurge in the development of employee assistance programs, coupled with demands for demonstrable effectiveness. This review examines the nature and scope of these programs, their administrative and methodological context, and the types and outcomes of evaluation studies conducted thus far. Proposals for improving future investigations through a number of different approaches and strategies are then made.

Ready for Fall? Near-Term Effects of Voluntary Summer Learning Programs on Low-Income Students' Learning Opportunities and Outcomes. RAND Summer Learning Series

ERIC Educational Resources Information Center

McCombs, Jennifer Sloan; Pane, John F.; Augustine, Catherine H.; Schwartz, Heather L.; Martorell, Paco; Zakaras, Laura

2014-01-01

Prior research has determined that low-income students lose more ground over the summer than their higher-income peers. Prior research has also shown that some summer learning programs can stem this loss, but we do not know whether large, district-run, voluntary programs can improve students' outcomes. To fill this gap, The Wallace Foundation…

Building capacity for water, sanitation, and hygiene programming: Training evaluation theory applied to CLTS management training in Kenya.

PubMed

Crocker, Jonny; Shields, Katherine F; Venkataramanan, Vidya; Saywell, Darren; Bartram, Jamie

2016-10-01

Training and capacity building are long established critical components of global water, sanitation, and hygiene (WaSH) policies, strategies, and programs. Expanding capacity building support for WaSH in developing countries is one of the targets of the Sustainable Development Goals. There are many training evaluation methods and tools available. However, training evaluations in WaSH have been infrequent, have often not utilized these methods and tools, and have lacked rigor. We developed a conceptual framework for evaluating training in WaSH by reviewing and adapting concepts from literature. Our framework includes three target outcomes: learning, individual performance, and improved programming; and two sets of influences: trainee and context factors. We applied the framework to evaluate a seven-month community-led total sanitation (CLTS) management training program delivered to 42 government officials in Kenya from September 2013 to May 2014. Trainees were given a pre-training questionnaire and were interviewed at two weeks and seven months after initial training. We qualitatively analyzed the data using our conceptual framework. The training program resulted in trainees learning the CLTS process and new skills, and improving their individual performance through application of advocacy, partnership, and supervision soft skills. The link from trainees' performance to improved programming was constrained by resource limitations and pre-existing rigidity of trainees' organizations. Training-over-time enhanced outcomes and enabled trainees to overcome constraints in their work. Training in soft skills is relevant to managing public health programs beyond WaSH. We make recommendations on how training programs can be targeted and adapted to improve outcomes. Our conceptual framework can be used as a tool both for planning and evaluating training programs in WaSH. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Results from 10 Years of a CBT Pain Self-Management Outpatient Program for Complex Chronic Conditions.

PubMed

Boschen, Kathryn A; Robinson, Edward; Campbell, Kent A; Muir, Sarah; Oey, Elvina; Janes, Kristen; Fashler, Samantha R; Katz, Joel

2016-01-01

Background. Traditional unimodal interventions may be insufficient for treating complex pain, as they do not address cognitive and behavioural contributors to pain. Cognitive Behavioural Therapy (CBT) and physical exercise (PE) are empirically supported treatments that can reduce pain and improve quality of life. Objectives. To examine the outcomes of a pain self-management outpatient program based on CBT and PE at a rehabilitation hospital in Toronto, Ontario. Methods. The pain management group (PMG) consisted of 20 sessions over 10 weeks. The intervention consisted of four components: education, cognitive behavioural skills, exercise, and self-management strategies. Outcome measures included the sensory, affective, and intensity of pain experience, depression, anxiety, pain disability, active and passive coping style, and general health functioning. Results. From 2002 to 2011, 36 PMGs were run. In total, 311 patients entered the program and 214 completed it. Paired t -tests showed significant pre- to posttreatment improvements in all outcomes measured. Patient outcomes did not differ according to the number or type of diagnoses. Both before and after treatment, women reported more active coping than men. Discussion. The PMGs improved pain self-management for patients with complex pain. Future research should use a randomized controlled design to better understand the outcomes of PMGs.

A cost effectiveness study of integrated care in health services delivery: a diabetes program in Australia

PubMed Central

McRae, Ian S; Butler, James RG; Sibthorpe, Beverly M; Ruscoe, Warwick; Snow, Jill; Rubiano, Dhigna; Gardner, Karen L

2008-01-01

Background Type 2 diabetes is rapidly growing as a proportion of the disease burden in Australia as elsewhere. This study addresses the cost effectiveness of an integrated approach to assisting general practitioners (GPs) with diabetes management. This approach uses a centralized database of clinical data of an Australian Division of General Practice (a network of GPs) to co-ordinate care according to national guidelines. Methods Long term outcomes for patients in the program were derived using clinical parameters after 5 years of program participation, and the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model, to project outcomes for 40 years from the time of diagnosis and from 5 years post-diagnosis. Cost information was obtained from a range of sources. While program costs are directly available, and costs of complications can be estimated from the UKPDS model, other costs are estimated by comparing costs in the Division with average costs across the state or the nation. The outcome and cost measures are used derive incremental cost-effectiveness ratios. Results The clinical data show that the program is effective in the short term, with improvement or no statistical difference in most clinical measures over 5 years. Average HbA1c levels increased by less than expected over the 5 year period. While the program is estimated to generate treatment cost savings, overall net costs are positive. However, the program led to projected improvements in expected life years and Quality Adjusted Life Expectancy (QALE), with incremental cost effectiveness ratios of $A8,106 per life-year saved and $A9,730 per year of QALE gained. Conclusions The combination of an established model of diabetes progression and generally available data has provided an opportunity to establish robust methods of testing the cost effectiveness of a program for which a formal control group was not available. Based on this methodology, integrated health care delivery provided by a network of GPs improved health outcomes of type 2 diabetics with acceptable cost effectiveness, which suggests that similar outcomes may be obtained elsewhere. PMID:18834551

Changing recruitment outcomes: the 'why' and the 'how'.

PubMed

MacLean, Lisa; Pato, Michèle T

2011-01-01

Residency programs compete for applicants and commit extensive resources to the recruitment process. After failing to fill in the match for 5 years (1999-2004), this program decided to make changes in its recruitment process. The authors describe one program's experience in improving recruitment outcomes. The new training director surveyed other program directors, reviewed medical student feedback, and evaluated previous recruitment processes, developing and implementing a new plan. Tracked outcome measures included USMLE scores, COMLEX scores, match results, and American graduate ratios. After implementation of the new process in 2004-2005, the program has filled all six positions every year. Average median COMLEX 1 and 2 scores increased from 35.0 to 77.5 (p<0.012). The American graduate-to-International medical graduate ratio (AMG/IMG ratio) for the program changed from 7/16 in 1999 to 19/5 for Years 2006-2009. Changes in the recruitment process can favorably alter match outcomes.

Evaluating participation in water resource management: A review

NASA Astrophysics Data System (ADS)

Carr, G.; BlöSchl, G.; Loucks, D. P.

2012-11-01

Key documents such as the European Water Framework Directive and the U.S. Clean Water Act state that public and stakeholder participation in water resource management is required. Participation aims to enhance resource management and involve individuals and groups in a democratic way. Evaluation of participatory programs and projects is necessary to assess whether these objectives are being achieved and to identify how participatory programs and projects can be improved. The different methods of evaluation can be classified into three groups: (i) process evaluation assesses the quality of participation process, for example, whether it is legitimate and promotes equal power between participants, (ii) intermediary outcome evaluation assesses the achievement of mainly nontangible outcomes, such as trust and communication, as well as short- to medium-term tangible outcomes, such as agreements and institutional change, and (iii) resource management outcome evaluation assesses the achievement of changes in resource management, such as water quality improvements. Process evaluation forms a major component of the literature but can rarely indicate whether a participation program improves water resource management. Resource management outcome evaluation is challenging because resource changes often emerge beyond the typical period covered by the evaluation and because changes cannot always be clearly related to participation activities. Intermediary outcome evaluation has been given less attention than process evaluation but can identify some real achievements and side benefits that emerge through participation. This review suggests that intermediary outcome evaluation should play a more important role in evaluating participation in water resource management.

Eating disorders in individuals with type 1 diabetes: case series and day hospital treatment outcome.

PubMed

Colton, Patricia Anne; Olmsted, Marion Patricia; Wong, Harmonie; Rodin, Gary Michael

2015-07-01

Women with type 1 diabetes are at high risk for eating disorders (ED), a combination that can increase medical complications and mortality. As little is known about treatment response in this population, clinical presentation and treatment outcome in an extended case series were assessed. A chart review at the Eating Disorders Day Hospital Program at Toronto General Hospital identified a total of 100 individuals with type 1 diabetes assessed 1990-2012. Of 37 who attended day hospital, most experienced improvement in ED symptoms, but only 18.8% had a good immediate treatment outcome, while 43.8% had an intermediate outcome and 37.5% had a poor outcome (meeting diagnostic criteria at discharge). This is poorer than program outcomes in individuals without diabetes (χ(2)  = 12.2, df = 2; p = 0.002). Factors influencing treatment engagement and outcome must be further studied and used to improve treatment results in this high-risk group. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

A Review of Multidisciplinary Interventions in Atopic Dermatitis

PubMed Central

Spielman, Sara C.; LeBovidge, Jennifer S.; Timmons, Karol G.; Schneider, Lynda C.

2015-01-01

Multidisciplinary interventions have been developed for patients with atopic dermatitis (AD) and their families, with the aim of improving outcomes such as disease control, adherence, and quality of life. We reviewed the content of different multidisciplinary approaches to intervention for AD and evidence for their impact on key outcome measures. We also provided data from our multidisciplinary outpatient program for pediatric AD. Studies included in the review suggest benefits of multidisciplinary interventions as models of treatment or adjuncts to standard medical care, with a positive impact on outcomes including disease severity and itching/scratching. There were limitations to existing studies, including heterogeneous methods used to assess quality of life outcomes across studies and lack of controlled studies assessing the outcome of clinical care programs. Further research will be useful in assessing the impact of multidisciplinary interventions on important outcomes such as treatment adherence and sleep, identifying the elements of multidisciplinary interventions that are most critical for improved outcomes, and identifying the best candidates for multidisciplinary intervention approaches. PMID:26239470

The Log Handwriting Program improved children's writing legibility: a pretest-posttest study.

PubMed

Mackay, Nadine; McCluskey, Annie; Mayes, Rachel

2010-01-01

We determined the feasibility and outcomes of the Log Handwriting Program (Raynal, 1990), an 8-week training program based on task-specific practice of handwriting. We used a pretest-posttest design involving 16 first- and second-grade Australian students. Handwriting training sessions occurred in schools for 45 min per week over 8 weeks, in groups of 2 or 3. Weekly homework was provided. The primary outcome measure was the Minnesota Handwriting Assessment (range = 0 to 34; Reisman, 1999). Legibility, form, alignment, size, spacing, and speed were measured. All six assessment subscales showed statistically significant differences. Legibility improved by a mean of 4.1 points (95% confidence interval = 2.5 to 5.7); form, 5.3 points; alignment, 7.8 points; size, 7.9 points; and space, 5.3 points. Speed decreased by 3.9 points. Preliminary evidence indicates that an 8-week Log Handwriting Program is feasible and improved handwriting in primary school children.

Risk and Protective Factors for Family Violence among Low-Income Fathers: Implications for Violence Prevention and Fatherhood Programs.

PubMed

Hayward, R Anna; Honegger, Laura; Hammock, Amy Cristina

2018-01-01

Over the last decade there has been an increased focus on improving father engagement to improve child and family outcomes. Recent research suggests that child and family outcomes improve with increased fatherhood engagement. This exploratory study examined risk and protective factors associated with approval of family violence among a sample of low-income fathers (N = 686) enrolled in a responsible fatherhood program. The program goals include increasing father involvement and economic stability and encouraging healthy relationships-with a focus on preventing intimate partner violence. Toward these aims, this study explored factors associated with fathers' self-reported approval of family violence. Understanding the prevalence of risk and protective factors in this population and factors associated with fathers' potential for family violence is important in developing programs to address responsible fatherhood and healthy relationships. © 2017 National Association of Social Workers.

Effectiveness of Telebehavioral Health Program Nurse Case Managers (NCM): Data Collection Tools and the Process for NCM-Sensitive Outcome Measures.

PubMed

Carlson, Judy; Cohen, Roslyn; Bice-Stephens, Wynona

2014-01-01

As a part of our nation's pursuit of improvements in patient care outcomes, continuity of care, and cost containment, the case manager has become a vital member on interdisciplinary teams and in health care agencies. Telebehavioral health programs, as a relatively new method of delivering behavioral health care, have recently begun to incorporate case management into their multidisciplinary teams. To determine the efficacy and efficiency of healthcare programs, program managers are charged with the determination of the outcomes of the care rendered to patient populations. However, programs that use telehealth methods to deliver care have unique structures in place that impact ability to collect outcome data. A military medical center that serves the Pacific region developed surveys and processes to distribute, administer, and collect information about a telehealth environment to obtain outcome data for the nurse case manager. This report describes the survey development and the processes created to capture nurse case manager outcomes. Additionally, the surveys and processes developed in this project for measuring outcomes may be useful in other settings and disciplines.

Canadian Pacific Railway mechanical services' 5-Alive safety program shows promise in reducing injuries.

DOT National Transportation Integrated Search

2006-09-01

The Federal Railroad Administration (FRA) Human Factors Research and Development (R&D) Program is sponsoring an Alternative Safety Measures Program to explore alternative methods for evaluating whether safety programs improve safety outcomes and the ...

Aligning Needs, Expectations, and Learning Outcomes to Sustain Self-Efficacy through Transfer Learning Community Programs

ERIC Educational Resources Information Center

Leptien, Jennifer R.

2015-01-01

This chapter addresses strengths and difficulties encountered in implementing transfer learning community models and how efficacy is supported through transfer learning community programming. Transfer programming best practices and recommendations for program improvements are presented.

Measuring Performance Excellence: Key Performance Indicators for Institutions Accepted into the Academic Quality Improvement Program (AQIP)

ERIC Educational Resources Information Center

Ballard, Paul J.

2013-01-01

Given growing interest in accountability and outcomes, the North Central Association's Higher Learning Commission developed a new path for accreditation, the Academic Quality Improvement Program (AQIP). The goal is to infuse continuous improvement and quality in the culture of higher education, and to blend traditional accreditation with the…

Establishing a portfolio of quality-improvement projects in pediatric surgery through advanced improvement leadership systems.

PubMed

Gerrein, Betsy T; Williams, Christina E; Von Allmen, Daniel

2013-01-01

Formal quality-improvement (QI) projects require that participants are educated in QI methods to provide them with the capability to carry out successful, meaningful work. However, orchestrating a portfolio of projects that addresses the strategic mission of the institution requires an extension of basic QI training to provide the division or business unit with the capacity to successfully develop and manage the portfolio. Advanced Improvement Leadership Systems is a program to help units create a meaningful portfolio. This program, used by the Division of Pediatric General and Thoracic Surgery at Cincinnati Children's Hospital Medical Center, helped establish a portfolio of targeted QI projects designed to achieve outstanding outcomes at competitive costs in multiple clinical areas aligned with the institution's strategic goals (improve disease-based outcomes, patient safety, flow, and patient and family experience). These objectives are addressed in an institutional strategic plan built around 5 core areas: Safety, Productivity, Care Coordination and Outcomes, Patient and Family Experience, and Value. By combining the portfolio of QI projects with improvements in the divisional infrastructure, effective improvement efforts were realized throughout the division. In the 9 months following the program, divisional capability resulted in a 16.5% increase (5.7% to 22.2%) of formally trained staff working on 10 QI teams. Concurrently, a leadership team, designed to coordinate projects, remove barriers, and provide technical support, provided the capacity to pursue this ongoing effort. The Advanced Improvement Leadership Systems program increased the Division's efficiency and effectiveness in pursing the QI mission that is integral at our hospital.

Establishing a Portfolio of Quality-Improvement Projects in Pediatric Surgery through Advanced Improvement Leadership Systems

PubMed Central

Gerrein, Betsy T; Williams, Christina E; von Allmen, Daniel

2013-01-01

Formal quality-improvement (QI) projects require that participants are educated in QI methods to provide them with the capability to carry out successful, meaningful work. However, orchestrating a portfolio of projects that addresses the strategic mission of the institution requires an extension of basic QI training to provide the division or business unit with the capacity to successfully develop and manage the portfolio. Advanced Improvement Leadership Systems is a program to help units create a meaningful portfolio. This program, used by the Division of Pediatric General and Thoracic Surgery at Cincinnati Children’s Hospital Medical Center, helped establish a portfolio of targeted QI projects designed to achieve outstanding outcomes at competitive costs in multiple clinical areas aligned with the institution’s strategic goals (improve disease-based outcomes, patient safety, flow, and patient and family experience). These objectives are addressed in an institutional strategic plan built around 5 core areas: Safety, Productivity, Care Coordination and Outcomes, Patient and Family Experience, and Value. By combining the portfolio of QI projects with improvements in the divisional infrastructure, effective improvement efforts were realized throughout the division. In the 9 months following the program, divisional capability resulted in a 16.5% increase (5.7% to 22.2%) of formally trained staff working on 10 QI teams. Concurrently, a leadership team, designed to coordinate projects, remove barriers, and provide technical support, provided the capacity to pursue this ongoing effort. The Advanced Improvement Leadership Systems program increased the Division’s efficiency and effectiveness in pursing the QI mission that is integral at our hospital. PMID:24361020

A pragmatic comparison of two diabetes education programs in improving type 2 diabetes mellitus outcomes.

PubMed

Dorland, Katherine; Liddy, Clare

2014-03-28

Although it is clear that education programs constitute key elements of improved diabetes management, uncertainty exists regarding the optimal method of delivering that education. In addition to the lack of consensus regarding the most appropriate delivery methods for these programs, there is a paucity of research which evaluates these methods in terms of specific clinical outcomes. This pragmatic study compares the effectiveness of two distinct diabetes education programs in improving clinical outcomes in patients with type 2 diabetes mellitus in a primary care setting. The two diabetes education classes (n = 80 enrolled) retrospectively evaluated were 'the ABC's of Diabetes' (one 2-hour didactic teaching session) and 'Conversation Maps' (3 highly interactive weekly classes, 6 hours in total). Eligible participants (n = 32) had their charts reviewed and outcome measures (i.e., glycosylated hemoglobin levels (HbA1c), low density lipoprotein (LDL), systolic blood pressure (SBP), diastolic blood pressure (DBP), and weight) recorded 1 year prior to and 6 months following the class. Pre- and post-class outcome measures were compared. A trend towards lower HbA1c was observed after completion of both classes, with an average reduction of 0.2%, and 0.6% after 6 months in the 'ABC's of Diabetes' class and 'Conversation Maps' class respectively. A significant decrease in weight was observed 6 months after the 'ABC's of Diabetes' class (p = 0.028), and in LDL after the 'Conversation Maps' class (p = 0.049). Patients with HbA1c ≥ 8% showed a drop of 1.1% in HbA1c 3 months after either class (p = 0.004). No significant difference in outcomes was found between the two diabetes education classes assessed. There was a trend towards improved glycemic control after both classes, and patients with high HbA1c levels demonstrated statistically significant improvements. This indicates that shorter sessions using didactic teaching methods may be equally effective in producing improvements in diabetes self-management as more intensive course formats.

Evaluation of group and self-directed formats of the Arthritis Foundation's Walk With Ease Program.

PubMed

Callahan, Leigh F; Shreffler, Jack H; Altpeter, Mary; Schoster, Britta; Hootman, Jennifer; Houenou, Laura O; Martin, Kathryn R; Schwartz, Todd A

2011-08-01

To evaluate the effects of a revised 6-week walking program for adults with arthritis, Walk With Ease (WWE), delivered in 2 formats, instructor-led group or self-directed. In an observational pre-post study design, 462 individuals with self-reported arthritis selected either a group format (n = 192) or a self-directed (n = 270) format. Performance and self-reported outcomes were assessed at baseline and at 6 weeks. Self-reported outcomes were assessed at 1 year. Adjusted mean outcome values for group and self-directed participants were determined using regression models, adjusting for covariates. At 6 weeks, significant adjusted mean improvements (P < 0.05) were seen for nearly all self-report and performance measures in both formats. Modest to moderate effect sizes (ES) were seen for disability (ES 0.16-0.23), pain, fatigue, and stiffness (ES 0.21-0.40), and helplessness (ES 0.24-0.28). The Arthritis Self-Efficacy (ASE) pain and symptom scales had modest improvements (ES 0.09-0.21). The performance measures of strength (ES 0.29-0.35), balance (ES 0.12-0.36), and walking pace (ES 0.12-0.32) all showed modest to moderate improvements. No adverse events were reported for either format. At 1 year, both formats showed modest improvement in ASE pain, but there were 5 outcomes where self-directed participants showed significant improvement, while the group participants did not. The revised WWE program decreases disability and improves arthritis symptoms, self-efficacy, and perceived control, balance, strength, and walking pace in individuals with arthritis, regardless of whether they are taking a group class or doing the program as self-directed walkers. At 1 year, some benefits are maintained, particularly among the self-directed. This is a safe, easy, and inexpensive program to promote community-based physical activity. Copyright © 2011 by the American College of Rheumatology.

Implementation of a diabetes self-management education program in primary care for adults using shared medical appointments.

PubMed

Sanchez, Iris

2011-01-01

The purpose of this study was to implement diabetes self-management education in primary care using the Chronic Care Model and shared medical appointments (SMA) to provide evidence-based interventions to improve process and measure outcomes. A quality improvement project using the Plan-Do-Check-Act cycle was implemented in a primary care setting in South Texas to provide diabetes self-management education for adults. Biological measures were evaluated in 70 patients at initiation of the project and thereafter based on current practice guidelines. The results of the project were consistent with the literature regarding the benefits, sustainability, and viability of SMA. As compared with that in studies presented in the literature, the patient population who participated in SMA had similar outcomes regarding improvement in A1C, self-management skills, and satisfaction. SMA are an innovative system redesign concept with the potential to provide comprehensive and coordinated care for patients with multiple and chronic health conditions while still being an efficient, effective, financially viable, and sustainable program. As the incidence and prevalence of diabetes increase, innovative models of care can meet the growing demand for access and utilization of diabetes self-management education programs. Programs focusing on chronic conditions to improve outcomes can be replicated by health care providers in primary care settings. SMA can increase revenue and productivity, improve disease management, and increase provider and patient satisfaction.

A randomised controlled trial of a self-management education program for osteoarthritis of the knee delivered by health care professionals.

PubMed

Coleman, Sophie; Briffa, N Kathryn; Carroll, Graeme; Inderjeeth, Charles; Cook, Nicola; McQuade, Jean

2012-01-27

Our aim in the present study was to determine whether a disease-specific self-management program for primary care patients with osteoarthritis (OA) of the knee (the Osteoarthritis of the Knee Self-Management Program (OAK)) implemented by health care professionals would achieve and maintain clinically meaningful improvements in health-related outcomes compared with a control group. Medical practitioners referred 146 primary care patients with OA of the knee. Volunteers with coexistent inflammatory joint disease or serious comorbidities were excluded. Randomisation was to either a control group or the OAK group. The OAK group completed a 6-week self-management program. The control group had a 6-month waiting period before entering the OAK program. Assessments were taken at baseline, 8 weeks and 6 months. The primary outcomes were the results measured using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) Pain and Function subscales on the Short Form 36 version 1 questionnaire (SF-36) Secondary outcomes were Visual Analogue Scale (VAS) pain, Timed Up & Go Test (TUG), knee range of motion and quadriceps and hamstring strength-isometric contraction. Responses to treatment (responders) and minimal clinically important improvements (MCIIs) were determined. In the OAK group, VAS pain improved from baseline to week 8 from mean (SEM) 5.21 (0.30) to 3.65 (0.29) (P ≤ 0.001). During this period, improvements in the OAK group compared with the control group and responses to treatment were demonstrated according to the following outcomes: WOMAC Pain, Physical Function and Total dimensions, as well as SF-36 Physical Function, Role Physical, Body Pain, Vitality and Social Functioning domains. In addition, from baseline to week 8, the proportion of MCIIs was greater among the OAK group than the control group for all outcomes. For the period between baseline and month 6, WOMAC Pain, Physical Function and Total dimensions significantly improved in the OAK group compared to the control group, as did the SF-36 Physical Function, Role Physical, Body Pain, Vitality and Social Functioning domains, as well as hamstring strength in both legs. During the same period, the TUG Test, range of motion extension and left-knee flexion improved compared with the control group, although these improvements had little clinical relevance. We recorded statistically significant improvements compared with a control group with regard to pain, quality of life and function for participants in the OAK program on the basis of WOMAC and SF-36 measures taken 8 weeks and 6 months from baseline.

Stakeholder involvement in the design of a patient-centered comparative effectiveness trial of the “On the Move” group exercise program in community-dwelling older adults

PubMed Central

Brach, Jennifer S.; Perera, Subashan; Gilmore, Sandra; VanSwearingen, Jessie M.; Brodine, Deborah; Wert, David; Nadkarni, Neelesh K.; Ricci, Edmund

2016-01-01

Background Group exercise programs for older adults often exclude the timing and coordination of movement. Stakeholder involvement in the research process is strongly encouraged and improves the relevance and adoption of findings. We describe stakeholder involvement in the design of a clinical trial of a group-based exercise program that incorporates timing and coordination of movement into the exercises. Methods The study was a cluster randomized, single-blind intervention trial to compare the effects on function, disability and mobility of a standard group exercise program and the “On the Move” group exercise program in older adults residing in independent living facilities and senior apartment buildings, and attending community centers. Exercise classes were twice weekly for 12 weeks delivered by study exercise leaders and facility activity staff personnel. Outcomes The primary outcomes function, disability and mobility were assessed at baseline and post-intervention. Function and disability were assessed using the Late Life Function and Disability Instrument, and mobility using the Six-Minute Walk Test and gait speed. Stakeholders Patient and provider stakeholders had significant input into the study aims, design, sample, intervention, outcomes and operational considerations. Summary A community-based exercise program to improve walking can be developed to address both investigator identified missing components in current exercise to improve walking and stakeholder defined needs and interest for the activity program. Involvement of stakeholders substantially improves the relevance of research questions, increases the transparency of research activities and may accelerate the adoption of research into practice. PMID:27521806

Correlates of improvement in substance abuse among dually diagnosed veterans with post-traumatic stress disorder in specialized intensive VA treatment.

PubMed

Coker, Kendell L; Stefanovics, Elina; Rosenheck, Robert

2016-01-01

Substantial rates of substance use comorbidity have been observed among veterans with Post-Traumatic Stress Disorder (PTSD), highlighting the need to identify patient and program characteristics associated with improved outcomes for substance abuse. Data were drawn from 12,270 dually diagnosed veterans who sought treatment from specialized intensive Veterans Health Administration PTSD programs between 1993 and 2011. The magnitude of the improvement in Addiction Severity Index (ASI) alcohol and drug use composite scores from baseline was moderate, with effect sizes (ES) of -.269 and -.287, respectively. Multivariate analyses revealed that treatment in longer-term programs, being prescribed psychiatric medication, and planned participation in reunions were all associated with slightly improved outcomes. Reductions in substance use measures were associated with robust improvements in PTSD symptoms and violent behavior. These findings suggest not only synergistic treatment effects linking improvement in PTSD symptoms with substance use disorders among dually diagnosed veterans with PTSD, but also to reductions in violent behavior. Furthermore, the findings indicate that proper discharge planning in addition to intensity and duration of treatment for dually diagnosed veterans with severe PTSD may result in better outcomes. Further dissemination of evidence-based substance abuse treatment may benefit this population. (c) 2016 APA, all rights reserved).

Role of Adult Asthma Education in Improving Asthma Control and Reducing Emergency Room Utilization and Hospital Admissions in an Inner City Hospital

PubMed Central

Mishra, Rashmi; Venkatram, Sindhaghatta; George, Teresa; Luo, Kristina; Diaz-Fuentes, Gilda

2017-01-01

Objective. Asthma education programs have been shown to decrease healthcare utilization and improve disease control and management. The purpose of our study was to evaluate the impact of an outpatient adult asthma education program in an inner city hospital caring for patients with low socioeconomic and educational status. Methods. An asthma education program was implemented in September 2014. Patients who received education from September 2014 to July 2015 were evaluated. Outcomes were compared for the same group of patients before and after education. Primary outcomes were emergency room (ER) visits and hospital admissions. Secondary outcomes were change in Asthma Control Test (ACT) score and number of pulmonary clinic visits. Results. Asthma education significantly decreased number of patients requiring ER visits and hospital admissions (p = 0.0005 and p = 0.0015, resp.). Asthma control as per ACT score ≥ 20 improved with education (p = 0.0001) with an increase in clinic visits (p = 0.0185). Conclusions. Our study suggests that implementation of a structured asthma education program in an inner city community hospital has a positive impact on reduction of ER visits and hospital admissions with improvement in asthma control. Institutional Review Board Clinical Study registration number is 01081507. PMID:28546781

Does disease management improve clinical and economic outcomes in patients with chronic diseases? A systematic review.

PubMed

Ofman, Joshua J; Badamgarav, Enkhe; Henning, James M; Knight, Kevin; Gano, Anacleto D; Levan, Rebecka K; Gur-Arie, Shoval; Richards, Margaret S; Hasselblad, Vic; Weingarten, Scott R

2004-08-01

To assess the clinical and economic effects of disease management in patients with chronic diseases. Electronic databases were searched for English-language articles from 1987 to 2001. Articles were included if they used a systematic approach to care and evaluated patients with chronic disease, reported objective measurements of the processes or outcomes of care, and employed acceptable experimental or quasi-experimental study designs as defined by the Cochrane Effective Practice and Organization of Care Group. Two reviewers evaluated 16,917 titles and identified 102 studies that met the inclusion criteria. Identified studies represented 11 chronic conditions: depression, diabetes, rheumatoid arthritis, chronic pain, coronary artery disease, asthma, heart failure, back pain, chronic obstructive pulmonary disease, hypertension, and hyperlipidemia. Disease management programs for patients with depression had the highest percentage of comparisons (48% [41/86]) showing substantial improvements in patient care, whereas programs for patients with chronic obstructive pulmonary disease (9% [2/22]) or chronic pain (8% [1/12]) appeared to be the least effective. Of the outcomes more frequently studied, disease management appeared to improve patient satisfaction (71% [12/17]), patient adherence (47% [17/36]), and disease control (45% [33/74]) most commonly and cost-related outcomes least frequently (11% to 16%). Disease management programs were associated with marked improvements in many different processes and outcomes of care. Few studies demonstrated a notable reduction in costs. Further research is needed to understand how disease management can most effectively improve the quality and cost of care for patients with chronic diseases.

Feasibility of a parenting program to prevent substance use among Latino youth: a community-based participatory research study.

PubMed

Allen, Michele L; Hurtado, Ghaffar A; Yon, Kyu Jin; Okuyemi, Kola S; Davey, Cynthia S; Marczak, Mary S; Stoppa, Patricia; Svetaz, Veronica M

2013-01-01

Family-skills training programs prevent adolescent substance use, but few exist for immigrant Latino families. This study assesses the feasibility of a family-skills training intervention developed using a community-based participatory research framework, and explores parental traditional values as a modifier of preliminary effects. One-group pretest-posttest. Four Latino youth-serving sites (school, clinic, church, social-service agency). Immigrant Latino parents of adolescents aged 10 to 14 years (N  =  83). Eight-session program in Spanish to improve parenting practices and parent-youth interpersonal relations designed with Latino parents and staff from collaborating organizations. Feasibility was assessed through retention, program appropriateness, and group interaction quality. Preliminary outcomes evaluated were (1) parenting self-efficacy, discipline, harsh parenting, monitoring, conflict, attachment, acceptance, and involvement, and (2) parent perception of adolescent internalizing, externalizing, and substance use behaviors. Covariates included sociodemographics and parental endorsement of traditional values. Feasibility outcomes were assessed with descriptive statistics. Paired t-tests measured changes in parenting outcomes. Adjusted multiple regression models were conducted for change in each outcome, and t-tests compared mean changes in outcomes between parents with high and low traditional values scores. Program appropriateness and group interaction scores were positive. Improvement was noted for eight parenting outcomes. Parents perceived that adolescent internalizing behaviors decreased. Parents with lower endorsement of traditional values showed greater pretest-posttest change in attachment, acceptance, and involvement. This intervention is feasible and may influence parenting contributors to adolescent substance use.

The science experience: The relationship between an inquiry-based science program and student outcomes

NASA Astrophysics Data System (ADS)

Poderoso, Charie

Science education reforms in U.S. schools emphasize the importance of students' construction of knowledge through inquiry. Organizations such as the National Science Foundation (NSF), the National Research Council (NRC), and the American Association for the Advancement of Science (AAAS) have demonstrated a commitment to searching for solutions and renewed efforts to improve science education. One suggestion for science education reform in U.S. schools was a transition from traditional didactic, textbook-based to inquiry-based instructional programs. While inquiry has shown evidence for improved student learning in science, what is needed is empirical evidence of those inquiry-based practices that affect student outcomes in a local context. This study explores the relationship between instructional programs and curricular changes affecting student outcomes in the Santa Ana Unified District (SAUSD): It provides evidence related to achievement and attitudes. SAUSD employs two approaches to teaching in the middle school science classrooms: traditional and inquiry-based approaches. The Leadership and Assistance for Science Education Reform (LASER) program is an inquiry-based science program that utilizes resources for implementation of the University of California Berkeley's Lawrence Hall of Science Education for Public Understanding Program (SEPUP) to support inquiry-based teaching and learning. Findings in this study provide empirical support related to outcomes of seventh-grade students, N = 328, in the LASER and traditional science programs in SAUSD.

Critical Care Delivery: The Importance of Process of Care and ICU Structure to Improved Outcomes: An Update From the American College of Critical Care Medicine Task Force on Models of Critical Care.

PubMed

Weled, Barry J; Adzhigirey, Lana A; Hodgman, Tudy M; Brilli, Richard J; Spevetz, Antoinette; Kline, Andrea M; Montgomery, Vicki L; Puri, Nitin; Tisherman, Samuel A; Vespa, Paul M; Pronovost, Peter J; Rainey, Thomas G; Patterson, Andrew J; Wheeler, Derek S

2015-07-01

In 2001, the Society of Critical Care Medicine published practice model guidelines that focused on the delivery of critical care and the roles of different ICU team members. An exhaustive review of the additional literature published since the last guideline has demonstrated that both the structure and process of care in the ICU are important for achieving optimal patient outcomes. Since the publication of the original guideline, several authorities have recognized that improvements in the processes of care, ICU structure, and the use of quality improvement science methodologies can beneficially impact patient outcomes and reduce costs. Herein, we summarize findings of the American College of Critical Care Medicine Task Force on Models of Critical Care: 1) An intensivist-led, high-performing, multidisciplinary team dedicated to the ICU is an integral part of effective care delivery; 2) Process improvement is the backbone of achieving high-quality ICU outcomes; 3) Standardized protocols including care bundles and order sets to facilitate measurable processes and outcomes should be used and further developed in the ICU setting; and 4) Institutional support for comprehensive quality improvement programs as well as tele-ICU programs should be provided.

Implementation of Neurocritical Care Is Associated With Improved Outcomes in Traumatic Brain Injury.

PubMed

Sekhon, Mypinder S; Gooderham, Peter; Toyota, Brian; Kherzi, Navid; Hu, Vivien; Dhingra, Vinay K; Hameed, Morad S; Chittock, Dean R; Griesdale, Donald E

2017-07-01

Background Traditionally, the delivery of dedicated neurocritical care (NCC) occurs in distinct NCC units and is associated with improved outcomes. Institution-specific logistical challenges pose barriers to the development of distinct NCC units; therefore, we developed a consultancy NCC service coupled with the implementation of invasive multimodal neuromonitoring, within a medical-surgical intensive care unit. Our objective was to evaluate the effect of a consultancy NCC program on neurologic outcomes in severe traumatic brain injury patients. We conducted a single-center quasi-experimental uncontrolled pre- and post-NCC study in severe traumatic brain injury patients (Glasgow Coma Scale ≤8). The NCC program includes consultation with a neurointensivist and neurosurgeon and multimodal neuromonitoring. Demographic, injury severity metrics, neurophysiologic data, and therapeutic interventions were collected. Glasgow Outcome Scale (GOS) at 6 months was the primary outcome. Multivariable ordinal logistic regression was used to model the association between NCC implementation and GOS at 6 months. A total of 113 patients were identified: 76 pre-NCC and 37 post-NCC. Mean age was 39 years (standard deviation [SD], 2) and 87 of 113 (77%) patients were male. Median admission motor score was 3 (interquartile ratio, 1-4). Daily mean arterial pressure was higher (95 mmHg [SD, 10]) versus (88 mmHg [SD, 10], p<0.001) and daily mean core body temperature was lower (36.6°C [SD, 0.90]) versus (37.2°C [SD, 1.0], p=0.001) post-NCC compared with pre-NCC, respectively. Multivariable regression modelling revealed the NCC program was associated with a 2.5 increased odds (odds ratios, 2.5; 95% confidence interval, 1.1-5.3; p=0.022) of improved 6-month GOS. Implementation of a NCC program is associated with improved 6 month GOS in severe TBI patients.

A retrospective evaluation of the Perfecting Patient Care University training program for health care organizations.

PubMed

Morganti, Kristy Gonzalez; Lovejoy, Susan; Beckjord, Ellen Burke; Haviland, Amelia M; Haas, Ann C; Farley, Donna O

2014-01-01

This study evaluated how the Perfecting Patient Care (PPC) University, a quality improvement (QI) training program for health care leaders and clinicians, affected the ability of organizations to improve the health care they provide. This training program teaches improvement methods based on Lean concepts and principles of the Toyota Production System and is offered in several formats. A retrospective evaluation was performed that gathered data on training, other process factors, and outcomes after staff completed the PPC training. A majority of respondents reported gaining QI competencies and cultural achievements from the training. Organizations had high average scores for the success measures of "outcomes improved" and "sustainable monitoring" but lower scores for diffusion of QI efforts. Total training dosage was significantly associated with the measures of QI success. This evaluation provides evidence that organizations gained the PPC competencies and cultural achievements and that training dosage is a driver of QI success.

Linking Community Hospital Initiatives With Osteopathic Medical Students' Quality Improvement Training: A Pilot Program.

PubMed

Brannan, Grace D; Russ, Ronald; Winemiller, Terry R; Mast, Eric

2016-01-01

Quality improvement (QI) continues to be a health care challenge, and the literature indicates that osteopathic medical students need more training. To qualify for portions of managed care reimbursement, hospitals are required to meet measures intended to improve quality of care and patient satisfaction, which may be challenging for small community hospitals with limited resources. Because osteopathic medical training is grounded on community hospital experiences, an opportunity exists to align the outcomes needs of hospitals and QI training needs of students. In this pilot program, 3 sponsoring hospitals recruited and mentored 1 osteopathic medical student each through a QI project. A mentor at each hospital identified a project that was important to the hospital's patient care QI goals. This pilot program provided osteopathic medical students with hands-on QI training, created opportunities for interprofessional collaboration, and contributed to hospital initiatives to improve patient outcomes.

Praises & Nudges: A Case of District-Wide Change.

ERIC Educational Resources Information Center

Doyle, Richard; And Others

This paper describes the processes and outcomes experienced by the Marshalltown Community School District (Iowa) as it implemented a shared decision-making, school-improvement program. A district Shared Decision Making (SDM) Team and School Improvement Program (SIP) teams were trained to facilitate greater staff participation in the…

Effectiveness of a Multilevel Workplace Health Promotion Program on Vitality, Health, and Work-Related Outcomes

PubMed Central

Hendriksen, Ingrid J.M.; Snoijer, Mirjam; de Kok, Brenda P.H.; van Vilsteren, Jeroen; Hofstetter, Hedwig

2016-01-01

Objective: Evaluation of the effectiveness of a workplace health promotion program on employees’ vitality, health, and work-related outcomes, and exploring the influence of organizational support and the supervisors’ role on these outcomes. Methods: The 5-month intervention included activities at management, team, and individual level targeting self-management to perform healthy behaviors: a kick-off session, vitality training sessions, workshops, individual coaching, and intervision. Outcome measures were collected using questionnaires, health checks, and sickness absence data at baseline, after the intervention and at 10 months follow-up. For analysis linear and generalized mixed models were used. Results: Vitality, work performance, sickness absence, and self-management significantly improved. Good organizational support and involved supervisors were significantly associated with lower sickness absence. Conclusions: Including all organizational levels and focusing on increasing self-management provided promising results for improving vitality, health, and work-related outcomes. PMID:27136605

Effectiveness of a Multilevel Workplace Health Promotion Program on Vitality, Health, and Work-Related Outcomes.

PubMed

Hendriksen, Ingrid J M; Snoijer, Mirjam; de Kok, Brenda P H; van Vilsteren, Jeroen; Hofstetter, Hedwig

2016-06-01

Evaluation of the effectiveness of a workplace health promotion program on employees' vitality, health, and work-related outcomes, and exploring the influence of organizational support and the supervisors' role on these outcomes. The 5-month intervention included activities at management, team, and individual level targeting self-management to perform healthy behaviors: a kick-off session, vitality training sessions, workshops, individual coaching, and intervision. Outcome measures were collected using questionnaires, health checks, and sickness absence data at baseline, after the intervention and at 10 months follow-up. For analysis linear and generalized mixed models were used. Vitality, work performance, sickness absence, and self-management significantly improved. Good organizational support and involved supervisors were significantly associated with lower sickness absence. Including all organizational levels and focusing on increasing self-management provided promising results for improving vitality, health, and work-related outcomes.

Learning Outcomes Assessment Step-By-Step: Enhancing Evidence-Based Practice in Career Services

ERIC Educational Resources Information Center

Makela, Julia Panke; Rooney, Gail S.

2012-01-01

What difference do your career programs and services make in clients' lives? How do you know? Answer these questions and more. Learn a practical approach to learning outcomes assessment that helps you tell the story of your career programs and services, celebrate your successes, and continuously improve your practice. Within this monograph, you…

A Meta-analysis of universal mental health prevention programs for higher education students.

PubMed

Conley, Colleen S; Durlak, Joseph A; Kirsch, Alexandra C

2015-05-01

This meta-analysis investigated the effectiveness of universal mental health prevention programs for higher education students on a range of adjustment outcomes. A systematic literature search identified 103 controlled published and unpublished interventions involving college, graduate, or professional students. As hypothesized, skill-training programs that included a supervised practice component were significantly more effective overall (mean effect size = 0.45, confidence interval (CI) = 0.39 to 0.52) compared to skill-training programs without supervised practice (0.11, CI = -0.01 to 0.22) and psychoeducational (information-only) programs (0.13, CI = 0.06 to 0.21). When comparisons on specific outcomes were possible, skill-training programs including supervised practice were significantly more effective than the other two groups of programs in reducing symptoms of depression, anxiety, stress, and general psychological distress, and in improving social-emotional skills, self-perceptions, and academic behaviors and performance. The magnitude of effects achieved in several outcome areas is comparable to or higher than that reported in other reviews of universal programs, suggesting that skill-training programs for higher education students that incorporate supervised practice now join the ranks of other effective preventive mental health interventions. This review offers several recommendations to improve the experimental rigor of future research.

All That Glitters Is Not Gold: School Reform in Charlotte-Mecklenburg.

ERIC Educational Resources Information Center

Smith, Stephen Samuel; Mickelson, Roslyn Arlin

2000-01-01

Compared the progress of the Charlotte-Mecklenburg school district, North Carolina, in improving student outcomes with progress in two other North Carolina school districts and the entire state. There was no evidence that the sweeping program of school reform in Charlotte-Mecklenburg improved academic outcomes except in a few advanced placement…

Elements for Successful Collaboration between K-8 School, Community Agency, and University Partners: The Lead Peace Partnership

ERIC Educational Resources Information Center

Bosma, Linda M.; Sieving, Renee E.; Ericson, Annie; Russ, Pamela; Cavender, Laura; Bonine, Mark

2010-01-01

Background: Researchers, schools, and community organizations are increasingly interested in forming partnerships to improve health and learning outcomes for adolescents. School-based service learning programs with young adolescents have been shown to improve students' health and educational outcomes. Quality school-based service learning practice…

An online randomized controlled trial, with or without problem-solving treatment, for long-term cancer survivors after hematopoietic cell transplantation.

PubMed

Syrjala, Karen L; Yi, Jean C; Artherholt, Samantha B; Romano, Joan M; Crouch, Marie-Laure; Fiscalini, Allison S; Hegel, Mark T; Flowers, Mary E D; Martin, Paul J; Leisenring, Wendy M

2018-05-05

This randomized controlled trial examines the efficacy of INSPIRE, an INternet-based Survivorship Program with Information and REsources, with or without problem-solving treatment (PST) telehealth calls, for survivors after hematopoietic cell transplantation (HCT). All adult survivors who met eligibility criteria were approached for consent. Participants completed patient-reported outcomes at baseline and 6 months. Those with baseline impaired scores on one or more of the outcomes were randomized to INSPIRE, INSPIRE + PST, or control with delayed INSPIRE access. Outcomes included Cancer and Treatment Distress, Symptom Checklist-90-R Depression, and Fatigue Symptom Inventory. Planned analyses compared arms for mean change in aggregated impaired outcomes and for proportion of participants improved on each outcome. Of 1306 eligible HCT recipients, 755 (58%) participated, and 344 (45%) had one or more impaired scores at baseline. We found no reduction in aggregated outcomes for either intervention (P > 0.3). In analyses of individual outcomes, participants randomized to INSPIRE + PST were more likely to improve in distress than controls (45 vs. 20%, RR 2.3, CI 1.0, 5.1); those randomized to INSPIRE alone were marginally more likely to improve in distress (40 vs. 20%, RR 2.0, CI 0.9, 4.5). The INSPIRE online intervention demonstrated a marginal benefit for distress that improved with the addition of telehealth PST, particularly for those who viewed the website or were age 40 or older. Online and telehealth programs such as INSPIRE offer opportunities to enhance HCT survivorship outcomes, particularly for mood, though methods would benefit from strategies to improve efficacy.

Home-Based Exercise Improves Fitness and Exercise Attitude and Intention in Women with GDM.

PubMed

Halse, Rhiannon E; Wallman, Karen E; Dimmock, James A; Newnham, John P; Guelfi, Kym J

2015-08-01

The purpose of the study was to determine the effect of a home-based cycling program for women with a recent diagnosis of gestational diabetes mellitus (GDM) on aerobic fitness, weight gain, self-reported mobility, attitude, and intentions toward maternal exercise, and obstetric and neonatal outcomes. Forty women (mean ± SD, 28.8 ± 0.9-wk gestation) were randomized to either a supervised, home-based exercise program, combining continuous steady-state and interval cycling at various intensities, in combination with unsupervised moderate intensity aerobic activity and conventional diabetic management (EX; n = 20) or to conventional management alone (CON; n = 20). The program began following diagnosis until week 34 of pregnancy (mean ± SD duration of training, 6 ± 1 wk). Mean compliance to the training program was 96%. Maternal aerobic fitness, and attitude and intentions toward exercise were improved in response to the home-based exercise intervention compared with CON (P < 0.05). No differences were observed between the groups with respect to maternal weight gain or obstetric and neonatal outcomes (P > 0.05). A home-based exercise program of 6 ± 1 wk in duration commenced after diagnosis of GDM can improve aerobic fitness and attitude and intentions toward exercise, with no adverse effect on maternal and neonatal pregnancy outcomes.

Patient goal setting as a method for program improvement/development in partial hospitalization programs.

PubMed

Gates, A

1991-12-01

Data were collected from a study of 49 patients in 1990 and 106 patients in 1991 admitted into Country View Treatment Center and Green Country Counseling Center. Country View is a 30-bed chemical dependency residential center operating under St. John Medical Center in Tulsa, Oklahoma. Green Country is an evening partial hospital chemical dependency program operating under St. John Medical Center in Tulsa, Oklahoma, The tools used in this study were the Country View Patient Self-Reporting Questionnaire, the global Rating Scale, and the Model of Recovering Alcoholics Behavior Stages and Goal Setting (Wing, 1990). These assessments were specifically designed to measure the patient's perceptions of goal setting and the patient's perspective on treatment outcome. The study outcome resulted in program improvement (Green Country evening partial hospital program) and the development of the Country View Substance Abuse Intermediate Link (SAIL) Program (day partial hospital).

Impact of academic facility type and volume on post-surgical outcomes following diagnosis of glioblastoma.

PubMed

Hauser, Alan; Dutta, Sunil W; Showalter, Timothy N; Sheehan, Jason P; Grover, Surbhi; Trifiletti, Daniel M

2018-01-01

To identify if facility type and/or facility volume impact overall survival (OS) following diagnosis of glioblastoma (GBM). We also sought to compare early post-surgical outcomes based on these factors. The National Cancer Database was queried for patients with GBM diagnosed from 2004 to 2013 with known survival. Patients were grouped based on facility type and facility volume. Multivariable analyses were performed to investigate factors associated OS following diagnosis and Chi-square tests were used to compare early post-surgical outcomes. 89,839 patients met inclusion criteria. Factors associated with improved OS on multivariable analysis included younger patient age, female gender, race, lower comorbidity score, higher performance score, smaller tumor size, unifocal tumors, MGMT hypermethylation, fully resected tumors, radiotherapy, and chemotherapy (each p < .001). Also, OS was improved among patients treated at centers averaging at least 30.2 cases per year (HR 0.948, compared to <7.4 cases/year, p < .001), and patients treated at Academic/Research programs had improved survival compared to those treated at Comprehensive Community Cancer programs (HR 1.069, p < .001) and Integrated Network Cancer programs (HR 1.126, p < .001). Similarly, Academic/Research programs and high volume centers demonstrated improved 30- and 90-day morality as well as 30-day readmission rates (p < .001). This study suggests that patients treated in Academic/Research programs and high patient-volume centers have increased survival and more favorable early-postsurgical outcomes. The extent to which differences in patient populations, socioeconomic factors, and/or provider expertise play into this cause will be areas of future research. Copyright © 2017 Elsevier Ltd. All rights reserved.

Mental health nurses in primary care: qualitative outcomes of the Mental Health Nurse Incentive Program.

PubMed

Lakeman, Richard

2013-10-01

The Mental Health Nurse Incentive Program (MHNIP) is a government-funded programme, which, since 2007, has enabled mental health nurses to work in primary care settings in Australia in collaboration with general practitioners (GPs) or private psychiatrists. To date, small-scale qualitative studies have explored outcomes of the programme from the point of view of nurses, consumers, and the perceptions of GPs. This study reports on an on-line survey of credentialed mental health nurses perceptions of outcomes of the MHNIP. Two hundred and twenty five nurses who worked in MHNIP provided detailed narrative responses that were examined using thematic content analysis. The most commonly-cited outcomes were reductions in symptoms or improved coping, improved relationships, and enhanced community participation. Other reported outcomes included reduced hospitalization or use of state-funded mental health services, better use of health services, the continuation or establishment of meaningful occupation, improved physical health and medication management, less use of coercive interventions, and greater independence. © 2013 The Author; International Journal of Mental Health Nursing © 2013 Australian College of Mental Health Nurses Inc.

Direct and Mediated Relationships Between Participation in a Telephonic Health Coaching Program and Health Behavior, Life Satisfaction, and Optimism.

PubMed

Sears, Lindsay E; Coberley, Carter R; Pope, James E

2016-07-01

The aim of this study was to examine the direct and mediated effects of a telephonic health coaching program on changes to healthy behaviors, life satisfaction, and optimism. This longitudinal correlational study of 4881 individuals investigated simple and mediated relationships between participation in a telephonic health risk coaching program and outcomes from three annual Well-being Assessments. Program participation was directly related to improvements in healthy behaviors, life satisfaction and optimism, and indirect effects of coaching on these variables concurrently and over a one-year time lag were also supported. Given previous research that improvements to life satisfaction, optimism, and health behaviors are valuable for individuals, employers, and communities, a clearer understanding of intervention approaches that may impact these outcomes simultaneously can drive greater program effectiveness and value on investment.

Effectiveness of home visiting programs on child outcomes: a systematic review

PubMed Central

2013-01-01

Background The effectiveness of paraprofessional home-visitations on improving the circumstances of disadvantaged families is unclear. The purpose of this paper is to systematically review the effectiveness of paraprofessional home-visiting programs on developmental and health outcomes of young children from disadvantaged families. Methods A comprehensive search of electronic databases (e.g., CINAHL PLUS, Cochrane, EMBASE, MEDLINE) from 1990 through May 2012 was supplemented by reference lists to search for relevant studies. Through the use of reliable tools, studies were assessed in duplicate. English language studies of paraprofessional home-visiting programs assessing specific outcomes for children (0-6 years) from disadvantaged families were eligible for inclusion in the review. Data extraction included the characteristics of the participants, intervention, outcomes and quality of the studies. Results Studies that scored 13 or greater out of a total of 15 on the validity tool (n = 21) are the focus of this review. All studies are randomized controlled trials and most were conducted in the United States. Significant improvements to the development and health of young children as a result of a home-visiting program are noted for particular groups. These include: (a) prevention of child abuse in some cases, particularly when the intervention is initiated prenatally; (b) developmental benefits in relation to cognition and problem behaviours, and less consistently with language skills; and (c) reduced incidence of low birth weights and health problems in older children, and increased incidence of appropriate weight gain in early childhood. However, overall home-visiting programs are limited in improving the lives of socially high-risk children who live in disadvantaged families. Conclusions Home visitation by paraprofessionals is an intervention that holds promise for socially high-risk families with young children. Initiating the intervention prenatally and increasing the number of visits improves development and health outcomes for particular groups of children. Future studies should consider what dose of the intervention is most beneficial and address retention issues. PMID:23302300

Atrioventricular and ventricular-to-ventricular programming in patients with cardiac resynchronization therapy: results from ALTITUDE.

PubMed

Steinberg, Benjamin A; Wehrenberg, Scott; Jackson, Kevin P; Hayes, David L; Varma, Niraj; Powell, Brian D; Day, John D; Frazier-Mills, Camille G; Stein, Kenneth M; Jones, Paul W; Piccini, Jonathan P

2015-12-01

Cardiac resynchronization therapy (CRT) improves outcomes in patients with heart failure, yet response rates are variable. We sought to determine whether physician-specified CRT programming was associated with improved outcomes. Using data from the ALTITUDE remote follow-up cohort, we examined sensed atrioventricular (AV) and ventricular-to-ventricular (VV) programming and their associated outcomes in patients with de novo CRT from 2009-2010. Outcomes included arrhythmia burden, left ventricular (LV) pacing, and all-cause mortality at 4 years. We identified 5709 patients with de novo CRT devices; at the time of implant, 34% (n = 1959) had entirely nominal settings programmed, 40% (n = 2294) had only AV timing adjusted, 11% (n = 604) had only VV timing adjusted, and 15% (n = 852) had both AV and VV adjusted from nominal programming. Suboptimal LV pacing (<95%) during follow-up was similar across groups; however, the proportion with atrial fibrillation (AF) burden >5% was lowest in the AV-only adjusted group (17.9%) and highest in the nominal (27.7%) and VV-only adjusted (28.3%) groups. Adjusted all-cause mortality was significantly higher among patients with non-nominal AV delay >120 vs. <120 ms (adjusted heart rate (HR) 1.28, p = 0.008) but similar when using the 180-ms cutoff (adjusted HR 1.13 for >180 vs. ≤180 ms, p = 0.4). Nominal settings for de novo CRT implants are frequently altered, most commonly the AV delay. There is wide variability in reprogramming. Patients with nominal or AV-only adjustments appear to have favorable pacing and arrhythmia outcomes. Sensed AV delays less than 120 ms are associated with improved survival.

Cognitive-Behavioral-Based Physical Therapy for Patients With Chronic Pain Undergoing Lumbar Spine Surgery: A Randomized Controlled Trial.

PubMed

Archer, Kristin R; Devin, Clinton J; Vanston, Susan W; Koyama, Tatsuki; Phillips, Sharon E; George, Steven Z; McGirt, Matthew J; Spengler, Dan M; Aaronson, Oran S; Cheng, Joseph S; Wegener, Stephen T

2016-01-01

The purpose of this study was to determine the efficacy of a cognitive-behavioral-based physical therapy (CBPT) program for improving outcomes in patients after lumbar spine surgery. A randomized controlled trial was conducted on 86 adults undergoing a laminectomy with or without arthrodesis for a lumbar degenerative condition. Patients were screened preoperatively for high fear of movement using the Tampa Scale for Kinesiophobia. Randomization to either CBPT or an education program occurred at 6 weeks after surgery. Assessments were completed pretreatment, posttreatment and at 3-month follow-up. The primary outcomes were pain and disability measured by the Brief Pain Inventory and Oswestry Disability Index. Secondary outcomes included general health (SF-12) and performance-based tests (5-Chair Stand, Timed Up and Go, 10-Meter Walk). Multivariable linear regression analyses found that CBPT participants had significantly greater decreases in pain and disability and increases in general health and physical performance compared with the education group at the 3-month follow-up. Results suggest a targeted CBPT program may result in significant and clinically meaningful improvement in postoperative outcomes. CBPT has the potential to be an evidence-based program that clinicians can recommend for patients at risk for poor recovery after spine surgery. This study investigated a targeted cognitive-behavioral-based physical therapy program for patients after lumbar spine surgery. Findings lend support to the hypothesis that incorporating cognitive-behavioral strategies into postoperative physical therapy may address psychosocial risk factors and improve pain, disability, general health, and physical performance outcomes. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

Scaling Up a Water, Sanitation, and Hygiene Program in Rural Bangladesh: The Role of Program Implementation.

PubMed

Benjamin-Chung, Jade; Sultana, Sonia; Halder, Amal K; Ahsan, Mohammed Ali; Arnold, Benjamin F; Hubbard, Alan E; Unicomb, Leanne; Luby, Stephen P; Colford, John M

2017-05-01

To evaluate whether the quality of implementation of a water, sanitation, and hygiene program called SHEWA-B and delivered by UNICEF to 20 million people in rural Bangladesh was associated with health behaviors and sanitation infrastructure access. We surveyed 33 027 households targeted by SHEWA-B and 1110 SHEWA-B hygiene promoters in 2011 and 2012. We developed an implementation quality index and compared the probability of health behaviors and sanitation infrastructure access in counterfactual scenarios over the range of implementation quality. Forty-seven percent of households (n = 14 622) had met a SHEWA-B hygiene promoter, and 47% of hygiene promoters (n = 527) could recall all key program messages. The frequency of hygiene promoter visits was not associated with improved outcomes. Higher implementation quality was not associated with better health behaviors or infrastructure access. Outcomes differed by only 1% to 3% in scenarios in which all clusters received low versus high implementation quality. SHEWA-B did not meet UNICEF's ideal implementation quality in any area. Improved implementation quality would have resulted in marginal changes in health behaviors or infrastructure access. This suggests that SHEWA-B's design was suboptimal for improving these outcomes.

The Cascading Effects of Multiple Dimensions of Implementation on Program Outcomes: a Test of a Theoretical Model.

PubMed

Berkel, Cady; Mauricio, Anne M; Sandler, Irwin N; Wolchik, Sharlene A; Gallo, Carlos G; Brown, C Hendricks

2017-12-14

This study tests a theoretical cascade model in which multiple dimensions of facilitator delivery predict indicators of participant responsiveness, which in turn lead to improvements in targeted program outcomes. An effectiveness trial of the 10-session New Beginnings Program for divorcing families was implemented in partnership with four county-level family courts. This study included 366 families assigned to the intervention condition who attended at least one session. Independent observers provided ratings of program delivery (i.e., fidelity to the curriculum and process quality). Facilitators reported on parent attendance and parents' competence in home practice of program skills. At pretest and posttest, children reported on parenting and parents reported child mental health. We hypothesized effects of quality on attendance, fidelity and attendance on home practice, and home practice on improvements in parenting and child mental health. Structural Equation Modeling with mediation and moderation analyses were used to test these associations. Results indicated quality was significantly associated with attendance, and attendance moderated the effect of fidelity on home practice. Home practice was a significant mediator of the links between fidelity and improvements in parent-child relationship quality and child externalizing and internalizing problems. Findings provide support for fidelity to the curriculum, process quality, attendance, and home practice as valid predictors of program outcomes for mothers and fathers. Future directions for assessing implementation in community settings are discussed.

Getting to Outcomes: A Best Practice Process to Help Schools Achieve Desired Outcomes

ERIC Educational Resources Information Center

Maras, Melissa A.; Wandersman, Abe; Splett, Joni Williams; Flaspohler, Paul; Weist, Mark

2012-01-01

This article describes Getting to Outcomes (GTO), a 10-step framework for accountability designed to facilitate effective implementation of evidence-based programs and improvement of home-grown practices (Getting to Outcomes and GTO are trademarks registered by the University of South Carolina and RAND; Wandersman, Imm, Chinman, & Kaftarian,…

Understanding Effective Program Improvement Schools through a Distributed Leadership Task Context Model

ERIC Educational Resources Information Center

Gipson, Frances Marie

2012-01-01

Federal, state, and local agencies face challenges organizing resources that create the conditions necessary to create, sustain, and replicate effective high performing schools. Knowing that leadership does impact achievement outcomes and that school districts tackle growing numbers of sanctioned Program Improvement schools, a distributed…

An Improved Database System for Program Assessment

ERIC Educational Resources Information Center

Haga, Wayne; Morris, Gerard; Morrell, Joseph S.

2011-01-01

This research paper presents a database management system for tracking course assessment data and reporting related outcomes for program assessment. It improves on a database system previously presented by the authors and in use for two years. The database system presented is specific to assessment for ABET (Accreditation Board for Engineering and…

Creating a learning healthcare system in surgery: Washington State’s Surgical Care and Outcomes Assessment Program (SCOAP) at 5 years

PubMed Central

Kwon, Steve; Florence, Michael; Grigas, Peter; Horton, Marc; Horvath, Karen; Johnson, Morrie; Jurkovich, Gregory; Klamp, Wendy; Peterson, Kristin; Quigley, Terence; Raum, William; Rogers, Terry; Thirlby, Richard; Farrokhi, Ellen T.; Flum, David R.

2014-01-01

There are increasing efforts towards improving the quality and safety of surgical care while decreasing the costs. In Washington state, there has been a regional and unique approach to surgical quality improvement. The development of the Surgical Care and Outcomes Assessment Program (SCOAP) was first described 5 years ago. SCOAP is a peer-to-peer collaborative that engages surgeons to determine the many process of care metrics that go into a “perfect” operation, track on risk adjusted outcomes that are specific to a given operation, and create interventions to correct under performance in both the use of these process measures and outcomes. SCOAP is a thematic departure from report card oriented QI. SCOAP builds off the collaboration and trust of the surgical community and strives for quality improvement by having peers change behaviors of one another. We provide, here, the progress of the SCOAP initiative and highlight its achievements and challenges. PMID:22129638

Technical Assistance and Changes in Nutrition and Physical Activity Practices in the National Early Care and Education Learning Collaboratives Project, 2015–2016

PubMed Central

Smith, Teresa M.; Estabrooks, Paul A.; Rasmussen, Cristy Geno; Blaser, Casey; Yaroch, Amy L

2018-01-01

Purpose and Objectives The National Early Care and Education Learning Collaboratives Project (ECELC) aims to improve best practices in early care and education (ECE) programs in topic areas of the Nutrition and Physical Activity Self-Assessment in Child Care (NAP SACC). Technical assistance is a component of the ECELC, yet its effect on outcomes is unclear. Beyond dose and duration of technical assistance, limited research exists on characteristics of technical assistance that contribute to outcomes. The objective of this study was to identify and describe technical assistance characteristics and explore associations with NAP SACC outcomes. Intervention Approach We collected data from 10 collaboratives comprising 84 ECE programs in 2 states in 2015–2016. The objective of technical assistance was to support programs in improving best practices. Technical assistance was provided to programs via on-site, telephone, or email and was tailored to program needs. Evaluation Methods We used a mixed-methods design to examine associations between technical assistance and NAP SACC outcomes. We used multiple regression analysis to assess quantitative data and qualitative comparative analysis to determine necessary and sufficient technical assistance conditions supporting NAP SACC outcomes. We also conducted a document review to describe technical assistance that referred conditions identified by the qualitative comparative analysis. Results Regression analyses detected an inverse relationship between changes in NAP SACC scores and hours of technical assistance. No clear pattern emerged in the qualitative comparative analysis, leaving no necessary and sufficient conditions. However, the qualitative comparative analysis identified feedback as a potentially important component of technical assistance, whereas resource sharing and frequent email were characteristics that seemed to reduce the likelihood of improved outcomes. Email and resource sharing were considered primarily general information rather than tailored technical assistance. Implications for Public Health Technical assistance may be used in programs and made adaptable to program needs. The inclusion and evaluation of technical assistance, especially tailored approaches, is warranted for environmental interventions, including ECE settings. PMID:29704371

Improving Accreditor's Evaluation of Experiential Learning Programs.

ERIC Educational Resources Information Center

Keeton, Morris T.

1980-01-01

Principles of good practice in assessing experiential learning include better self-evaluation of the learning outcomes of experiential components, systematic program auditing, and training of external evaluators. (SK)

20 CFR 632.70 - Waiver of regulations under Parts 632 and 636.

Code of Federal Regulations, 2010 CFR

2010-04-01

...; promoting coordination of JTPA programs with other human resources programs; or substantially improving the job placement outcomes of the JTPA program. (2) The request shall describe the regulatory requirements... INDIAN AND NATIVE AMERICAN EMPLOYMENT AND TRAINING PROGRAMS Program Design and Management § 632.70 Waiver...

A trauma outreach program provided by a level I trauma center is an effective way to initiate peer review at referring hospitals and foster process improvements.

PubMed

Byrnes, Matthew C; Irwin, Eric; Becker, Leslie; Thorson, Melissa; Beilman, Greg; Horst, Patrick; Croston, Kevin

2010-04-01

The initial care of critically injured patients has profound effects on ultimate outcomes. The "golden hour" of trauma care is often provided by rural hospitals before definitive transfer. There are, however, no standardized methods for providing educational feedback to these hospitals for the purposes of performance improvement. We hypothesized that an outreach program would stimulate peer review and identify systematic deficiencies in the care of patients with injuries. We developed a quality improvement program aimed at providing educational feedback to hospitals that referred patients to our American College of Surgeons-verified level I trauma center. We traveled to each referral center to provide feedback on the initial treatment and ultimate outcome of patients that were transferred to us. These feedback sessions were presented in the format of case presentations and case discussions. The outreach program was presented at each hospital every 3 months to 6 months. Nine hospitals were included in our program. We received 334 patients in transfer from these hospitals during the study period. Formal peer review that focused on trauma patients increased from 14% of hospitals to 100% of hospitals after institution of the program. Eighty-five percent of hospitals thought that the care of patients with injuries was improved as a result of the program. Eighty-five percent of hospitals developed process improvement initiatives as a result of the program. A formal outreach program can stimulate peer review at rural hospitals, provide continuing education in the care of patients with injuries, and foster process improvements at referring hospitals.

The Productive Ward Program™: A Two-Year Implementation Impact Review Using a Longitudinal Multilevel Study.

PubMed

Van Bogaert, Peter; Van Heusden, Danny; Verspuy, Martijn; Wouters, Kristien; Slootmans, Stijn; Van der Straeten, Johnny; Van Aken, Paul; White, Mark

2017-03-01

Aim To investigate the impact of the quality improvement program "Productive Ward - Releasing Time to Care™" using nurses' and midwives' reports of practice environment, burnout, quality of care, job outcomes, as well as workload, decision latitude, social capital, and engagement. Background Despite the requirement for health systems to improve quality and the proliferation of quality improvement programs designed for healthcare, the empirical evidence supporting large-scale quality improvement programs impacting patient satisfaction, staff engagement, and quality care remains sparse. Method A longitudinal study was performed in a large 600-bed acute care university hospital at two measurement intervals for nurse practice environment, burnout, and quality of care and job outcomes and three measurement intervals for workload, decision latitude, social capital, and engagement between June 2011 and November 2014. Results Positive results were identified in practice environment, decision latitude, and social capital. Less favorable results were identified in relation to perceived workload, emotional exhaustion. and vigor. Moreover, measures of quality of care and job satisfaction were reported less favorably. Conclusion This study highlights the need to further understand how to implement large-scale quality improvement programs so that they integrate with daily practices and promote "quality improvement" as "business as usual."

Resilience Training for Work-related Stress Among Health Care Workers: Results of a Randomized Clinical Trial Comparing In-person and Smartphone-delivered Interventions.

PubMed

Mistretta, Erin G; Davis, Mary C; Temkit, M'hamed; Lorenz, Christopher; Darby, Betty; Stonnington, Cynthia M

2018-01-24

The aim of this study was to assess whether an in-person mindfulness-based resilience training (MBRT) program or a smartphone-delivered resiliency-based intervention improved stress, well-being, and burnout in employees at a major tertiary health care institution. Sixty participants were randomized to a 6-week MBRT, a resiliency-based smartphone intervention, or an active control group. Stress, well-being, and burnout were assessed at baseline, at program completion, and 3 months postintervention. Both the MBRT and the smartphone groups showed improvements in well-being, whereas only the MBRT group showed improvements in stress and emotional burnout over time. The control group did not demonstrate sustained improvement on any outcome. Findings suggest that brief, targeted interventions improve psychological outcomes and point to the need for larger scale studies comparing the individual and combined treatments that can inform development of tailored, effective, and low-cost programs for health care workers.

The Utah Remote Monitoring Project: improving health care one patient at a time.

PubMed

Shane-McWhorter, Laura; Lenert, Leslie; Petersen, Marta; Woolsey, Sarah; McAdam-Marx, Carrie; Coursey, Jeffrey M; Whittaker, Thomas C; Hyer, Christian; LaMarche, Deb; Carroll, Patricia; Chuy, Libbey

2014-10-01

The expanding role of technology to augment diabetes care and management highlights the need for clinicians to learn about these new tools. As these tools continue to evolve and enhance improved outcomes, it is imperative that clinicians consider the role of telemonitoring, or remote monitoring, in patient care. This article describes a successful telemonitoring project in Utah. This was a nonrandomized prospective observational preintervention-postintervention study, using a convenience sample. Patients with uncontrolled diabetes and/or hypertension from four rural and two urban primary care clinics and one urban stroke center participated in a telemonitoring program. The primary clinical outcome measures were changes in hemoglobin A1C (A1C) and blood pressure. Other outcomes included fasting lipids, weight, patient engagement, diabetes knowledge, hypertension knowledge, medication adherence, and patient perceptions of the usefulness of the telemonitoring program. Mean A1C decreased from 9.73% at baseline to 7.81% at the end of the program (P<0.0001). Systolic blood pressure also declined significantly, from 130.7 mm Hg at baseline to 122.9 mm Hg at the end (P=0.0001). Low-density lipoprotein content decreased significantly, from 103.9 mg/dL at baseline to 93.7 mg/dL at the end (P=0.0263). Other clinical parameters improved nonsignificantly. Knowledge of diabetes and hypertension increased significantly (P<0.001 for both). Patient engagement and medication adherence also improved, but not significantly. Per questionnaires at study end, patients felt the telemonitoring program was useful. Telemonitoring improved clinical outcomes and may be a useful tool to help enhance disease management and care of patients with diabetes and/or hypertension.

Factors influencing job satisfaction of new graduate nurses participating in nurse residency programs: a systematic review.

PubMed

Lin, Patrice S; Viscardi, Molly Kreider; McHugh, Matthew D

2014-10-01

Nurse residency programs are designed to increase competence and skill, and ease the transition from student to new graduate nurse. These programs also offer the possibility to positively influence the job satisfaction of new graduate nurses, which could decrease poor nursing outcomes. However, little is known about the impact of participation in a nurse residency program on new graduate nurses' satisfaction. This review examines factors that influence job satisfaction of nurse residency program participants. Eleven studies were selected for inclusion, and seven domains influencing new graduate nurses' satisfaction during participation in nurse residency programs were identified: extrinsic rewards, scheduling, interactions and support, praise and recognition, professional opportunities, work environment, and hospital system. Within these domains, the evidence for improved satisfaction with nurse residency program participation was mixed. Further research is necessary to understand how nurse residency programs can be designed to improve satisfaction and increase positive nurse outcomes. Copyright 2014, SLACK Incorporated.

Feasibility and Preliminary Outcomes From a Pilot Study of an Integrated Health-Mental Health Promotion Program in School Mental Health Services

PubMed Central

George, Melissa W.; Trumpeter, Nevelyn N.; Wilson, Dawn K.; McDaniel, Heather L.; Schiele, Bryn; Prinz, Ron; Weist, Mark D.

2014-01-01

The prevalence of unmet health and mental health needs among youth has spurred the growing consensus to develop strategies that integrate services to promote overall well-being. This pilot study reports on the feasibility and outcomes of a theory-driven, family-focused, integrated health-mental health promotion program for underserved adolescents receiving school mental health services. Parent and adolescent assessments conducted prior to and following the brief, 6-session promotion program showed significant improvements in family support, youth self-efficacy, health behaviors, and mental health outcomes. Clinician reports contributed to a characterization of the feasibility, acceptability, and future recommendations for the integrated program. PMID:24297005

A mobility program for an inpatient acute care medical unit.

PubMed

Wood, Winnie; Tschannen, Dana; Trotsky, Alyssa; Grunawalt, Julie; Adams, Danyell; Chang, Robert; Kendziora, Sandra; Diccion-MacDonald, Stephanie

2014-10-01

For many patients, hospitalization brings prolonged periods of bed rest, which are associated with such adverse health outcomes as increased length of stay, increased risk of falls, functional decline, and extended-care facility placement. Most studies of progressive or early mobility protocols designed to minimize these adverse effects have been geared toward specific patient populations and conducted by multidisciplinary teams in either ICUs or surgical units. Very few mobility programs have been developed for and implemented on acute care medical units. This evidence-based quality improvement project describes how a mobility program, devised for and put to use on a general medical unit in a large Midwestern academic health care system, improved patient outcomes.

Quality Assurance Through Quality Improvement and Professional Development in the National Breast and Cervical Cancer Early Detection Program

PubMed Central

Siegl, Elvira J.; Miller, Jacqueline W.; Khan, Kris; Harris, Susan E.

2015-01-01

Quality assurance (QA) is the process of providing evidence that the outcome meets the established standards. Quality improvement (QI), by contrast, is the act of methodically developing ways to meet acceptable quality standards and evaluating current processes to improve overall performance. In the case of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), the desired outcome is the delivery of quality health care services to program clients. The NBCCEDP provides professional development to ensure that participating providers have current knowledge of evidence-based clinical standards regarding breast and cervical cancer screening and diagnosis and are monitoring women with abnormal screening results for timely follow-up. To assess the quality of clinical care provided to NBCCEDP clients, performance data are collected by NBCCEDP grantees and compared against predetermined Centers for Disease Control and Prevention (CDC) benchmarks known as Data Quality Indicator Guides. In this article, the authors describe 1) the development and use of indicators for QI in the NBCCEDP and 2) the professional development activities implemented to improve clinical outcomes. QA identifies problems, whereas QI systematically corrects them. The quality of service delivery and improved patient outcomes among NBCCEDP grantees has enhanced significantly because of continuous monitoring of performance and professional development. By using QA, NBCCEDP grantees can maximize the quality of patient screening, diagnostic services, and follow-up. Examples of grantee activities to maintain quality of care are also described in this report. PMID:25099901

The impact of care management information technology model on quality of care after percutaneous coronary intervention: "Bridging the Divides".

PubMed

Weintraub, William S; Fanari, Zaher; Elliott, Daniel; Ostertag-Stretch, Jennifer; Muther, Ann; Lynahan, Margaret; Kerzner, Roger; Salam, Tabassum; Scherrer, Herbert; Anderson, Sharon; Russo, Carla A; Kolm, Paul; Steinberg, Terri H

2017-07-03

Reducing readmissions and improving metrics of care are a national priority. Supplementing traditional care with care management may improve outcomes. The Bridges program was an initial evaluation of a care management platform (CareLinkHub), supported by information technology (IT) developed to improve the quality and transition of care from hospital to home after percutaneous coronary intervention (PCI) and reduce readmissions. CareLink is comprised of care managers, patient navigators, pharmacists and physicians. Information to guide care management is guided by a middleware layer to gather information, PLR (ColdLight Solutions, LLC) and presented to CareLink staff on a care management platform, Aerial™ (Medecision). An additional analytic engine [Neuron™ (ColdLight Solutions, LLC)] helps, evaluates and guide care. The "Bridges" program enrolled a total of 2054 PCI patients with 2835 admission from April, 1st 2013 through March 1st, 2015. The data of the program was compared with those of 3691 PCI patients with 4414 admissions in the 3years prior to the program. No impact was seen with respect to inpatient and observation readmission, or emergency department visits. Similarly no change was noticed in LDL control. There was minimal improvement in BP control and only in the CTM-3 and SAQ-7 physical limitation scores in the patients' reported outcomes. Patient follow-up with physicians within 1week of discharge improved during the Bridges years. The CareLink hub platform was successfully implemented. Little or no impact on outcome metrics was seen in the short follow-up time. The Bridges program suggests that population health management must be a long-term goal, improving preventive care in the community. Copyright © 2017 Elsevier Inc. All rights reserved.

Health Mentor-Reported Outcomes and Perceptions of Student Team Performance in a Longitudinal Interprofessional Education Program.

PubMed

Umland, Elena; Collins, Lauren; Baronner, Ashley; Lim, Edwin; Giordano, Carolyn

2016-01-01

The need to evaluate the impact of interprofessional education (IPE) on learner outcomes is clear, but assessment of IPE's impact on patient health and well-being is lacking. This mixed-methods study evaluated perspectives of community volunteers, health mentors (HMs) who have at least one chronic condition, who participated in an IPE curriculum. In May 2014, 93 HMs concluding the Health Mentors Program completed a survey evaluating their student teams according to the Interprofessional Education Collaborative core competencies' four domains and program impact on health/wellbeing using a 4-point Likert scale (1=strongly disagree; 4=strongly agree). The average response to statements regarding the four domains of values/ethics, roles/responsibilities, communication, and teamwork statements were all >3.0. HMs rated program satisfaction on a 10-point scale (1=least satisfied, 10=most satisfied) and answered open-ended outcome questions. The average program satisfaction score was 9.13±1.43; increased motivation to make and maintain healthy behaviors was reported. In a follow-up focus group with 10 mentors, high satisfaction levels from working with interprofessional student teams were reported, and substantial improvements in managing health conditions and improving overall health status were relayed. Further studies will determine if the patient-reported outcomes of the mentors correlate with objective health measures.

Efficacy of a biomechanically-based yoga exercise program in knee osteoarthritis: A randomized controlled trial.

PubMed

Kuntz, Alexander B; Chopp-Hurley, Jaclyn N; Brenneman, Elora C; Karampatos, Sarah; Wiebenga, Emily G; Adachi, Jonathan D; Noseworthy, Michael D; Maly, Monica R

2018-01-01

Certain exercises could overload the osteoarthritic knee. We developed an exercise program from yoga postures with a minimal knee adduction moment for knee osteoarthritis. The purpose was to compare the effectiveness of this biomechanically-based yoga exercise (YE), with traditional exercise (TE), and a no-exercise attention-equivalent control (NE) for improving pain, self-reported physical function and mobility performance in women with knee osteoarthritis. Single-blind, three-arm randomized controlled trial. Community in Southwestern Ontario, Canada. A convenience sample of 31 women with symptomatic knee osteoarthritis was recruited through rheumatology, orthopaedic and physiotherapy clinics, newspapers and word-of-mouth. Participants were stratified by disease severity and randomly allocated to one of three 12-week, supervised interventions. YE included biomechanically-based yoga exercises; TE included traditional leg strengthening on machines; and NE included meditation with no exercise. Participants were asked to attend three 1-hour group classes/sessions each week. Primary outcomes were pain, self-reported physical function and mobility performance. Secondary outcomes were knee strength, depression, and health-related quality of life. All were assessed by a blinded assessor at baseline and immediately following the intervention. The YE group demonstrated greater improvements in KOOS pain (mean difference of 22.9 [95% CI, 6.9 to 38.8; p = 0.003]), intermittent pain (mean difference of -19.6 [95% CI, -34.8 to -4.4; p = 0.009]) and self-reported physical function (mean difference of 17.2 [95% CI, 5.2 to 29.2; p = 0.003]) compared to NE. Improvements in these outcomes were similar between YE and TE. However, TE demonstrated a greater improvement in knee flexor strength compared to YE (mean difference of 0.1 [95% CI, 0.1 to 0.2]. Improvements from baseline to follow-up were present in quality of life score for YE and knee flexor strength for TE, while both also demonstrated improvements in mobility. No improvement in any outcome was present in NE. The biomechanically-based yoga exercise program produced clinically meaningful improvements in pain, self-reported physical function and mobility in women with clinical knee OA compared to no exercise. While not statistically significant, improvements in these outcomes were larger than those elicited from the traditional exercise-based program. Though this may suggest that the yoga program may be more efficacious for knee OA, future research studying a larger sample is required. ClinicalTrials.gov (NCT02370667).

Efficacy of a biomechanically-based yoga exercise program in knee osteoarthritis: A randomized controlled trial

PubMed Central

Kuntz, Alexander B.; Chopp-Hurley, Jaclyn N.; Brenneman, Elora C.; Karampatos, Sarah; Wiebenga, Emily G.; Adachi, Jonathan D.; Noseworthy, Michael D.

2018-01-01

Objective Certain exercises could overload the osteoarthritic knee. We developed an exercise program from yoga postures with a minimal knee adduction moment for knee osteoarthritis. The purpose was to compare the effectiveness of this biomechanically-based yoga exercise (YE), with traditional exercise (TE), and a no-exercise attention-equivalent control (NE) for improving pain, self-reported physical function and mobility performance in women with knee osteoarthritis. Design Single-blind, three-arm randomized controlled trial. Setting Community in Southwestern Ontario, Canada. Participants A convenience sample of 31 women with symptomatic knee osteoarthritis was recruited through rheumatology, orthopaedic and physiotherapy clinics, newspapers and word-of-mouth. Interventions Participants were stratified by disease severity and randomly allocated to one of three 12-week, supervised interventions. YE included biomechanically-based yoga exercises; TE included traditional leg strengthening on machines; and NE included meditation with no exercise. Participants were asked to attend three 1-hour group classes/sessions each week. Measurements Primary outcomes were pain, self-reported physical function and mobility performance. Secondary outcomes were knee strength, depression, and health-related quality of life. All were assessed by a blinded assessor at baseline and immediately following the intervention. Results The YE group demonstrated greater improvements in KOOS pain (mean difference of 22.9 [95% CI, 6.9 to 38.8; p = 0.003]), intermittent pain (mean difference of -19.6 [95% CI, -34.8 to -4.4; p = 0.009]) and self-reported physical function (mean difference of 17.2 [95% CI, 5.2 to 29.2; p = 0.003]) compared to NE. Improvements in these outcomes were similar between YE and TE. However, TE demonstrated a greater improvement in knee flexor strength compared to YE (mean difference of 0.1 [95% CI, 0.1 to 0.2]. Improvements from baseline to follow-up were present in quality of life score for YE and knee flexor strength for TE, while both also demonstrated improvements in mobility. No improvement in any outcome was present in NE. Conclusions The biomechanically-based yoga exercise program produced clinically meaningful improvements in pain, self-reported physical function and mobility in women with clinical knee OA compared to no exercise. While not statistically significant, improvements in these outcomes were larger than those elicited from the traditional exercise-based program. Though this may suggest that the yoga program may be more efficacious for knee OA, future research studying a larger sample is required. Trial registration ClinicalTrials.gov (NCT02370667) PMID:29664955

ENVIRONMENTAL TECHNOLOGY VERIFICATION (ETV) PROGRAM CASE STUDIES: DEMONSTRATING PROGRAM OUTCOMES

EPA Science Inventory

The U.S. Environmental Protection Agency (EPA) Environmental Technology Verification (ETV) Program evaluates the performance of innovative air, water, pollution prevention and monitoring technologies that have the potential to improve human health and the environment. This bookle...

The implementation of a community-based aerobic walking program for mild to moderate knee osteoarthritis: A knowledge translation randomized controlled trial: Part II: Clinical outcomes

PubMed Central

2012-01-01

Background Osteoarthritis (OA) is the most common joint disorder in the world, as it is appears to be prevalent among 80% of individuals over the age of 75. Although physical activities such as walking have been scientifically proven to improve physical function and arthritic symptoms, individuals with OA tend to adopt a sedentary lifestyle. There is therefore a need to improve knowledge translation in order to influence individuals to adopt effective self-management interventions, such as an adapted walking program. Methods A single-blind, randomized control trial was conducted. Subjects (n = 222) were randomized to one of three knowledge translation groups: 1) Walking and Behavioural intervention (WB) (18 males, 57 females) which included the supervised community-based aerobic walking program combined with a behavioural intervention and an educational pamphlet on the benefits of walking; 2) Walking intervention (W) (24 males, 57 females) wherein participants only received the supervised community-based aerobic walking program intervention and the educational pamphlet; 3) Self-directed control (C) (32 males, 52 females) wherein participants only received the educational pamphlet. One-way analyses of variance were used to test for differences in quality of life, adherence, confidence, and clinical outcomes among the study groups at each 3 month assessment during the 12-month intervention period and 6-month follow-up period. Results The clinical and quality of life outcomes improved among participants in each of the three comparative groups. However, there were few statistically significant differences observed for quality of life and clinical outcomes at long-term measurements at 12-months end of intervention and at 6- months post intervention (18-month follow-up). Outcome results varied among the three groups. Conclusion The three groups were equivalent when determining the effectiveness of knowledge uptake and improvements in quality of life and other clinical outcomes. OA can be managed through the implementation of a proven effective walking program in existing community-based walking clubs. Trial registration Current Controlled Trials IRSCTNO9193542 PMID:23234575

Can outcome-based continuing medical education improve performance of immigrant physicians?

PubMed

Castel, Orit Cohen; Ezra, Vered; Alperin, Mordechai; Nave, Rachel; Porat, Tamar; Golan, Avivit Cohen; Vinker, Shlomo; Karkabi, Khaled

2011-01-01

Immigrant physicians are a valued resource for physician workforces in many countries. Few studies have explored the education and training needs of immigrant physicians and ways to facilitate their integration into the health care system in which they work. Using an educational program developed for immigrant civilian physicians working in military primary care clinics at the Israel Defence Force, we illustrate how an outcome-based CME program can address practicing physicians' needs for military-specific primary care education and improve patient care. Following an extensive needs assessment, a 3-year curriculum was developed. The curriculum was delivered by a multidisciplinary educational team. Pre/post multiple-choice examinations, objective structured clinical examinations (OSCE), and end-of-program evaluations were administered for curriculum evaluation. To evaluate change in learners' performance, data from the 2003 (before-program) and 2006 (after-program) work-based assessments were retrieved retrospectively. Change in the performance of program participants was compared with that of immigrant physicians who did not participate in the program. Out of 28 learners, 23 (82%) completed the program. Learners did significantly better in the annual post-tests compared with the pretests (p <.01) and improved their OSCE scores (p <.001). Most program graduates (90%) rated overall satisfaction as very good or excellent. In comparison with nonparticipants, program graduates performed better on work-based assessments (Cohen's d =.63). Our intensive, outcome-based, longitudinal CME program has yielded encouraging results. Other medical educators, facing the challenge of integrating immigrant physicians to fit their health care system, may consider adapting our approach. Copyright © 2011 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

The Case for Diabetes Population Health Improvement: Evidence-Based Programming for Population Outcomes in Diabetes.

PubMed

Golden, Sherita Hill; Maruthur, Nisa; Mathioudakis, Nestoras; Spanakis, Elias; Rubin, Daniel; Zilbermint, Mihail; Hill-Briggs, Felicia

2017-07-01

The goal of this review is to describe diabetes within a population health improvement framework and to review the evidence for a diabetes population health continuum of intervention approaches, including diabetes prevention and chronic and acute diabetes management, to improve clinical and economic outcomes. Recent studies have shown that compared to usual care, lifestyle interventions in prediabetes lower diabetes risk at the population-level and that group-based programs have low incremental medial cost effectiveness ratio for health systems. Effective outpatient interventions that improve diabetes control and process outcomes are multi-level, targeting the patient, provider, and healthcare system simultaneously and integrate community health workers as a liaison between the patient and community-based healthcare resources. A multi-faceted approach to diabetes management is also effective in the inpatient setting. Interventions shown to promote safe and effective glycemic control and use of evidence-based glucose management practices include provider reminder and clinical decision support systems, automated computer order entry, provider education, and organizational change. Future studies should examine the cost-effectiveness of multi-faceted outpatient and inpatient diabetes management programs to determine the best financial models for incorporating them into diabetes population health strategies.

Equity monitoring for social marketing: use of wealth quintiles and the concentration index for decision making in HIV prevention, family planning, and malaria programs.

PubMed

Chakraborty, Nirali M; Firestone, Rebecca; Bellows, Nicole

2013-01-01

The majority of social marketing programs are intended to reach the poor. It is therefore essential that social marketing organizations monitor the health equity of their programs and improve targeting when the poor are not being reached. Current measurement approaches are often insufficient for decision making because they fail to show a program's ability to reach the poor and demonstrate progress over time. Further, effective program equity metrics should be benchmarked against a national reference population and consider exposure, not just health outcomes, to measure direct results of implementation. This study compares two measures of health equity, concentration indices and wealth quintiles, using a defined reference population, and considers benefits of both measures together to inform programmatic decision making. Three datasets from recent cross-sectional behavioral surveys on malaria, HIV, and family planning from Nepal and Burkina Faso were used to calculate concentration indices and wealth quintiles. Each sample was standardized to national wealth distributions based on recent Demographic and Health Surveys. Wealth quintiles were generated and concentration indices calculated for health outcomes and program exposure in each sample. Chi-square and t-tests were used to assess statistical significance of results. Reporting wealth quintiles showed that recipients of Population Services International (PSI) interventions were wealthier than national populations. Both measures indicated that desirable health outcomes were usually concentrated among wealthier populations. Positive and significant concentration indices in all three surveys indicated that wealth and program exposure were correlated; however this relationship was not necessarily linear. In analyzing the equity of modern contraceptive use stratified by exposure to family planning messages in Nepal, the outcome was equitable (concentration index = 0.006, p = 0.68) among the exposed, while the wealthy were more likely to use modern contraceptives (concentration index = 0.071, p < 0.01) among the unexposed. Using wealth quintiles and concentration indices together for equity monitoring improves usability of findings for decision making. Applying both metrics, and analyzing equity of exposure along with health outcomes, provides results that have statistical and programmatic significance. Benchmarking equity data against national data improves generalizability. This approach benefits social marketers and global health implementers to improve strategic decision making and programs' ability to reach the poor.

Equity monitoring for social marketing: use of wealth quintiles and the concentration index for decision making in HIV prevention, family planning, and malaria programs

PubMed Central

2013-01-01

Background The majority of social marketing programs are intended to reach the poor. It is therefore essential that social marketing organizations monitor the health equity of their programs and improve targeting when the poor are not being reached. Current measurement approaches are often insufficient for decision making because they fail to show a program's ability to reach the poor and demonstrate progress over time. Further, effective program equity metrics should be benchmarked against a national reference population and consider exposure, not just health outcomes, to measure direct results of implementation. This study compares two measures of health equity, concentration indices and wealth quintiles, using a defined reference population, and considers benefits of both measures together to inform programmatic decision making. Methods Three datasets from recent cross-sectional behavioral surveys on malaria, HIV, and family planning from Nepal and Burkina Faso were used to calculate concentration indices and wealth quintiles. Each sample was standardized to national wealth distributions based on recent Demographic and Health Surveys. Wealth quintiles were generated and concentration indices calculated for health outcomes and program exposure in each sample. Chi-square and t-tests were used to assess statistical significance of results. Results Reporting wealth quintiles showed that recipients of Population Services International (PSI) interventions were wealthier than national populations. Both measures indicated that desirable health outcomes were usually concentrated among wealthier populations. Positive and significant concentration indices in all three surveys indicated that wealth and program exposure were correlated; however this relationship was not necessarily linear. In analyzing the equity of modern contraceptive use stratified by exposure to family planning messages in Nepal, the outcome was equitable (concentration index = 0.006, p = 0.68) among the exposed, while the wealthy were more likely to use modern contraceptives (concentration index = 0.071, p < 0.01) among the unexposed. Conclusions Using wealth quintiles and concentration indices together for equity monitoring improves usability of findings for decision making. Applying both metrics, and analyzing equity of exposure along with health outcomes, provides results that have statistical and programmatic significance. Benchmarking equity data against national data improves generalizability. This approach benefits social marketers and global health implementers to improve strategic decision making and programs' ability to reach the poor. PMID:23902715

Improving patients' home cooking - A case series of participation in a remote culinary coaching program.

PubMed

Polak, Rani; Pober, David M; Budd, Maggi A; Silver, Julie K; Phillips, Edward M; Abrahamson, Martin J

2017-08-01

This case series describes and examines the outcomes of a remote culinary coaching program aimed at improving nutrition through home cooking. Participants (n = 4) improved attitudes about the perceived ease of home cooking (p < 0.01) and self-efficacy to perform various culinary skills (p = 0.02); and also improved in confidence to continue online learning of culinary skills and consume healthier food. We believe this program might be a viable response to the need for effective and scalable health-related culinary interventions.

Food subsidy programs and the health and nutritional status of disadvantaged families in high income countries: a systematic review

PubMed Central

2012-01-01

Background Less healthy diets are common in high income countries, although proportionally higher in those of low socio-economic status. Food subsidy programs are one strategy to promote healthy nutrition and to reduce socio-economic inequalities in health. This review summarises the evidence for the health and nutritional impacts of food subsidy programs among disadvantaged families from high income countries. Methods Relevant studies reporting dietary intake or health outcomes were identified through systematic searching of electronic databases. Cochrane Public Health Group guidelines informed study selection and interpretation. A narrative synthesis was undertaken due to the limited number of studies and heterogeneity of study design and outcomes. Results Fourteen studies were included, with most reporting on the Special Supplemental Nutrition Program for Women, Infants and Children in the USA. Food subsidy program participants, mostly pregnant or postnatal women, were shown to have 10–20% increased intake of targeted foods or nutrients. Evidence for the effectiveness of these programs for men or children was lacking. The main health outcome observed was a small but clinically relevant increase in mean birthweight (23–29g) in the two higher quality WIC studies. Conclusions Limited high quality evidence of the impacts of food subsidy programs on the health and nutrition of adults and children in high income countries was identified. The improved intake of targeted nutrients and foods, such as fruit and vegetables, could potentially reduce the rate of non-communicable diseases in adults, if the changes in diet are sustained. Associated improvements in perinatal outcomes were limited and most evident in women who smoked during pregnancy. Thus, food subsidy programs for pregnant women and children should aim to focus on improving nutritional status in the longer term. Further prospective studies and economic analyses are needed to confirm the health benefits and justify the investment in food subsidy programs. PMID:23256601

Food subsidy programs and the health and nutritional status of disadvantaged families in high income countries: a systematic review.

PubMed

Black, Andrew P; Brimblecombe, Julie; Eyles, Helen; Morris, Peter; Vally, Hassan; O Dea, Kerin

2012-12-21

Less healthy diets are common in high income countries, although proportionally higher in those of low socio-economic status. Food subsidy programs are one strategy to promote healthy nutrition and to reduce socio-economic inequalities in health. This review summarises the evidence for the health and nutritional impacts of food subsidy programs among disadvantaged families from high income countries. Relevant studies reporting dietary intake or health outcomes were identified through systematic searching of electronic databases. Cochrane Public Health Group guidelines informed study selection and interpretation. A narrative synthesis was undertaken due to the limited number of studies and heterogeneity of study design and outcomes. Fourteen studies were included, with most reporting on the Special Supplemental Nutrition Program for Women, Infants and Children in the USA. Food subsidy program participants, mostly pregnant or postnatal women, were shown to have 10-20% increased intake of targeted foods or nutrients. Evidence for the effectiveness of these programs for men or children was lacking. The main health outcome observed was a small but clinically relevant increase in mean birthweight (23-29g) in the two higher quality WIC studies. Limited high quality evidence of the impacts of food subsidy programs on the health and nutrition of adults and children in high income countries was identified. The improved intake of targeted nutrients and foods, such as fruit and vegetables, could potentially reduce the rate of non-communicable diseases in adults, if the changes in diet are sustained. Associated improvements in perinatal outcomes were limited and most evident in women who smoked during pregnancy. Thus, food subsidy programs for pregnant women and children should aim to focus on improving nutritional status in the longer term. Further prospective studies and economic analyses are needed to confirm the health benefits and justify the investment in food subsidy programs.

Intervening with practitioners to improve the quality of prevention: One year findings from a randomized trial of Assets-Getting To Outcomes

PubMed Central

Chinman, Matthew; Acosta, Joie; Ebener, Patricia; Burkhart, Q; Malone, Patrick; Paddock, Susan M.; Clifford, Michael; Corsello, Maryann; Duffy, Tim; Hunter, Sarah; Jones, Margaret; Lahti, Michel; Phillips, Andrea; Savell, Susan; Scales, Peter C.; Tellett-Royce, Nancy

2013-01-01

There continues to be a gap in prevention outcomes achieved in research trials vs. “real world” practice. This article summarizes interim findings from a randomized trial testing Assets-Getting To Outcomes (AGTO), a two-year intervention to build prevention practitioners’ capacity to implement positive youth development-oriented prevention practices in 12 prevention coalitions in Maine. A survey of coalition members was used to assess change on individual practitioners’ prevention capacity between Baseline and one year later. Structured interviews with 32 program leaders (16 intervention, 16 control) were used to assess changes in prevention practices during the same time period. Change in prevention capacity over time between intervention and control did not differ, however in secondary analyses of only those assigned to the AGTO condition, AGTO users had evidenced greater improvement in their self-efficacy to conduct Assets-based programming and the frequency with which they engaged in AGTO behaviors. Non-users’ self-efficacy of AGTO declined. Interview ratings showed improvement in several key areas of performance among intervention programs. Improvement was associated with the number of technical assistance hours received. These results suggest that, after one year, AGTO is beginning to improve the capacity of community practitioners who make use of it. PMID:23605473

Evaluation of a therapeutic community treatment program: a long-term follow-up study in Spain.

PubMed

Fernández-Montalvo, Javier; López-Goñi, José J; Illescas, Cristina; Landa, Natalia; Lorea, Iñaki

2008-01-01

The aims of this study is to carry out a long-term follow-up evaluation of a well-established therapeutic community treatment for addictions in Navarre (Spain) and to make a comparison between the program completers and the dropouts, as well as between relapsing and nonrelapsing patients, on a broad set of variables. A long-term follow-up design (mean of 6 years after leaving treatment) was used to analyze the outcomes of the therapeutic program. The sample consisted of 155 subjects (113 completers and 42 dropouts). A personal interview was carried out with each one of the located subjects. The interviews took place between September 2000 and September 2004. Treatment "dropouts" manifested a higher and earlier rate both of relapses, and of new treatments for their drug addiction than the completion group. The program was also effective in reducing criminal behavior and improving the state of health. Significant differences were found across outcome variables when comparison was made between treatment completers and "dropouts." All subjects improved on outcome variables after receiving the treatment. When relapsing and nonrelapsing patients were compared, significant outcome differences were also found between groups. The study's limitations are noted and future needed research is suggested.

Costs and consequences of a cash transfer for hospital births in a rural district of Uttar Pradesh, India.

PubMed

Coffey, Diane

2014-08-01

The Janani Suraksha Yojana, India's "safe motherhood program," is a conditional cash transfer to encourage women to give birth in health facilities. Despite the program's apparent success in increasing facility-based births, quantitative evaluations have not found corresponding improvements in health outcomes. This study analyses original qualitative data collected between January, 2012 and November, 2013 in a rural district in Uttar Pradesh to address the question of why the program has not improved health outcomes. It finds that health service providers are focused on capturing economic rents associated with the program, and provide an extremely poor quality care. Further, the program does not ultimately provide beneficiaries a large net monetary transfer at the time of birth. Based on a detailed accounting of the monetary costs of hospital and home deliveries, this study finds that the value of the transfer to beneficiaries is small due to costs associated with hospital births. Finally, this study also documents important emotional and psychological costs to women of delivering in the hospital. These findings suggest the need for a substantial rethinking of the program, paying careful attention to incentivizing health outcomes. Copyright © 2014 Elsevier Ltd. All rights reserved.

Nurses supporting nurses: creating a mentoring program for staff nurses to improve the workforce environment.

PubMed

Latham, Christine L; Hogan, Mikel; Ringl, Karen

2008-01-01

The hospital workforce environment has been recognized as an important factor for nurse retention and patient safety, yet there is ongoing evidence that inadequate communication, intraprofessional oppression, and lack of collaboration and conflict resolution continue to disempower nurses and hinder improvement of workforce conditions. A 3-year academic-hospital partnership developed and used a registered nurse (RN) mentor and advocacy program to improve the RN work environment and selected patient outcomes. The partnership initiated mentor-mentee teams and a Workforce Environment Governance Board, and obtained preliminary data on outcomes related to mentor-mentee teamwork, changes in the level of support within each unit, and the impact of improved working conditions on nurse and patient satisfaction, nurse vacancy and turnover rates, and 3 patient safety outcomes related to fall and pressure ulcer prevention and use of restraints. Dedicated mentors not only engaged in supporting fellow nurses but also assisted with enhancing the overall work environment for RNs. The partnership enhanced mutual respect between frontline RNs and managers, and allowed frontline RNs to improve the culture of support. The comprehensive approach to incorporating mentor-mentee teams changes the way fellow nurses and others perceive nurses, augments support by managers and coworkers, and improves patient care outcomes.

What works in implementation of integrated care programs for older adults with complex needs? A realist review

PubMed Central

Kirst, Maritt; Im, Jennifer; Burns, Tim; Baker, G. Ross; Goldhar, Jodeme; O'Campo, Patricia; Wojtak, Anne; Wodchis, Walter P

2017-01-01

Abstract Purpose A realist review of the evaluative evidence was conducted on integrated care (IC) programs for older adults to identify key processes that lead to the success or failure of these programs in achieving outcomes such as reduced healthcare utilization, improved patient health, and improved patient and caregiver experience. Data sources International academic literature was searched in 12 indexed, electronic databases and gray literature through internet searches, to identify evaluative studies. Study selection Inclusion criteria included evaluative literature on integrated, long-stay health and social care programs, published between January 1980 and July 2015, in English. Data extraction Data were extracted on the study purpose, period, setting, design, population, sample size, outcomes, and study results, as well as explanations of mechanisms and contextual factors influencing outcomes. Results of data synthesis A total of 65 articles, representing 28 IC programs, were included in the review. Two context-mechanism-outcome configurations (CMOcs) were identified: (i) trusting multidisciplinary team relationships and (ii) provider commitment to and understanding of the model. Contextual factors such as strong leadership that sets clear goals and establishes an organizational culture in support of the program, along with joint governance structures, supported team collaboration and subsequent successful implementation. Furthermore, time to build an infrastructure to implement and flexibility in implementation, emerged as key processes instrumental to success of these programs. Conclusions This review included a wide range of international evidence, and identified key processes for successful implementation of IC programs that should be considered by program planners, leaders and evaluators. PMID:28992156

Programmatic assessment of a university-based implant training program using patient-reported outcomes.

PubMed

Al-Sabbagh, Mohanad; Jenkins, Diane W; de Leeuw, Reny; Nihill, Patricia; Robinson, Fonda G; Thomas, Mark V

2014-11-01

The University of Kentucky College of Dentistry (UKCD) established an implant training program that provides training in the use of a single implant system, evidence-based diagnostic and treatment protocols (standardized work practices), and a total quality management system (Implant Quality Assurance Program). The aim of this study was to assess the programmatic effectiveness of the UKCD implant training program by reporting the success and survival of implants placed, using patient-reported outcomes and comparing them to previously established benchmarks. A total of 415 patients (963 implants) were interviewed, approximately 50 percent of all qualified patients. The implant survival rate was 97 percent, and 88 percent of the implants were considered successful (as determined by patient-centric criteria). These outcomes were consistent with the program's previously established benchmarks of 90 percent. These results suggest that work standardization (in the form of specific treatment protocols) and the use of a formal, incremental learning system can result in positive patient outcomes. Clinical outcomes should be monitored in academic dental settings as part of clinical process improvement, and these outcomes can provide a means of assessing the effectiveness of the training program.

National Marrow Donor Program

DTIC Science & Technology

2008-08-05

Research in HLA Typing, Hematopoietic Stem Cell Transplantation and Clinical Studies to Improve Outcomes 16. SECURITY CLASSIFICATION OF: 19a. NAME...new action item was added to Workflow Management screen for the SCTOD ( Stem Cell Therapeutic Outcomes Data) Data Form. The information will be passed...Improvement Amendment NRP National Response Plan CME Continuing Medical Education NST Non-myeloablative Allogeneic Stem Cell Transplantation COG

How Learning and Cognitive Science Can Improve Student Outcomes. Middle School Matters Program No. 1

ERIC Educational Resources Information Center

Graesser, Art; Rodriguez, Gina; Brasiel, Sarah J.

2013-01-01

There are research-based principles and practices from the learning and cognitive sciences that can be applied to all content areas in middle grades education to improve student outcomes. Even teachers of courses like Physical Education can consider these strategies for assisting students in remembering rules of sports, different sports…

Mentoring Interventions and the Impact of Protective Assets on the Reproductive Health of Adolescent Girls and Young Women.

PubMed

Plourde, Kate F; Ippoliti, Nicole B; Nanda, Geeta; McCarraher, Donna R

2017-08-01

Adolescent girls and young women (AGYW) are disproportionately affected by HIV and AIDS and other negative reproductive health (RH) outcomes. Emerging evidence suggests that programs to build AGYW's assets can help reduce their vulnerability to poor RH. Mentoring interventions have demonstrated a positive impact on a variety of youth development outcomes, including the protective assets needed to circumvent poor RH outcomes. The purpose of this review was to understand the types of mentoring programs for AGYW that have demonstrated effectiveness in improving protective assets, and/or, RH knowledge, intentions, behaviors, or outcomes themselves. Interventions were identified through an electronic search of the peer-reviewed and the gray literature. Studies were excluded in stages based on reviews of titles, abstracts, and full text. A review of 491 publications yielded a total of 19 articles that were included in the final review. The majority of the publications examined the impact of the one-to-one mentoring model in the United States. However, a good proportion examined the impact of both one-on-one and group-based interventions globally. The few interventions that followed a group-based model demonstrated more promise; evaluations of this model demonstrated a positive impact on RH knowledge and behavior, academic achievement, financial behavior, and social networks, as well as reductions in the experience of violence. Group-based mentoring programs demonstrated the most promise in building AGYW's protective assets and improving their RH outcomes. The most successful interventions consisted of multiple components, including mentoring, that sought to directly improve AGYW's protective assets and met with more frequency over a longer duration. Despite the promising evidence, more research is needed to better understand the relationship between assets and RH; the characteristics of successful mentoring programs; and the influence mentoring alone has on RH outcomes, versus mentoring as part of a larger RH program. Copyright © 2017 Society for Adolescent Health and Medicine. All rights reserved.

Feasibility of a Parenting Program to Prevent Substance Use Among Latino Youth: A Community-Based Participatory Research Study

PubMed Central

Allen, Michele L.; Hurtado, Ghaffar A.; Yon, Kyu Jin; Okuyemi, Kola S.; Davey, Cynthia S.; Marczak, Mary S.; Stoppa, Patricia; Svetaz, Veronica M.

2014-01-01

Purpose Family-skills training programs prevent adolescent substance use, but few exist for immigrant Latino families. This study assesses the feasibility of a family-skills training intervention developed using a community-based participatory research framework, and explores parental traditional values as a modifier of preliminary effects. Design One-group pretest-posttest. Setting Four Latino youth–serving sites (school, clinic, church, social-service agency). Subjects Immigrant Latino parents of adolescents aged 10 to 14 years (N = 83). Intervention Eight-session program in Spanish to improve parenting practices and parent-youth interpersonal relations designed with Latino parents and staff from collaborating organizations. Measures Feasibility was assessed through retention, program appropriateness, and group interaction quality. Preliminary outcomes evaluated were (1) parenting self-efficacy, discipline, harsh parenting, monitoring, conflict, attachment, acceptance, and involvement, and (2) parent perception of adolescent internalizing, externalizing, and substance use behaviors. Covariates included sociodemographics and parental endorsement of traditional values. Analysis Feasibility outcomes were assessed with descriptive statistics. Paired t-tests measured changes in parenting outcomes. Adjusted multiple regression models were conducted for change in each outcome, and t-tests compared mean changes in outcomes between parents with high and low traditional values scores. Results Program appropriateness and group interaction scores were positive. Improvement was noted for eight parenting outcomes. Parents perceived that adolescent internalizing behaviors decreased. Parents with lower endorsement of traditional values showed greater pretest-posttest change in attachment, acceptance, and involvement. Conclusion This intervention is feasible and may influence parenting contributors to adolescent substance use. (Am J Health Promot 2013;27[4]:240–244.) PMID:23448413

Canadian Pacific Railway Investigation of Safety-Related Occurrences Protocol considered helpful by both labor and management.

DOT National Transportation Integrated Search

2006-09-01

The Federal Railroad Administration (FRA) Human Factors Research and Development (R&D) Program sponsored an Alternative Safety Measures Program designed to explore alternative methods for evaluating whether safety programs improve safety outcomes and...

ENVIRONMENTAL TECHNOLOGY VERIFICATION (ETV) PROGRAM CASE STUDIES: DEMONSTRATING PROGRAM OUTCOMES, VOLUME II

EPA Science Inventory

The U.S. Environmental Protection Agency (EPA) Environmental Technology Verification (ETV) Program evaluates the performance of innovative air, water, pollution prevention and monitoring technologies that have the potential to improve human health and the environment. This bookle...

Environmental Technology Verification Program - ETV - Case Studies: Demonstrating Program Outcomes

EPA Science Inventory

The U.S. Environmental Protection Agency (EPA) Environmental Technology Verification (ETV) Program evaluates the performance of innovative air, water, pollution prevention and monitoring technologies that have the potential to improve human health and the environment. This cd con...

Positive outcomes following gait therapy intervention for hip osteoarthritis: A longitudinal study.

PubMed

Solomonow-Avnon, Deborah; Herman, Amir; Levin, Daniel; Rozen, Nimrod; Peled, Eli; Wolf, Alon

2017-10-01

Footwear-generated biomechanical manipulation of lower-limb joints was shown to beneficially impact gait and quality of life in knee osteoarthritis patients, but has not been tested in hip osteoarthritis patients. We examined a customized gait treatment program using a biomechanical device shown in previous investigations to be capable of manipulating hip biomechanics via foot center of pressure (COP) modulation. The objective of this study was to assess the treatment program for hip osteoarthritis patients, enrolled in a 1-year prospective investigation, by means of objective gait and spatiotemporal parameters, and subjective quality of life measures. Gait analysis and completion of questionnaires were performed at the start of the treatment (baseline), and after 3, 6, and 12 months. Outcome parameters were evaluated over time using linear mixed effects models, and association between improvement in quality of life measures and change in objective outcomes was tested using mixed effect linear regression models. Quality of life measures improved compared to baseline, accompanied by increased gait speed and cadence. Sagittal-plane hip joint kinetics, kinematics, and spatiotemporal parameters changed throughout the study compared to baseline, in a manner suggesting improvement of gait. The most substantial improvement occurred within 3 months after treatment initiation, after which improvement approximately plateaued, but was sustained at 12 months. Speed and cadence, as well as several sagittal-plane gait parameters, were significant predictors of improvement in quality of life. Evidence suggests that a biomechanical gait therapy program improves subjective and objective outcomes measures and is a valid treatment option for hip osteoarthritis. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2222-2232, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Mental health predicts better academic outcomes: A longitudinal study of elementary school students in Chile

PubMed Central

Murphy, J. Michael; Guzmán, Javier; McCarthy, Alyssa; Squicciarini, Ana María; George, Myriam; Canenguez, Katia; Dunn, Erin C.; Baer, Lee; Simonsohn, Ariela; Smoller, Jordan W.; Jellinek, Michael

2015-01-01

The world’s largest school-based mental health program, Habilidades para la Vida [Skills for Life, SFL], has been operating at a national scale in Chile for fifteen years. SFL’s activities include using standardized measures to screen elementary school students and providing preventive workshops to students at risk for mental health problems. This paper used SFL’s data on 37,397 students who were in first grade in 2009 and third grade in 2011 to ascertain whether first grade mental health predicted subsequent academic achievement and whether remission of mental health problems predicted improved academic outcomes. Results showed that mental health was a significant predictor of future academic performance and that, overall, students whose mental health improved between first and third grade made better academic progress than students whose mental health did not improve or worsened. Our findings suggest that school-based mental health programs like SFL may help improve students’ academic outcomes. PMID:24771270

Multidisciplinary teamwork and communication training.

PubMed

Deering, Shad; Johnston, Lindsay C; Colacchio, Kathryn

2011-04-01

Every delivery is a multidisciplinary event, involving nursing, obstetricians, anesthesiologists, and pediatricians. Patients are often in labor across multiple provider shifts, necessitating numerous handoffs between teams. Each handoff provides an opportunity for errors. Although a traditional approach to improving patient outcomes has been to address individual knowledge and skills, it is now recognized that a significant number of complications result from team, rather than individual, failures. In 2004, a Sentinel Alert issued by the Joint Commission revealed that most cases of perinatal death and injury are caused by problems with an organization's culture and communication failures. It was recommended that hospitals implement teamwork training programs in an effort to improve outcomes. Instituting a multidisciplinary teamwork training program that uses simulation offers a risk-free environment to practice skills, including communication, role clarification, and mutual support. This experience should improve patient safety and outcomes, as well as enhance employee morale. Published by Elsevier Inc.

Improving Ecological Response Monitoring of Environmental Flows

NASA Astrophysics Data System (ADS)

King, Alison J.; Gawne, Ben; Beesley, Leah; Koehn, John D.; Nielsen, Daryl L.; Price, Amina

2015-05-01

Environmental flows are now an important restoration technique in flow-degraded rivers, and with the increasing public scrutiny of their effectiveness and value, the importance of undertaking scientifically robust monitoring is now even more critical. Many existing environmental flow monitoring programs have poorly defined objectives, nonjustified indicator choices, weak experimental designs, poor statistical strength, and often focus on outcomes from a single event. These negative attributes make them difficult to learn from. We provide practical recommendations that aim to improve the performance, scientific robustness, and defensibility of environmental flow monitoring programs. We draw on the literature and knowledge gained from working with stakeholders and managers to design, implement, and monitor a range of environmental flow types. We recommend that (1) environmental flow monitoring programs should be implemented within an adaptive management framework; (2) objectives of environmental flow programs should be well defined, attainable, and based on an agreed conceptual understanding of the system; (3) program and intervention targets should be attainable, measurable, and inform program objectives; (4) intervention monitoring programs should improve our understanding of flow-ecological responses and related conceptual models; (5) indicator selection should be based on conceptual models, objectives, and prioritization approaches; (6) appropriate monitoring designs and statistical tools should be used to measure and determine ecological response; (7) responses should be measured within timeframes that are relevant to the indicator(s); (8) watering events should be treated as replicates of a larger experiment; (9) environmental flow outcomes should be reported using a standard suite of metadata. Incorporating these attributes into future monitoring programs should ensure their outcomes are transferable and measured with high scientific credibility.

Effects of a tailor-made exercise program on exercise adherence and health outcomes in patients with knee osteoarthritis: a mixed-methods pilot study.

PubMed

Lee, Fung-Kam Iris; Lee, Tze-Fan Diana; So, Winnie Kwok-Wei

2016-01-01

Previous studies showed that exercise intervention was effective in symptoms control of knee osteoarthritis (OA) but poor intervention adherence reduced the exercise effect. It has been suspected that the design of exercise intervention mainly from the health care professionals' perspective could not address the patients' barriers to exercise. Therefore, a tailor-made exercise program which incorporated the patient's perspective in the design was developed and ready for evaluation. This pilot study estimated the effects of a tailor-made exercise program on exercise adherence and health outcomes, and explored the participants' perception and experience of the program. The intervention of this study was a 4-week community-based group exercise program, which required the participants to attend a 1-hour session each week. Thirty-four older people with knee OA were recruited to the program. Mixed-methods study design was used to estimate the effects of this program and explore the participants' perception and experience of the program. Exercise adherence and performance in return-demonstration of the exercise were assessed at 12 weeks after the program. Disease-specific health status (Western Ontario and McMaster Universities Osteoarthritis Index), general health status (12-item Short Form of the Medical Outcome Study Questionnaire), knee range of motion, muscle strength, and endurance of the lower extremities (Timed-Stands Test) were measured at the beginning of the program and 12 weeks after. Six participants were interviewed individually on the 12th week. Thirty-three participants (75.0±7.3 years) completed the one-group pretest and post-test study. The participants' exercise adherence was 91.4%±14.54%, and their correct performance in return-demonstration was 76.7%±21.75%. Most of the participants' health outcomes significantly improved at posttests except the 12-item Short Form of the Medical Outcome Study Questionnaire physical health summary score. The qualitative findings provided rich information to explain and support the quantitative results. The results of this study showed that a tailor-made exercise program could improve exercise adherence and health outcomes in older people with knee OA.

Effects of a tailor-made exercise program on exercise adherence and health outcomes in patients with knee osteoarthritis: a mixed-methods pilot study

PubMed Central

Lee, Fung-Kam Iris; Lee, Tze-Fan Diana; So, Winnie Kwok-Wei

2016-01-01

Introduction Previous studies showed that exercise intervention was effective in symptoms control of knee osteoarthritis (OA) but poor intervention adherence reduced the exercise effect. It has been suspected that the design of exercise intervention mainly from the health care professionals’ perspective could not address the patients’ barriers to exercise. Therefore, a tailor-made exercise program which incorporated the patient’s perspective in the design was developed and ready for evaluation. Objectives This pilot study estimated the effects of a tailor-made exercise program on exercise adherence and health outcomes, and explored the participants’ perception and experience of the program. Methods The intervention of this study was a 4-week community-based group exercise program, which required the participants to attend a 1-hour session each week. Thirty-four older people with knee OA were recruited to the program. Mixed-methods study design was used to estimate the effects of this program and explore the participants’ perception and experience of the program. Exercise adherence and performance in return-demonstration of the exercise were assessed at 12 weeks after the program. Disease-specific health status (Western Ontario and McMaster Universities Osteoarthritis Index), general health status (12-item Short Form of the Medical Outcome Study Questionnaire), knee range of motion, muscle strength, and endurance of the lower extremities (Timed-Stands Test) were measured at the beginning of the program and 12 weeks after. Six participants were interviewed individually on the 12th week. Results Thirty-three participants (75.0±7.3 years) completed the one-group pretest and post-test study. The participants’ exercise adherence was 91.4%±14.54%, and their correct performance in return-demonstration was 76.7%±21.75%. Most of the participants’ health outcomes significantly improved at posttests except the 12-item Short Form of the Medical Outcome Study Questionnaire physical health summary score. The qualitative findings provided rich information to explain and support the quantitative results. Conclusion The results of this study showed that a tailor-made exercise program could improve exercise adherence and health outcomes in older people with knee OA. PMID:27785001

Designing for Scale: Reflections on Rolling Out Reading Improvement in Kenya and Liberia.

PubMed

Gove, Amber; Korda Poole, Medina; Piper, Benjamin

2017-03-01

Since 2008, the Ministries of Education in Liberia and Kenya have undertaken transitions from small-scale pilot programs to improve reading outcomes among primary learners to the large-scale implementation of reading interventions. The effects of the pilots on learning outcomes were significant, but questions remained regarding whether such large gains could be sustained at scale. In this article, the authors dissect the Liberian and Kenyan experiences with implementing large-scale reading programs, documenting the critical components and conditions of the program designs that affected the likelihood of successfully transitioning from pilot to scale. They also review the design, deployment, and effectiveness of each pilot program and the scale, design, duration, enabling conditions, and initial effectiveness results of the scaled programs in each country. The implications of these results for the design of both pilot and large-scale reading programs are discussed in light of the experiences of both the Liberian and Kenyan programs. © 2017 Wiley Periodicals, Inc.

School Improvement Grants: Early Implementation under Way, but Reforms Affected by Short Time Frames. Report to Congressional Requesters. GAO-11-741

ERIC Educational Resources Information Center

Scott, George A.

2011-01-01

The School Improvement Grants (SIG) program, which was created in 2002, funds reforms in the country's lowest-performing schools with the goal of improving student outcomes, such as standardized test scores and graduation rates. Congress greatly increased SIG program funding from $125 million available in fiscal year 2007--the first year the…

Expanding access to high-cost medicines through the E2 access program in Thailand: effects on utilisation, health outcomes and cost using an interrupted time-series analysis.

PubMed

Sruamsiri, Rosarin; Wagner, Anita K; Ross-Degnan, Dennis; Lu, Christine Y; Dhippayom, Teerapon; Ngorsuraches, Surachat; Chaiyakunapruk, Nathorn

2016-03-17

In 2008, the Thai government introduced the 'high-cost medicines E2 access program' as a part of the National List of Essential Medicines to increase patient access to medicines, improve clinical outcomes and make medicines more affordable. Our objective was to examine whether the 'high-cost medicines E2 access program' achieved its goals. Interrupted time-series design study. 3 tertiary hospitals in different regions of Thailand, January 2006 to December 2012. Patients with target acute and chronic disease diagnoses who newly met E2 program criteria for selected study medicines. High-cost medicines E2 access program. Level and trend changes over time in the proportions of eligible patients who received the indicated E2 medicines and who improved clinically, as well as in costs of treatment. A total of 2024 patients were included in utilisation analyses and 1375 patients with selected acute diseases contributed to analyses of clinical outcome. After 1 year of the E2 program implementation, the percentage of eligible patients receiving the indicated E2 program medicines increased significantly (relative change 12.7% (95% CI 4.4% to 21.0%), especially among those insured by the government's universal coverage scheme (relative change 19.9% (95% CI 9.5% to 30.5%)). The increase in the proportion of clinically improved patients with acute conditions was not significant (relative change 6.2% (95% CI -1.9% to 15.1%)). Quarterly healthcare costs per patient dropped significantly (relative change -13.5% (95% CI -26.9% to -1.7%)). In the study hospitals, the E2 access program seems to have facilitated patient access to specialty medicines, may have contributed to improved health outcomes, and decreased treatment costs. Routine monitoring is needed to assess effects of expanding the programme, including effects on quality of care and financial sustainability. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Developing Leadership for Life: Outcomes from a Collegiate Student-Alumni Mentoring Program

ERIC Educational Resources Information Center

Priest, Kerry L.; Donley, Sarah

2014-01-01

This application brief describes the exploratory assessment of a mentoring program between current students and alumni of a leadership studies minor program. We connect leadership education research and practice in two ways: first, we describe a process of qualitative program evaluation to inform program best practices and improvement. In doing…

Evolving from Quantity to Quality: A New Yardstick for Assessment

ERIC Educational Resources Information Center

Fulcher, Keston H.; Orem, Chris D.

2010-01-01

Higher education experts tout learning outcomes assessment as a vehicle for program improvement. To this end the authors share a rubric designed explicitly to evaluate the quality of assessment and how it leads to program improvement. The rubric contains six general assessment areas, which are further broken down into 14 elements. Embedded within…

Learning from Consistently High Performing and Improving Schools for English Language Learners in Boston Public Schools

ERIC Educational Resources Information Center

Tung, Rosann; Diez, Virginia; Gagnon, Laurie; Uriarte, Miren; Stazesky, Pamela

2011-01-01

This study is part of a collaborative project entitled "Identifying Success in Schools and Programs for English Language Learners in Boston Public Schools". The companion to this report, entitled "Improving Educational Outcomes of English Language Learners in Schools and Programs in Boston Public Schools", provides a…

New Research Strengthens Home Visiting Field: The Pew Home Visiting Campaign

ERIC Educational Resources Information Center

Doggett, Libby

2013-01-01

Extensive research has shown that home visiting parental education programs improve child and family outcomes, and they save money for states and taxpayers. Now, the next generation of research is deepening understanding of those program elements that are essential to success, ways to improve existing models, and factors to consider in tailoring…

Research Utilizing Problem Solving: Outcome Evaluation Report. Improving Teaching Competencies Program.

ERIC Educational Resources Information Center

Murray, Stephen L.; And Others

This report presents data collected about the impact of the Research Utilizing Problem Solving (RUPS) instructional system on the classrooms of teachers trained in two RUPS workshops, which were part of the Improving Teaching Competencies Program at the Northwest Regional Educational Laboratory. The report is divided into four chapters, the first…

Management of Hypertension in Private Practice: A Randomized Controlled Trial in Continuing Medical Education.

ERIC Educational Resources Information Center

Gullion, David S.; And Others

1988-01-01

A randomized control trial was used to evaluate a physician education program designed to improve physician management of patients' hypertension, hypertension-related behaviors, and diastolic blood pressure. It was suggested that more intensive continuing medical education programs are needed to improve physician performance and patient outcome.…

Feasibility of an acceptance and commitment therapy adjunctive web-based program for counseling centers.

PubMed

Levin, Michael E; Pistorello, Jacqueline; Hayes, Steven C; Seeley, John R; Levin, Crissa

2015-07-01

Web-based adjunctive tools provide a promising method for addressing the challenges college counseling centers face in meeting the mental health needs of students. The current study tested an initial adjunctive prototype based on acceptance and commitment therapy (ACT) in a pre-post open trial with 30 counselors and 82 student clients across 4 counseling centers. Results indicated high ratings of program satisfaction and usability with counselors and students. The majority of students completed at least part of the program. Significant improvements were found across almost all outcome and ACT process measures with student clients. Improvements in student outcomes were predicted by both changes in psychological inflexibility and how often counselors discussed the program with students. Results are discussed in relation to support for and future development of a flexible, adjunctive ACT program for counseling centers. (c) 2015 APA, all rights reserved).

Disaster Research Team Building: A Case Study of a Web-based Disaster Research Training Program.

PubMed

Beaton, Randal D; Johnson, L Clark; Maida, Carl A; Houston, J Brian; Pfefferbaum, Betty

2012-11-19

This case study describes the process and outcomes of the Northwest Center for Public Health Practice Child and Family Disaster Research Training (UWDRT) Program housed at the University of Washington, which used web-based distance learning technology. The purposes of this program were to provide training and to establish a regional cadre of researchers and clinicians; to increase disaster mental health research capacity and collaboration; and to improve the scientific rigor of research investigations of disaster mental health in children and families. Despite a number of obstacles encountered in development and implementation, outcomes of this program included increased team member awareness and knowledge of child and family disaster mental health issues; improved disaster and public health instruction and training independent of the UWDRT program; informed local and state disaster response preparedness and response; and contributions to the child and family disaster mental health research literature.

Adaptive Programming Improves Outcomes in Drug Court: An Experimental Trial.

PubMed

Marlowe, Douglas B; Festinger, David S; Dugosh, Karen L; Benasutti, Kathleen M; Fox, Gloria; Croft, Jason R

2012-04-01

Prior studies in Drug Courts reported improved outcomes when participants were matched to schedules of judicial status hearings based on their criminological risk level. The current experiment determined whether incremental efficacy could be gained by periodically adjusting the schedule of status hearings and clinical case-management sessions in response to participants' ensuing performance in the program. The adjustments were made pursuant to a priori criteria specified in an adaptive algorithm. Results confirmed that participants in the full adaptive condition (n = 62) were more than twice as likely as those assigned to baseline-matching only (n = 63) to be drug-abstinent during the first 18 weeks of the program; however, graduation rates and the average time to case resolution were not significantly different. The positive effects of the adaptive program appear to have stemmed from holding noncompliant participants more accountable for meeting their attendance obligations in the program. Directions for future research and practice implications are discussed.

Initial Results With Image-guided Cochlear Implant Programming in Children.

PubMed

Noble, Jack H; Hedley-Williams, Andrea J; Sunderhaus, Linsey; Dawant, Benoit M; Labadie, Robert F; Camarata, Stephen M; Gifford, René H

2016-02-01

Image-guided cochlear implant (CI) programming can improve hearing outcomes for pediatric CI recipients. CIs have been highly successful for children with severe-to-profound hearing loss, offering potential for mainstreamed education and auditory-oral communication. Despite this, a significant number of recipients still experience poor speech understanding, language delay, and, even among the best performers, restoration to normal auditory fidelity is rare. Although significant research efforts have been devoted to improving stimulation strategies, few developments have led to significant hearing improvement over the past two decades. Recently introduced techniques for image-guided CI programming (IGCIP) permit creating patient-customized CI programs by making it possible, for the first time, to estimate the position of implanted CI electrodes relative to the nerves they stimulate using CT images. This approach permits identification of electrodes with high levels of stimulation overlap and to deactivate them from a patient's map. Previous studies have shown that IGCIP can significantly improve hearing outcomes for adults with CIs. The IGCIP technique was tested for 21 ears of 18 pediatric CI recipients. Participants had long-term experience with their CI (5 mo to 13 yr) and ranged in age from 5 to 17 years old. Speech understanding was assessed after approximately 4 weeks of experience with the IGCIP map. Using a two-tailed Wilcoxon signed-rank test, statistically significant improvement (p < 0.05) was observed for word and sentence recognition in quiet and noise, as well as pediatric self-reported quality-of-life (QOL) measures. Our results indicate that image guidance significantly improves hearing and QOL outcomes for pediatric CI recipients.

Improving Participation in After-School Programs

ERIC Educational Resources Information Center

Walker, Karen E.; Arbreton, Amy J. A.

2005-01-01

After-school programs attempt to provide safe havens that keep youth off the streets and offer them a variety of opportunities to enhance their experiences and skills, including educational outcomes such as grades. What the programs actually accomplish has been somewhat different. Major evaluations of after-school programs have shown that they do…

Advocating for Continuing Nursing Education in a Pediatric Hospital: The Prince Scholar and Sabbatical Programs.

ERIC Educational Resources Information Center

Sperhac, Arlene M.; Goodwin, Laura D.

2000-01-01

A 5-year evaluation revealed positive outcomes of two nursing continuing education programs: a sabbatical program providing funding for completion of education/research projects and a nursing scholar program funding professional development. Knowledge and skills increased and the hospital practice environment was improved. (SK)

Characteristics of successful asthma programs.

PubMed

Clark, Noreen; Lachance, Laurie; Milanovich, Amy Friedman; Stoll, Shelley; Awad, Daniel F

2009-01-01

We identified characteristics of interventions associated with positive asthma outcomes to understand how programs can be improved. We identified asthma interventions from the peer-reviewed literature or through a nomination process for unpublished programs. Initially, we identified 532 interventions. Of those, 223 met our eligibility criteria (e.g., focus on asthma, completed an evaluation, and demonstrated at least one asthma-related health outcome) and provided information on program components and processes, administration, evaluation, and findings through telephone interviews, program documents, and published reports. We analyzed bivariate relationships between programmatic factors and outcomes using Chi-square statistics, Fisher's exact tests, and unconditional logistic regression. We confirmed findings for all programs by analyzing the subset with published results in peer-reviewed journals. Our findings indicated that programs were more likely to report a positive impact on health outcomes if they (1) were community based, (2) engaged the participation of community-based organizations, (3) provided program components in a clinical setting, (4) provided asthma training to health-care providers, (5) collaborated with other organizations and institutions and with government agencies, (6) designed a program for a specific racial/ethnic group, (7) tailored content or delivery based on individual health or educational needs, and (8) conducted environmental assessments and tailored interventions based on these assessments. Positive asthma outcomes were associated with specific program characteristics: being community centered, clinically connected, and continuously collaborative. Program developers and implementers who build these characteristics into their interventions will be more likely to realize desired asthma outcomes.

An Outcome Evaluation of the Success for Kids Program

PubMed Central

Maestas, Nicole; Gaillot, Sarah J.

2012-01-01

Abstract This article presents results from a multisite, quantitative evaluation of the international Success for Kids (SFK) after-school program. The program seeks to build resilience in children by teaching them to access inner resources and build positive connections with others. The SFK program is unlike most after-school programs both in its focus on spiritual development and in its emphasis on outcomes related to resilience rather than academics. The authors found that the program had beneficial effects on adaptive skills, behavioral problems, overexternalization of problems, and school problems, and the effects persisted at 12-week follow-up. Interestingly, the program positively affected school-related outcomes, even though SFK is not an academic intervention. Specifically, it improved reported study skills and reduced reported learning problems and attention problems. Overall, a major strength of the program appears to be its careful attention to uniformity of program delivery—in particular, its standardized curriculum, use of experienced teachers, and formal teacher-training program. PMID:28083226

An Outcome Evaluation of the Success for Kids Program.

PubMed

Maestas, Nicole; Gaillot, Sarah J

2012-01-01

This article presents results from a multisite, quantitative evaluation of the international Success for Kids (SFK) after-school program. The program seeks to build resilience in children by teaching them to access inner resources and build positive connections with others. The SFK program is unlike most after-school programs both in its focus on spiritual development and in its emphasis on outcomes related to resilience rather than academics. The authors found that the program had beneficial effects on adaptive skills, behavioral problems, overexternalization of problems, and school problems, and the effects persisted at 12-week follow-up. Interestingly, the program positively affected school-related outcomes, even though SFK is not an academic intervention. Specifically, it improved reported study skills and reduced reported learning problems and attention problems. Overall, a major strength of the program appears to be its careful attention to uniformity of program delivery-in particular, its standardized curriculum, use of experienced teachers, and formal teacher-training program.

Using program impact pathways to understand and improve program delivery, utilization, and potential for impact of Helen Keller International's homestead food production program in Cambodia.

PubMed

Olney, Deanna K; Vicheka, Sao; Kro, Meng; Chakriya, Chhom; Kroeun, Hou; Hoing, Ly Sok; Talukder, Aminzzaman; Quinn, Victoria; Iannotti, Lora; Becker, Elisabeth; Roopnaraine, Terry

2013-06-01

Evidence of the impact of homestead food production programs on nutrition outcomes such as anemia and growth is scant. In the absence of information on program impact pathways, it is difficult to understand why these programs, which have been successful in increasing intake of micronutrient-rich foods, have had such limited documented impact on nutrition outcomes. To conduct a process evaluation of Helen Keller International's (HKI's) homestead food production program in Cambodia to assess whether the program was operating as planned (in terms of design, delivery, and utilization) and to identify ways in which the program might need to be strengthened in order to increase its potential for impact. A program theory framework, which laid out the primary components along the hypothesized program impact pathways, was developed in collaboration with HKI and used to design the research. Semistructured interviews and focus group discussions with program beneficiaries (n = 36 and 12, respectively), nonbeneficiaries (n = 12), and program implementers (n = 17 and 2, respectively) and observations of key program delivery points, including health and nutrition training sessions (n = 6), village model farms (n = 6), and household gardens of beneficiaries (n = 36) and nonbeneficiaries (n = 12), were conducted to assess the delivery and utilization of the primary program components along the impact pathways. The majority of program components were being delivered and utilized as planned. However, challenges with some of the key components posited to improve outcomes such as anemia and growth were noted. Among these were a gap in the expected pathway from poultry production to increased intake of eggs and poultry meat, and some weaknesses in the delivery of the health and nutrition training sessions and related improvements in knowledge among the village health volunteers and beneficiaries. Although the program has been successful in delivering the majority of the program components as planned and has documented achievements in improving household production and intake of micronutrient-rich foods, it is likely that strengthening delivery and increasing utilization of some program components would increase its potential for nutritional impacts. This research has highlighted the importance of designing a program theory framework and assessing the components that lie along the primary program impact pathways to optimize program service delivery and utilization and, in turn, potential for impact.

Dissemination and adoption of the advanced primary care model in the Maryland multi-payer patient centered medical home program.

PubMed

Khanna, Niharika; Shaya, Fadia; Chirikov, Viktor; Steffen, Ben; Sharp, David

2014-02-01

The Maryland Learning Collaborative together with the Maryland Multi-Payer Program transformed 52 medical practices into patient-centered medical homes (PCMH). The Maryland Learning Collaborative developed an Internet-based 14-question Likert scale survey to assess the impact of the PCMH model on practices and providers, concerning how this new method is affecting patient care and outcomes. The survey was sent to 339 practitioners and 52 care management teams at 18 months into the program. Sixty-seven survey results were received and analyzed. After 18 months of participation in the PCMH initiative, participants demonstrated a better understanding of the PCMH initiative, improved patient access to care, improved care coordination, and increased health information technology optimization (p > .001). The findings from the survey evaluation suggest that practice participation in the Maryland Multi-Payer Program has enhanced access to care, influenced patient outcomes, improved care coordination, and increased use of health information technology.

Inpatient rehabilitation improves functional capacity, peripheral muscle strength and quality of life in patients with community-acquired pneumonia: a randomised trial.

PubMed

José, Anderson; Dal Corso, Simone

2016-04-01

Among people who are hospitalised for community-acquired pneumonia, does an inpatient exercise-based rehabilitation program improve functional outcomes, symptoms, quality of life and length of hospital stay more than a respiratory physiotherapy regimen? Randomised trial with concealed allocation, intention-to-treat analysis and blinding of some outcomes. Forty-nine adults hospitalised for community-acquired pneumonia. The experimental group (n=32) underwent a physical training program that included warm-up, stretching, peripheral muscle strength training and walking at a controlled speed for 15 minutes. The control group (n=17) underwent a respiratory physiotherapy regimen that included percussion, vibrocompression, respiratory exercises and free walking. The intervention regimens lasted 8 days. The primary outcome was the Glittre Activities of Daily Living test, which assesses the time taken to complete a series of functional tasks (eg, rising from a chair, walking, stairs, lifting and bending). Secondary outcomes were distance walked in the incremental shuttle walk test, peripheral muscle strength, quality of life, dyspnoea, lung function, C-reactive protein and length of hospital stay. Measures were taken 1 day before and 1 day after the intervention period. There was greater improvement in the experimental group than in the control group on the Glittre Activities of Daily Living test (mean between-group difference 39 seconds, 95% CI 20 to 59) and the incremental shuttle walk test (mean between-group difference 130 m, 95% CI 77 to 182). There were also significantly greater improvements in quality of life, dyspnoea and peripheral muscle strength in the experimental group than in the control group. There were no between-group differences in lung function, C-reactive protein or length of hospital stay. The improvement in functional outcomes after an inpatient rehabilitation program was greater than the improvement after standard respiratory physiotherapy. The exercise training program led to greater benefits in functional capacity, peripheral muscle strength, dyspnoea and quality of life. ClinicalTrials.gov, NCT02103400. Copyright © 2016 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

Group cognitive behavioral therapy to improve the quality of care to opioid-treated patients with chronic noncancer pain: a practice improvement project.

PubMed

Whitten, Stacey K; Stanik-Hutt, Julie

2013-07-01

To enhance outcomes of patients with chronic noncancer pain (CNCP) treated with opioids in a primary care setting by implementing an evidence-based quality improvement project. The project consisted of the implementation of a 6-week cognitive behavioral therapy (CBT) program. Twenty-two patients with CNCP completed the program. Impact of the project was evaluated by comparing pre- and postintervention participant self-reports of mood on the Beck Depression Inventory and functional status on the Brief Pain Inventory and Short Form-36. Patient perception of treatment benefit was also measured using the Patient Global Impression of Change. Qualitative provider perceptions of the program were also collected. Paired t-test statistics were used to analyze the data. Mood (including negative attitude, performance difficulty, and physical complaints), and patient impression of treatment benefit improved significantly after CBT was added. Primary care providers reported that the CBT supported their overall management of these complex patients. The addition of a CBT program improved selected outcomes in this self-selected sample of patients with CNCP treated with opioids. ©2012 The Author(s) ©2012 American Association of Nurse Practitioners.

A randomised controlled trial of the efficacy of the ABCD Parenting Young Adolescents Program: rationale and methodology

PubMed Central

2010-01-01

Background The transition to adolescence is a time of increased vulnerability for risk taking and poor health, social and academic outcomes. Parents have an important role in protecting their children from these potential harms. While the effectiveness of parenting programs in reducing problem behavior has been demonstrated, it is not known if parenting programs that target families prior to the onset of significant behavioral difficulties in early adolescence (9-14 years) improve the wellbeing of adolescents and their parents. This paper describes the rationale and methodology of a randomised controlled trial testing the efficacy of a parenting program for the promotion of factors known to be associated with positive adolescent outcomes, such as positive parenting practices, parent-adolescent relationships and adolescent behavior. Methods/Design One hundred and eighty parents were randomly allocated to an intervention or wait list control group. Parents in the intervention group participated in the ABCD Parenting Young Adolescents Program, a 6-session behavioral family intervention program which also incorporates acceptance-based strategies. Participants in the Wait List control group did not receive the intervention during a six month waiting period. The study was designed to comply with recommendations of the CONSORT statement. The primary outcome measures were reduction in parent-adolescent conflict and improvements in parent-adolescent relationships. Secondary outcomes included improvements in parent psychosocial wellbeing, parenting self-efficacy and perceived effectiveness, parent-adolescent communication and adolescent behavior. Conclusions Despite the effectiveness of parenting programs in reducing child behavioral difficulties, very few parenting programs for preventing problems in adolescents have been described in the peer reviewed literature. This study will provide data which can be used to examine the efficacy of a universal parenting interventions for the promotion of protective factors associated with adolescent wellbeing and will add to the literature regarding the relationships between parent, parenting and adolescent factors. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12609000194268. PMID:20723219

A specialist peer mentoring program for university students on the autism spectrum: A pilot study.

PubMed

Siew, Choo Ting; Mazzucchelli, Trevor G; Rooney, Rosanna; Girdler, Sonya

2017-01-01

The provision of peer mentoring may improve tertiary education outcomes of students with autism spectrum disorder (ASD). This study evaluated the pilot year of the Curtin Specialist Mentoring Program (CSMP), a specialised peer mentoring program for university students with ASD aimed at improving self-reported well-being, academic success and retention in university studies. A single group pre-test, post-test design was employed. Quantitative and qualitative evaluations were undertaken with 10 young adults with ASD to explore the effectiveness and acceptability of the CSMP program. Students completed a battery of questionnaires focused on general anxiety, state communication apprehension, perceived communication competence, and communication apprehension both prior to, and five months after commencing enrolment in the CSMP. Information regarding academic success and retention was also obtained. Interviews with participants provided further insight into their experience of the program. Students enrolled in the CSMP showed significant improvement in social support and general communication apprehension assessment scores. Interviews revealed key features of the CSMP that may have contributed to these positive outcomes. The current study provides preliminary evidence that a specialised peer mentoring program can improve the well-being of students with ASD, and highlights the importance of interventions which are individualised, flexible, based on a social model, and target environmental factors such as social support.

The development of a community and home-based chronic care management program for older adults.

PubMed

Cooper, Jennifer; McCarter, Kathryn A

2014-01-01

The objective of this paper was to evaluate a chronic care management program piloted by a visiting nurses association. Desired outcomes were to increase nurses' knowledge of self-management of chronic conditions and improve patient self-efficacy and clinical measures. The program provided educational development for nurses and piloted encounters with patients with chronic conditions targeting community health nurses for a chronic care professional (CCP) certification and invited 300 faith community nurses to an education program on chronic condition(s). Thirteen patients with chronic condition(s) were enrolled. Chronic care professional modules were used to increase nurses' knowledge and were measured by successful completion of a certification exam. Faith community nurses participated in an education program and completed a posttest to measure knowledge of content. Patient improvement in self-management was measured by pre- and postintervention self-efficacy scores and clinical measures. Seventeen nurses successfully completed the exam, and 38 faith community nurses participated in the program and completed the posttest. Three patients showed improvement in self-efficacy scores and eight in clinical measures. The educational development of community nurses prepared them to provide effective encounters to improve self-efficacy and clinical outcomes for older adults with chronic conditions. © 2013 Wiley Periodicals, Inc.

From decentralization to commonization of HIV healthcare resources: keys to reduction in health disparity and equitable distribution of health services in Nigeria.

PubMed

Oleribe, Obinna Ositadimma; Oladipo, Olabisi Abiodun; Ezieme, Iheaka Paul; Crossey, Mary Margaret Elizabeth; Taylor-Robinson, Simon David

2016-01-01

Access to quality care is essential for improved health outcomes. Decentralization improves access to healthcare services at lower levels of care, but it does not dismantle structural, funding and programming restrictions to access, resulting in inequity and inequality in population health. Unlike decentralization, Commonization Model of care reduces health inequalities and inequity, dismantles structural, funding and other program related obstacles to population health. Excellence and Friends Management Care Center (EFMC) using Commonization Model (CM), fully integrated HIV services into core health services in 121 supported facilities. This initiative improved access to care, treatment, support services, reduced stigmatization/discrimination, and improved uptake of HTC. We call on governments to adequately finance CM for health systems restructuring towards better health outcomes.

A video approach to interactive patient education.

PubMed

Maller, C E; Twitty, V J; Sauve, A

1997-04-01

A quality improvement model presents the stages of designing and producing a preoperative videotape for improved patient satisfaction outcomes. PACU nurses formed an interdisciplinary team of providers and patients to update an existing preoperative sound/slide program into video. Improved patient outcomes were reflected in greater availability, accessibility, and consistency of preoperative instruction. A videotape program for home viewing was instituted to reach out to the surgical patient population served by the Albuquerque Veterans Affairs Medical Center in New Mexico. A quality improvement storyboard approach to videotape production met Joint Commission on Accreditation of Health Care Organization (JCAHO) standards for interactive patient education at a recent JCAHO survey. Preliminary evaluative data from patients supports a growing appeal of videos to patients and family members as an additional preoperative teaching strategy for adult surgical patients.

Evaluating School Violence Programs. Urban Diversity Series.

ERIC Educational Resources Information Center

Flaxman, Erwin, Ed.

The essays in this collection review information, resources, and guidelines on the basic principles of internal evaluations of school violence programs. This information can help staff with program definition, planning, implementation, continuous improvement, and measurement of outcomes. "Introduction" (Erwin Flaxman) examines types of…

Patient perspectives about bariatric surgery unveil experiences, education, satisfaction, and recommendations for improvement.

PubMed

Groller, Karen D; Teel, Cynthia; Stegenga, Kristin H; El Chaar, Maher

2018-02-17

Following bariatric surgery, up to 35% of patients struggle with strict regimens and experience weight recidivism within 2 years [1-5]. Accredited weight management centers (WMC) must provide educational programs and support patients in lifestyle changes before and after surgery. Educational programs, however, may not be evidence-based or patient-centered and may vary in curriculum, approach, and educator type [6]. To obtain patient descriptions about the weight loss surgery (WLS) experience, including education, satisfaction, and recommendations for improvement. Participants were recruited from a university hospital-based WMC in Pennsylvania. This qualitative descriptive study used purposive sampling and inductive content analysis. A NEW ME-VERSION 2.0, encompassed themes from semistructured interviews with 11 participants (36% male). Theme 1: Programming and Tools, explained how individuals undergoing WLS found support through educational programming. Theme 2: Updates and Upgrades, identified issues surrounding quality of life and challenges before and after surgery. Theme 3: Lessons Learned and Future Considerations, identified satisfaction levels and recommendations for improving the WLS experience. Participants reported positive experiences, acknowledging educational programs and extensive WMC resources, yet also offered recommendations for improving educational programming. Patient narratives provided evidence about the WLS experience. Achievement of weight goals, adherence to rules, and improved health status contributed to perceptions of WLS success. Participants encouraged educators to identify expected outcomes of educational programming, monitor holistic transformations, foster peer support, and use technology in WMC programming. Results also validated the need for the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program's education requirement (standard 5.1). Future educational research could help develop best practices in WLS patient education and assess associations between education and clinical outcomes. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Medication knowledge to be improved in participants in community universities in Taiwan: Outcome of a nationwide community university program.

PubMed

Huang, Yen-Ming; Yang, Yea-Huei Kao; Lin, Swu-Jane; Chen, Karin Chiung-Sheue; Kuo, Chuan-Chi; Wu, Fe-Lin Lin

2015-12-01

To assess knowledge improvement by the participants in a pharmacist-facilitated national community education program over a 4-month semester and to identify the educational needs of adults related to medications. This was a single-group, pre- and post-program comparative study. From February 2005 to February 2006, 1983 community residents participating in the education program implemented at 57 community universities nationwide were included. A questionnaire consisting of 50 true/false questions was administered before and after the program to assess the participants' medication knowledge. Paired t test was used to analyze the pre- and post-program differences and generalized linear mixed models were applied to examine the demographic variables that might influence the background knowledge and outcome after adjusting for school effects. A total of 848 participants (42.8%) completed the pre-to-post questionnaire. Baseline medication knowledge was positively correlated with participants' education level and negatively correlated with age. Significant improvement (11.3%, p < 0.001) in medication knowledge was evident at the end of the program. The age and education level were significant determinants in the improvement of the pre-to-post program test score. The specific areas that required improvement most in the knowledge of the participants were: instructions on refill prescriptions, proper storage of medication, the health insurance system, drug use in special populations, and over-the-counter drugs. This national program improved participants' medication knowledge over a 4-month period. Patient counseling focusing more on the knowledge deficiency identified in this study during patient care is recommended. Copyright © 2015. Published by Elsevier B.V.

Improved Surgical Outcomes for ACS NSQIP Hospitals Over Time: Evaluation of Hospital Cohorts With up to 8 Years of Participation.

PubMed

Cohen, Mark E; Liu, Yaoming; Ko, Clifford Y; Hall, Bruce L

2016-02-01

The American College of Surgeons, National Surgical Quality Improvement Program (ACS NSQIP) surgical quality feedback models are recalibrated every 6 months, and each hospital is given risk-adjusted, hierarchical model, odds ratios that permit comparison to an estimated average NSQIP hospital at a particular point in time. This approach is appropriate for "relative" benchmarking, and for targeting quality improvement efforts, but does not permit evaluation of hospital or program-wide changes in quality over time. We report on long-term improvement in surgical outcomes associated with participation in ACS NSQIP. ACS NSQIP data (2006-2013) were used to create prediction models for mortality, morbidity (any of several distinct adverse outcomes), and surgical site infection (SSI). For each model, for each hospital, and for year of first participation (hospital cohort), hierarchical model observed/expected (O/E) ratios were computed. The primary performance metric was the within-hospital trend in logged O/E ratios over time (slope) for mortality, morbidity, and SSI. Hospital-averaged log O/E ratio slopes were generally negative, indicating improving performance over time. For all hospitals, 62%, 70%, and 65% of hospitals had negative slopes for mortality, morbidity, and any SSI, respectively. For hospitals currently in the program for at least 3 years, 69%, 79%, and 71% showed improvement in mortality, morbidity, and SSI, respectively. For these hospitals, we estimate 0.8%, 3.1%, and 2.6% annual reductions (with respect to prior year's rates) for mortality, morbidity, and SSI, respectively. Participation in ACS NSQIP is associated with reductions in adverse events after surgery. The magnitude of quality improvement increases with time in the program.

Navigating change: how outreach facilitators can help clinicians improve patient outcomes.

PubMed

Laferriere, Dianne; Liddy, Clare; Nash, Kate; Hogg, William

2012-01-01

The objective of this study was to describe outreach facilitation as an effective method of assisting and supporting primary care practices to improve processes and delivery of care. We spent 4 years working with 83 practices in Eastern Ontario, Canada, on the Improved Delivery of Cardiovascular Care through the Outreach Facilitation program. Primary care practices, even if highly motivated, face multiple challenges when providing quality patient care. Outreach facilitation can be an effective method of assisting and supporting practices to make the changes necessary to improve processes and delivery of care. Multiple jurisdictions use outreach facilitation for system redesign, improved efficiencies, and advanced access. The development and implementation of quality improvement programs using practice facilitation can be challenging. Our research team has learned valuable lessons in developing tools, finding resources, and assisting practices to reach their quality improvement goals. These lessons can lead to improved experiences for the practices and overall improved outcomes for the patients they serve.

Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program.

PubMed

Deyle, Gail D; Allison, Stephen C; Matekel, Robert L; Ryder, Michael G; Stang, John M; Gohdes, David D; Hutton, Jeremy P; Henderson, Nancy E; Garber, Matthew B

2005-12-01

Manual therapy and exercise have not previously been compared with a home exercise program for patients with osteoarthritis (OA) of the knee. The purpose of this study was to compare outcomes between a home-based physical therapy program and a clinically based physical therapy program. One hundred thirty-four subjects with OA of the knee were randomly assigned to a clinic treatment group (n=66; 61% female, 39% male; mean age [+/-SD]=64+/-10 years) or a home exercise group (n=68, 71% female, 29% male; mean age [+/-SD]=62+/-9 years). Subjects in the clinic treatment group received supervised exercise, individualized manual therapy, and a home exercise program over a 4-week period. Subjects in the home exercise group received the same home exercise program initially, reinforced at a clinic visit 2 weeks later. Measured outcomes were the distance walked in 6 minutes and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Both groups showed clinically and statistically significant improvements in 6-minute walk distances and WOMAC scores at 4 weeks; improvements were still evident in both groups at 8 weeks. By 4 weeks, WOMAC scores had improved by 52% in the clinic treatment group and by 26% in the home exercise group. Average 6-minute walk distances had improved about 10% in both groups. At 1 year, both groups were substantially and about equally improved over baseline measurements. Subjects in the clinic treatment group were less likely to be taking medications for their arthritis and were more satisfied with the overall outcome of their rehabilitative treatment compared with subjects in the home exercise group. Although both groups improved by 1 month, subjects in the clinic treatment group achieved about twice as much improvement in WOMAC scores than subjects who performed similar unsupervised exercises at home. Equivalent maintenance of improvements at 1 year was presumably due to both groups continuing the identical home exercise program. The results indicate that a home exercise program for patients with OA of the knee provides important benefit. Adding a small number of additional clinical visits for the application of manual therapy and supervised exercise adds greater symptomatic relief.

Process Evaluation for Improving K12 Program Effectiveness: Case Study of a National Institutes of Health Building Interdisciplinary Research Careers in Women's Health Research Career Development Program.

PubMed

Raymond, Nancy C; Wyman, Jean F; Dighe, Satlaj; Harwood, Eileen M; Hang, Mikow

2018-06-01

Process evaluation is an important tool in quality improvement efforts. This article illustrates how a systematic and continuous evaluation process can be used to improve the quality of faculty career development programs by using the University of Minnesota's Building Interdisciplinary Research Careers in Women's Health (BIRCWH) K12 program as an exemplar. Data from a rigorous process evaluation incorporating quantitative and qualitative measurements were analyzed and reviewed by the BIRCWH program leadership on a regular basis. Examples are provided of how this evaluation model and processes were used to improve many aspects of the program, thereby improving scholar, mentor, and advisory committee members' satisfaction and scholar outcomes. A rigorous evaluation plan can increase the effectiveness and impact of a research career development plan.

Keeping the "continuous" in continuous quality improvement: exploring perceived outcomes of CQI program use in community pharmacy.

PubMed

Boyle, Todd A; Bishop, Andrea C; Duggan, Kellie; Reid, Carolyn; Mahaffey, Thomas; MacKinnon, Neil J; Mahaffey, Amelia

2014-01-01

Given the significant potential of continuous quality improvement (CQI) programs in enhancing overall levels of patient safety, community pharmacies in North America are under increasing pressure to have a formal and documented CQI program in place. However, while such initiatives may seem great on paper, in practice the outcomes of such programs to community pharmacy practice remain unclear. To explore the perceived outcomes identified by community pharmacies that adopted and actively used a standardized (i.e., common across pharmacies) CQI program for at least 1 year and to develop a framework for how such outcomes were achieved. A multi-site study of SafetyNET-Rx, a standardized and technologically sophisticated (e.g., online reporting of medication errors to a national database) CQI program, involving community pharmacies in Nova Scotia, Canada, was performed. During the summer and fall of 2011, 22 interviews were conducted with the CQI facilitators in 12 Nova Scotia community pharmacies; equally split between independent/banners and corporate chains. Of the CQI facilitators, 14 were pharmacists, while the remaining eight were pharmacy technicians. Thematic analysis following the procedures presented by Braun and Clarke was adopted to identify and explore the major outcomes. Results of the thematic analysis highlighted a number of perceived outcomes from the use of a standardized CQI program in community pharmacies, specifically: (1) perceived reduction in the number of medication errors that were occurring in the pharmacy, (2) increased awareness/confidence of individual actions related to dispensing, (3) increased understanding of the dispensing and related processes/workflow, (4) increased openness to talking about medication errors among pharmacy staff, and (5) quality and safety becoming more entrenched in the workflow (e.g., staff is more aware of their roles and responsibilities in patient safety and confident that the dispensing processes are safe and reliable). In achieving such outcomes, pharmacies had to balance customizing the CQI program to address a number of operational challenges, with ensuring that the core standardized components remained in place. This research identified the perceived outcomes of CQI program use by CQI facilitators. Additionally, the findings are incorporated into a framework for CQI implementation that can be used by pharmacy managers, corporate head offices, and regulatory authorities to leverage greater CQI adoption and success. Copyright © 2014 Elsevier Inc. All rights reserved.

The Pain Course: Exploring the Feasibility of an Internet-delivered Pain Management Program When Offered by a Tertiary Pain Management Service.

PubMed

Dear, Blake F; Courtney, Catherine; Khor, Kok Eng; McDonald, Sarah; Ricciardi, Tahlia; Gandy, Milena; Fogliati, Vincent J; Titov, Nick

2018-06-01

This study examined the acceptability and preliminary outcomes of an internet-delivered pain management program, the Pain Course, when offered by a specialist pain management clinic in a large public hospital. A single-group feasibility open-trial design was used and 39 patients participated in the program, which ran for 8 weeks. Participants were supported through the program with weekly contact from a Clinical Psychologist at the clinic. All participants provided data at posttreatment and >90% of participants completed all 5 lessons of the course. High levels of satisfaction were observed and relatively little clinician time (M=71.99 min/participant; SD=32.82 min) was required to support patients through the program. Preliminary evidence of clinical improvements in depression symptoms (avg. improvement=38%; Cohen d=0.74), but not disability levels or anxiety symptoms, was observed in the overall sample. However, evidence of improvements was observed across all the primary outcomes among patients who had clinical levels of difficulties with disability (n=20; avg. improvement=11%; Cohen d=0.64), depression (n=17; avg. improvement=35%; Cohen d=1.24) and anxiety (n=8; avg. improvement=29%; Cohen d=0.57). These findings highlight the potential value of internet-delivered programs when provided by specialist pain management clinics as a part of their services and the value of larger scale studies in this area.

Polytrauma transitional rehabilitation programs: Comprehensive rehabilitation for community integration after brain injury.

PubMed

Duchnick, Jennifer J; Ropacki, Susan; Yutsis, Maya; Petska, Kelly; Pawlowski, Carey

2015-08-01

When the U.S. Congress passed the Veterans Health Programs Improvement Act of 2004 and the Consolidated Appropriations Act in 2005, Veterans Affairs (VA) traumatic brain injury centers responded by establishing and developing the polytrauma rehabilitation centers and polytrauma transitional rehabilitation programs (PTRPs) across 4 sites in Minneapolis, Minnesota, Palo Alto, California, Richmond, Virginia, and Tampa, Florida, in 2007. The 5th PTRP was opened in 2011 in San Antonio, Texas. This article presents the context of establishing these programs within a VA system, describes aspects of programmatic design, and shares characteristics and outcomes of individuals served by the first 4 national centers. PTRPs provide specialized, interdisciplinary brain injury rehabilitation to active-duty service members and veterans with complex rehabilitation needs. A total of 286 individuals participated in the first 4 PTRPs during the first 3 years. Admission and discharge data were collected as part of routine care, and data review focused on describing the demographic, injury, and neurobehavioral functioning outcomes across 4 sites. Mayo-Portland Adaptability Inventory Abilities, Adjustment, and Participation subscales and total scale T-scores served as primary functioning outcome measures. Mean scores are presented. Statistical analysis found a significant change in total scale T-score from admission to discharge, consistent with improved patient functional ability. Challenges associated with the development and implementation of programs are discussed. Elements of programming may be applicable for other health care organizations that seek to improve rehabilitation care delivery. (c) 2015 APA, all rights reserved).

Improving practice with integration of patient directed activity during inpatient rehabilitation.

PubMed

Trammell, Molly; Kapoor, Priyanka; Swank, Chad; Driver, Simon

2017-01-01

Early initiation of rehabilitation following stroke promotes better long-term outcomes than delayed onset, emphasizing the importance of inpatient therapy. However, literature indicates that following stroke individuals in inpatient rehabilitation spend the majority of their day in their bedroom and inactive. Consequently, since amount of functional activity is posited to relate to outcomes, the current rehabilitation model needs to be challenged with innovative solutions to maximize recovery. In an attempt to promote greater activity and higher doses of therapy during inpatient rehabilitation, we implemented the "Patient Directed Activity Program" to facilitate specific movement and improve outcomes for patients post stroke. Our interdisciplinary activity program was conceptualized on a theoretical model for stroke recovery and principles of experience-dependent neural plasticity. The "Patient Directed Activity Program" includes distinct activity stations designed to increase repetition, stimulation, attention, and activity of the affected upper extremities, lower extremities, and trunk. Each task-specific activity was easily graded to achieve moderate- to high-intensity. The activity program prescribed individuals up to three additional 30-minute bouts of activities daily that were to be completed independently, and in addition to standard of care. Clinical application: After implementing this program in our facility for one year as a quality improvement project, the intervention has been delivered as an Institutional Review Board approved randomized controlled trial (Clinical Trial #NCT02446197). Challenges with people and facilities have been overcome, resulting in a feasible program that can be delivered in an inpatient setting. High satisfaction has been reported by patients and clinicians.

Does your equipment maintenance management program measure up?

PubMed

Deinstadt, Deborah C

2003-01-01

Identifying a clear maintenance philosophy is the first step toward choosing the right program for your healthcare organization. The second step is gaining a clear understanding of how proposed savings and improvements will be delivered. The third and last step is requiring that the proposed company or manager have specific tools in place for measuring and analyzing program performance. There are three primary philosophies underlying current equipment management options. These include risk-transfer philosophy (e.g., maintenance insurance, service contracts, multi-vendor and outsource programs), asset management philosophy (e.g., programs delivering a management system based on managed time-and-materials), and internal management (in-house managed programs). The last step in selecting the right program is insisting that proper performance measurements be built into the proposed management program. A well-managed program provides results in three general areas: financial outcomes, operational improvements and process improvements. Financial outcomes are the easiest to measure. Operational and process improvements are more challenging to assess but equally important to the program's overall success. To accurately identify results in these three areas, the overall management program should measure the following eight separate components: procedures and support for department staff; equipment inventory, benchmark costs, and budget guidelines; experienced equipment support team; objective, independent analysis of maintenance events; repair documentation and reporting; vendor relations; equipment acquisition analysis; and recommendations for improvement. Do everything you reasonably can to assure that the selected company can work side-by-side with you, providing objective, measurable advice that is ultimately in your best interest. You will then know that you have been thorough in your marketplace selection and can confidently move into implementation, expecting tangible and successful results.

Completion of a Veteran-Focused Civic Service Program Improves Health and Psychosocial Outcomes in Iraq and Afghanistan Veterans With a History of Traumatic Brain Injury

PubMed Central

Lawrence, Karen A.; Matthieu, Monica M.; Robertson-Blackmore, Emma

2017-01-01

Introduction Volunteering as a health promotion intervention is positively related to improved health and well-being in civilians and older adults. Yet, the impacts of participating in a community-based volunteering program on returning military veterans have not been studied, nor have the outcomes for veterans who have experienced a traumatic brain injury (TBI). Materials and Methods This observational, pre–post survey examines health, psychological, and social outcomes from a cohort of post-9/11/01 veterans with (N = 67) and without a reported TBI history (N = 273) who completed a 6-month, 20-hour per week veteran-focused civic service program. This study was approved by the Saint Louis University Institutional Review Board. Results Veterans with a TBI history who completed the 6-month civic service program conducted by a veteran-focused national nonprofit organization showed significant pre–post improvement (p < 0.05) in overall health, decreased post-traumatic stress disorder (PTSD) symptoms, increased perceived self-efficacy, decreased feelings of isolation and loneliness, and increased perceived availability of social support. These significant findings were not due to participants seeking external help for emotional problems. Out of four aspects of PTSD symptomatology assessed, “feeling numb or detached from others, activities, or surroundings” most accounted for the decrease in PTSD scores. Given this and taken together with the significant decrease in social isolation and loneliness and the social nature of the program, we posit that decreased social isolation and loneliness is the primary driver of the improved psychological and social outcomes documented here. Finally, pre–post change scores did not differ significantly between veterans with and without a TBI, indicating that TBI history did not hinder the ability to benefit from this program. Conclusion Completion of this civic service program positively impacted veterans with TBI, especially on psychological and social outcomes important to recovery and life satisfaction after TBI. Civic service may provide an innovative approach to promoting wellness in returning veterans with a TBI. Results of this study provide preliminary evidence that civic service decreases social isolation and loneliness in veterans with a reported TBI history. Given our findings, volunteering may prevent against social isolation and be promotional of perceived social support in veterans with TBI. PMID:28810970

Completion of a Veteran-Focused Civic Service Program Improves Health and Psychosocial Outcomes in Iraq and Afghanistan Veterans With a History of Traumatic Brain Injury.

PubMed

Lawrence, Karen A; Matthieu, Monica M; Robertson-Blackmore, Emma

2017-07-01

Volunteering as a health promotion intervention is positively related to improved health and well-being in civilians and older adults. Yet, the impacts of participating in a community-based volunteering program on returning military veterans have not been studied, nor have the outcomes for veterans who have experienced a traumatic brain injury (TBI). This observational, pre-post survey examines health, psychological, and social outcomes from a cohort of post-9/11/01 veterans with (N = 67) and without a reported TBI history (N = 273) who completed a 6-month, 20-hour per week veteran-focused civic service program. This study was approved by the Saint Louis University Institutional Review Board. Veterans with a TBI history who completed the 6-month civic service program conducted by a veteran-focused national nonprofit organization showed significant pre-post improvement (p < 0.05) in overall health, decreased post-traumatic stress disorder (PTSD) symptoms, increased perceived self-efficacy, decreased feelings of isolation and loneliness, and increased perceived availability of social support. These significant findings were not due to participants seeking external help for emotional problems. Out of four aspects of PTSD symptomatology assessed, "feeling numb or detached from others, activities, or surroundings" most accounted for the decrease in PTSD scores. Given this and taken together with the significant decrease in social isolation and loneliness and the social nature of the program, we posit that decreased social isolation and loneliness is the primary driver of the improved psychological and social outcomes documented here. Finally, pre-post change scores did not differ significantly between veterans with and without a TBI, indicating that TBI history did not hinder the ability to benefit from this program. Completion of this civic service program positively impacted veterans with TBI, especially on psychological and social outcomes important to recovery and life satisfaction after TBI. Civic service may provide an innovative approach to promoting wellness in returning veterans with a TBI. Results of this study provide preliminary evidence that civic service decreases social isolation and loneliness in veterans with a reported TBI history. Given our findings, volunteering may prevent against social isolation and be promotional of perceived social support in veterans with TBI. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

“I am not telling. The mobile is telling”: Factors influencing the outcomes of a community health worker mHealth intervention in India

PubMed Central

Dieleman, Marjolein; Kraamwinkel, Nadine; Van Belle, Sara; Chaudoury, Murari; Broerse, Jacqueline E. W.

2018-01-01

Introduction Improving maternal health outcomes remains a priority in Low and Middle Income Countries. With the rapid proliferation of mobile health technologies, there is an increased interest in understanding how these technologies can effectively improve maternal health outcomes particularly maternal health seeking knowledge and behaviors. However, few studies present clear explanations of the program developers’ rationale (theory of change) and contextual factors that could influence program outcomes. This mixed-methods study assesses Mobile for Mothers, a community health workers (CHW) utilized maternal mHealth intervention. We present the program developers’ rationale and utilize it as a framework to guide our study that aimed to identify intervention-related and contextual factors, which influence the observed outcomes of a CHW, utilized mHealth intervention. Materials and methods Quantitative methods (a questionnaire with 740 women who received the intervention and survey of 57 CHWs who utilized the intervention) and qualitative methods (12 interviews and 4 group discussions with CHWs and 20 interviews and 5 group discussions with pregnant and lactating women and 15 interviews and 2 group discussions with men) were conducted. These were used to understand how the mHealth intervention was implemented and to gain insight into contextual factors that potentially influenced the observed intervention outcomes. Results Results were grouped following three categories: (1) perceptions and experiences of CHWs utilizing the mHealth technology; (2) CHW-related outcomes; and (3) contextual factors that influence maternal health-seeking behavior. The overall response of CHWs and community members to the intervention was positive. However, contextual factors like the relationship between the CHWs and their respective communities, the pregnant women’s decision-making power and lack of access due to financial influenced the observed outcomes. Conclusion Mobile health applications are promising interventions for improving the performance of CHWs and health-seeking behavior of pregnant women. However, the contextual factors play a crucial role in intervention outcomes and need to be explicated by program developers during intervention design and implementation. PMID:29584773

Supported Employment Outcomes across a Decade: Is There Evidence of Improvement in the Quality of Implementation?

ERIC Educational Resources Information Center

Mank, David; Cioffi, Andrea; Yovanoff, Paul

2003-01-01

Data from 13 supported employment programs and 680 employees with developmental disabilities show little or no increase in wages or hours outcomes for people in jobs acquired in the late 1990s compared to the early 1990s. There are, however, improvements in the typical features of job acquisition, roles, and orientation. (Contains references.) (CR)

Improved Clinical Outcomes in Patients with Positive Blood Culture by Proactive Intervention of Antimicrobial Use-Impact of Antimicrobial Stewardship Program Implementation on Clinical Practice.

PubMed

Yamada, Takehiro; Kagami, Keisuke; Imai, Shungo; Akizawa, Koji; Iwasaki, Sumio; Fukumoto, Tatsuya; Ishiguro, Nobuhisa; Iseki, Ken

2017-01-01

Bacteremia is one of the most serious infectious illness resulting from nosocomial infection. Therefore, appropriate antimicrobial chemotherapy should be provided as soon as possible to patients exhibiting symptoms of infectious disease and having positive blood culture results. Antimicrobial stewardship (AS) guidelines were recently released by the Infectious Diseases Society of America. The guidelines recommend "proactive intervention and feedback" as one of the core strategies for implementing optimal antimicrobial drug use to improve patient outcomes in clinical settings. We began using the AS program for optimizing antimicrobial chemotherapy in patients with positive blood culture results. The results of blood cultures and antimicrobial prescriptions for the corresponding patients were daily reviewed by a pharmacist and a physician, members of the infection control team (ICT). If the antimicrobial agents selected were inappropriate, ICT made a recommendation to the attending physicians who prescribed the antibiotics. To evaluate the outcomes of this program, we conducted a single-center, retrospective investigation for near a hundred of patients who underwent intervention by infection-control physician and pharmacist. Resolution of bacteremia (determined by blood culture results) was 96.3% in the group that accepted intervention, whereas only 16.7% of the cases resolved in the group that did not accept intervention. These results strongly suggest the importance of the infection disease-specialist team intervention. This program could become an important method for improving clinical outcomes in patients with bacteremia.

Cardiac surgical outcomes improvement led by a physician champion working with a nurse clinical coordinator.

PubMed

Stanford, John R; Swaney-Berghoff, Laurie; Recht, Kimberly

2012-01-01

Cardiac surgical outcomes improvement in a community hospital was driven by a physician champion working with a nurse clinical coordinator. Specific system improvements implemented were (1) nurse checklists of vital signs, cardiovascular function parameters, and life support appliance operation; (2) use of the EuroSCORE system of preoperative patient risk assessment; (3) monthly morbidity and mortality conferences; and (4) daily patient progress tracking. The hospital received 1 star (bottom 12% of hospitals for quality outcomes) from the Society of Thoracic Surgeons Adult Cardiac Database in 2006 prior to program inception, 2 stars (middle 76% of hospitals for quality outcomes) in 2007 and 2008, and 3 stars (top 12% of hospitals) in 2009. The physician and nurse together combined a strategy for clinical improvement with the cultural practices at the hospital to ensure that system improvements approved at the strategic level were implemented at the point of care. Both strategy and culture must be addressed to ensure patient outcomes improvement.

Changes in disability following physical therapy intervention for patients with low back pain: dependence on symptom duration.

PubMed

Badke, Mary Beth; Boissonnault, William G

2006-06-01

To assess the impact of symptom duration on functional outcome, functional improvement, pain, and patient perception of recovery after a physical therapy (PT) program for low back pain (LBP) and to determine what variables are significantly associated with improved function. Retrospective case series. Outpatient setting at a tertiary care facility. Patients (N=130) who were seen for PT between June 2003 and November 2004. A customized rehabilitation program was developed for each patient based on examination findings and included a combination of the following interventions: mobilization/manipulation, flexibility exercises, strengthening exercises, endurance exercises, massage techniques, and heat and cold modalities. Functional outcome, functional improvement, perceived pain, and perceived improvement scores in the CareConnections Outcomes System (formerly TAOS) database. Persons whose symptom duration was greater than 6 months had significantly less functional improvement than persons whose symptom duration was less than 1 month. The median percentage improvement score for perceived recovery was also significantly lower for the chronic group than for the acute group. There was no significant difference in the percentage decrease in pain among the acute, subacute, and chronic groups. In regression analyses, a model with age (P=.001), symptom duration (P=.002), and inclusion of strengthening, flexibility, and mobilization and manipulation exercises (P=.001) fit the data well and explained 55.5% of the variance in functional improvement score for all 3 groups combined. Patients showed improvements in function following a rehabilitation program for LBP. The functional improvement score is influenced by age, symptom duration, and inclusion of mobilization/manipulation and strengthening and flexibility exercises.

The Centers for Disease Control and Prevention: Findings From The National Healthy Worksite Program

PubMed Central

Lang, Jason; Cluff, Laurie; Payne, Julianne; Matson-Koffman, Dyann; Hampton, Joel

2017-01-01

Objective To evaluate employers’ implementation of evidence-based interventions, and changes in employees’ behaviors associated with participating in the national healthy worksite program (NHWP). Methods NHWP recruited 100 small and mid-sized employers and provided training and support for 18 months. Outcome measures were collected with an employer questionnaire, an employee survey, and biometric data at baseline and 18 months later. Results The 41 employers who completed the NHWP implemented significantly more evidence-based interventions and had more comprehensive worksite health promotion programs after participating. Employees made significant improvements in physical activity and nutritional behaviors, but did not significantly improve employee weight. Conclusions Training and technical support can help small and mid-sized employers implement evidence-based health interventions to promote positive employee behavior changes. A longer follow up period may be needed to assess whether NHWP led to improvements in clinical outcomes. PMID:28594703

The Centers for Disease Control and Prevention: Findings From The National Healthy Worksite Program.

PubMed

Lang, Jason; Cluff, Laurie; Payne, Julianne; Matson-Koffman, Dyann; Hampton, Joel

2017-07-01

To evaluate employers' implementation of evidence-based interventions, and changes in employees' behaviors associated with participating in the national healthy worksite program (NHWP). NHWP recruited 100 small and mid-sized employers and provided training and support for 18 months. Outcome measures were collected with an employer questionnaire, an employee survey, and biometric data at baseline and 18 months later. The 41 employers who completed the NHWP implemented significantly more evidence-based interventions and had more comprehensive worksite health promotion programs after participating. Employees made significant improvements in physical activity and nutritional behaviors, but did not significantly improve employee weight. Training and technical support can help small and mid-sized employers implement evidence-based health interventions to promote positive employee behavior changes. A longer follow up period may be needed to assess whether NHWP led to improvements in clinical outcomes.

The Chicago Parent Program: Comparing 1-Year Outcomes for African American and Latino Parents of Young Children

PubMed Central

Breitenstein, Susan M.; Gross, Deborah; Fogg, Louis; Ridge, Alison; Garvey, Christine; Julion, Wrenetha; Tucker, Sharon

2012-01-01

Data were merged from two prevention randomized trials testing 1-year outcomes of a parenting skills program, the Chicago Parent Program (CPP), and comparing its effects for African-American (n=291) versus Latino (n=213) parents and their preschool children. Compared to controls, intervention parents had improved self-efficacy, used less corporal punishment and more consistent discipline, and demonstrated more positive parenting. Intervention children had greater reductions in behavior problems based on parent-report, teacher-report, and observation. Although improvements from CPP were evident for parents in both racial/ethnic groups, Latino parents reported greater improvements in their children’s behavior and in parenting self-efficacy but exhibited greater decreases in praise. Findings support the efficacy of the CPP for African American and Latino parents and young children from low-income urban communities. PMID:22622598

The Chicago Parent Program: comparing 1-year outcomes for African American and Latino parents of young children.

PubMed

Breitenstein, Susan M; Gross, Deborah; Fogg, Louis; Ridge, Alison; Garvey, Christine; Julion, Wrenetha; Tucker, Sharon

2012-10-01

Data were merged from two prevention randomized trials testing 1-year outcomes of a parenting skills program, the Chicago Parent Program (CPP) and comparing its effects for African-American (n = 291) versus Latino (n = 213) parents and their preschool children. Compared to controls, intervention parents had improved self-efficacy, used less corporal punishment and more consistent discipline, and demonstrated more positive parenting. Intervention children had greater reductions in behavior problems based on parent-report, teacher-report, and observation. Although improvements from the CPP were evident for parents in both racial/ethnic groups, Latino parents reported greater improvements in their children's behavior and in parenting self-efficacy but exhibited greater decreases in praise. Findings support the efficacy of the CPP for African American and Latino parents and young children from low-income urban communities. Copyright © 2012 Wiley Periodicals, Inc.

Addressing Literacy and Numeracy to Improve Diabetes Care

PubMed Central

Cavanaugh, Kerri; Wallston, Kenneth A.; Gebretsadik, Tebeb; Shintani, Ayumi; Huizinga, Mary Margaret; Davis, Dianne; Gregory, Rebecca Pratt; Malone, Robb; Pignone, Michael; DeWalt, Darren; Elasy, Tom A.; Rothman, Russell L.

2009-01-01

OBJECTIVE Diabetic patients with lower literacy or numeracy skills are at greater risk for poor diabetes outcomes. This study evaluated the impact of providing literacy- and numeracy-sensitive diabetes care within an enhanced diabetes care program on A1C and other diabetes outcomes. RESEARCH DESIGN AND METHODS In two randomized controlled trials, we enrolled 198 adult diabetic patients with most recent A1C ≥7.0%, referred for participation in an enhanced diabetes care program. For 3 months, control patients received care from existing enhanced diabetes care programs, whereas intervention patients received enhanced programs that also addressed literacy and numeracy at each institution. Intervention providers received health communication training and used the interactive Diabetes Literacy and Numeracy Education Toolkit with patients. A1C was measured at 3 and 6 months follow-up. Secondary outcomes included self-efficacy, self-management behaviors, and treatment satisfaction. RESULTS At 3 months, both intervention and control patients had significant improvements in A1C from baseline (intervention −1.50 [95% CI −1.80 to −1.02]; control −0.80 [−1.10 to −0.30]). In adjusted analysis, there was greater improvement in A1C in the intervention group than in the control group (P = 0.03). At 6 months, there were no differences in A1C between intervention and control groups. Self-efficacy improved from baseline for both groups. No significant differences were found for self-management behaviors or satisfaction. CONCLUSIONS A literacy- and numeracy-focused diabetes care program modestly improved self-efficacy and glycemic control compared with standard enhanced diabetes care, but the difference attenuated after conclusion of the intervention. PMID:19741187

Quantitative Improvements in Hop Test Scores After a 6-Week Neuromuscular Training Program.

PubMed

Meierbachtol, Adam; Rohman, Eric; Paur, Eric; Bottoms, John; Tompkins, Marc

2016-09-12

In patients who have undergone anterior cruciate ligament reconstruction (ACLR), the effect of neuromuscular re-education (NMR) programs on standard hop tests outcomes, including limb symmetry indices (LSIs), is unknown. Both legs will show improvement in hop test-measured units after neuromuscular training, but the involved leg will show relatively greater improvement leading to improved limb symmetry. Patients younger than 18 years will show more improvement than patients who are older. Retrospective cohort study. Level 3. Patients self-selected their participation in this NMR program, which was completed after traditional outpatient physical therapy. Pre- and post-hop test scores were recorded as the primary outcome measure. Seventy-one patients met the inclusion criteria and completed hop testing. Overall, the involved leg showed significant improvements (pretest/posttest) for single-leg hop (138.30 cm/156.89 cm), triple crossover hop (370.05 cm/423.11 cm), and timed hop (2.21 s/1.99 s). Similarly, on the uninvolved leg, improvements were seen for the single-leg hop (159.30 cm/171.87 cm) and triple crossover hop (427.50 cm/471.27 cm). Overall mean limb symmetry improved across all 4 hop tests, but there was significant improvement only on the single-leg hop (87% pretest to 92% posttest). Patients younger than 18 years showed mean significant LSI improvement on the triple crossover hop. Utilizing an intensive 6-week NMR program after ACLR prior to return to sport can improve quantitative hop test measurements. Patients younger than 18 years had greater improvement than those 18 years and older. Advanced NMR programs can be successfully utilized in the postoperative ACLR setting to improve quantitative limb symmetry. © 2016 The Author(s).

Quantitative Improvements in Hop Test Scores After a 6-Week Neuromuscular Training Program

PubMed Central

Meierbachtol, Adam; Rohman, Eric; Paur, Eric; Bottoms, John; Tompkins, Marc

2016-01-01

Background: In patients who have undergone anterior cruciate ligament reconstruction (ACLR), the effect of neuromuscular re-education (NMR) programs on standard hop tests outcomes, including limb symmetry indices (LSIs), is unknown. Hypothesis: Both legs will show improvement in hop test–measured units after neuromuscular training, but the involved leg will show relatively greater improvement leading to improved limb symmetry. Patients younger than 18 years will show more improvement than patients who are older. Study Design: Retrospective cohort study. Level of Evidence: Level 3. Methods: Patients self-selected their participation in this NMR program, which was completed after traditional outpatient physical therapy. Pre– and post–hop test scores were recorded as the primary outcome measure. Results: Seventy-one patients met the inclusion criteria and completed hop testing. Overall, the involved leg showed significant improvements (pretest/posttest) for single-leg hop (138.30 cm/156.89 cm), triple crossover hop (370.05 cm/423.11 cm), and timed hop (2.21 s/1.99 s). Similarly, on the uninvolved leg, improvements were seen for the single-leg hop (159.30 cm/171.87 cm) and triple crossover hop (427.50 cm/471.27 cm). Overall mean limb symmetry improved across all 4 hop tests, but there was significant improvement only on the single-leg hop (87% pretest to 92% posttest). Patients younger than 18 years showed mean significant LSI improvement on the triple crossover hop. Conclusion: Utilizing an intensive 6-week NMR program after ACLR prior to return to sport can improve quantitative hop test measurements. Patients younger than 18 years had greater improvement than those 18 years and older. Clinical Relevance: Advanced NMR programs can be successfully utilized in the postoperative ACLR setting to improve quantitative limb symmetry. PMID:27620968

Scaling Up a Water, Sanitation, and Hygiene Program in Rural Bangladesh: The Role of Program Implementation

PubMed Central

Sultana, Sonia; Halder, Amal K.; Ahsan, Mohammed Ali; Arnold, Benjamin F.; Hubbard, Alan E.; Unicomb, Leanne; Luby, Stephen P.; Colford, John M.

2017-01-01

Objectives. To evaluate whether the quality of implementation of a water, sanitation, and hygiene program called SHEWA-B and delivered by UNICEF to 20 million people in rural Bangladesh was associated with health behaviors and sanitation infrastructure access. Methods. We surveyed 33 027 households targeted by SHEWA-B and 1110 SHEWA-B hygiene promoters in 2011 and 2012. We developed an implementation quality index and compared the probability of health behaviors and sanitation infrastructure access in counterfactual scenarios over the range of implementation quality. Results. Forty-seven percent of households (n = 14 622) had met a SHEWA-B hygiene promoter, and 47% of hygiene promoters (n = 527) could recall all key program messages. The frequency of hygiene promoter visits was not associated with improved outcomes. Higher implementation quality was not associated with better health behaviors or infrastructure access. Outcomes differed by only 1% to 3% in scenarios in which all clusters received low versus high implementation quality. Conclusions. SHEWA-B did not meet UNICEF’s ideal implementation quality in any area. Improved implementation quality would have resulted in marginal changes in health behaviors or infrastructure access. This suggests that SHEWA-B’s design was suboptimal for improving these outcomes. PMID:28323462

Evaluation of a home-based exercise program in the treatment of Alzheimer's disease: the Maximizing Independence in Dementia (MIND) study.

PubMed

Steinberg, Martin; Leoutsakos, Jeannie-Marie Sheppard; Podewils, Laura Jean; Lyketsos, C G

2009-07-01

To determine the feasibility and efficacy of a home-based exercise intervention program to improve the functional performance of patients with Alzheimer's Disease (AD). Twenty-seven home-dwelling patients with AD were randomized to either an exercise intervention program delivered by their caregivers or a home safety assessment control. Measures of functional performance (primary), cognition, neuropsychiatric symptoms, quality of life and caregiver burden (secondary) were obtained at baseline and at 6 and 12 weeks following randomization. For each outcome measure, intent-to-treat analyses using linear random effects models were performed. Feasibility and adverse events were also assessed. Adherence to the exercise program was good. On the primary outcomes (functional performance) patients in the exercise group demonstrated a trend for improved performance on measures of hand function and lower extremity strength. On secondary outcome measures, trends toward worse depression and lower quality of life ratings were noted. The physical exercise intervention developed for the study, delivered by caregivers to home-dwelling patients with AD, was feasible and was associated with a trend for improved functional performance in this group of frail patients. Given the limited efficacy to date of pharmacotherapies for AD, further study of exercise intervention, in a variety of care setting, is warranted.

Evaluating the cost-effectiveness of cancer patient navigation programs: conceptual and practical issues.

PubMed

Ramsey, Scott; Whitley, Elizabeth; Mears, Victoria Warren; McKoy, June M; Everhart, Rachel M; Caswell, Robert J; Fiscella, Kevin; Hurd, Thelma C; Battaglia, Tracy; Mandelblatt, Jeanne

2009-12-01

Patient navigators-individuals who assist patients through the healthcare system to improve access to and understanding of their health and healthcare-are increasingly used for underserved individuals at risk for or with cancer. Navigation programs can improve access, but it is unclear whether they improve the efficiency and efficacy of cancer diagnostic and therapeutic services at a reasonable cost, such that they would be considered cost-effective. In the current study, the authors outline a conceptual model for evaluating the cost-effectiveness of cancer navigation programs. They describe how this model is being applied to the Patient Navigation Research Program, a multicenter study supported by the National Cancer Institute's Center to Reduce Cancer Health Disparities. The Patient Navigation Research Program is testing navigation interventions that aim to reduce time to delivery of quality cancer care (noncancer resolution or cancer diagnosis and treatment) after identification of a screening abnormality. Examples of challenges to evaluating cost-effectiveness of navigation programs include the heterogeneity of navigation programs, the sometimes distant relation between navigation programs and outcome of interest (eg, improving access to prompt diagnostic resolution and life-years gained), and accounting for factors in underserved populations that may influence both access to services and outcomes. In this article, the authors discuss several strategies for addressing these barriers. Evaluating the costs and impact of navigation will require some novel methods, but will be critical in recommendations concerning dissemination of navigation programs. (c) 2009 American Cancer Society.

A Transplant-Specific Quality Initiative-Introducing TransQIP: A Joint Effort of the ASTS and ACS.

PubMed

Parekh, J; Ko, C; Lappin, J; Greenstein, S; Hirose, R

2017-07-01

In an attempt to improve surgical quality in the field of transplantation, the American College of Surgeons (ACS) and American Society of Transplant Surgeons have initiated a national quality improvement program in transplantation. This transplant-specific quality improvement program, called TransQIP, has been built from the ground up by transplant surgeons and captures detailed information on donor and recipient factors as well as transplant-specific outcomes. It is built upon the existing ACS/National Surgical Quality Improvement Program infrastructure and is designed to capture 100% of liver and kidney transplants performed at participating sites. TransQIP has completed its alpha pilot and will embark upon its beta phase at approximately 30 centers in the spring of 2017. Going forward, we anticipate TransQIP will help satisfy Centers for Medicare and Medicaid Services requirements for a quality improvement program, surgeon requirements for maintenance of certification, and qualify as a clinical practice improvement activity under the Merit-Based Incentive Payment System. Most importantly, we believe TransQIP will provide insight into surgical outcomes in transplantation that will allow the field to provide better care to our patients. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

Sequential Multiple Assignment Randomized Trial (SMART) with Adaptive Randomization for Quality Improvement in Depression Treatment Program

PubMed Central

Chakraborty, Bibhas; Davidson, Karina W.

2015-01-01

Summary Implementation study is an important tool for deploying state-of-the-art treatments from clinical efficacy studies into a treatment program, with the dual goals of learning about effectiveness of the treatments and improving the quality of care for patients enrolled into the program. In this article, we deal with the design of a treatment program of dynamic treatment regimens (DTRs) for patients with depression post acute coronary syndrome. We introduce a novel adaptive randomization scheme for a sequential multiple assignment randomized trial of DTRs. Our approach adapts the randomization probabilities to favor treatment sequences having comparatively superior Q-functions used in Q-learning. The proposed approach addresses three main concerns of an implementation study: it allows incorporation of historical data or opinions, it includes randomization for learning purposes, and it aims to improve care via adaptation throughout the program. We demonstrate how to apply our method to design a depression treatment program using data from a previous study. By simulation, we illustrate that the inputs from historical data are important for the program performance measured by the expected outcomes of the enrollees, but also show that the adaptive randomization scheme is able to compensate poorly specified historical inputs by improving patient outcomes within a reasonable horizon. The simulation results also confirm that the proposed design allows efficient learning of the treatments by alleviating the curse of dimensionality. PMID:25354029

Universal Free School Breakfast: A Qualitative Process Evaluation According to the Perspectives of Senior Stakeholders.

PubMed

Harvey-Golding, Louise; Donkin, Lynn Margaret; Defeyter, Margaret Anne

2016-01-01

In the last decade, the provision of school breakfast has increased significantly in the UK. However, there is an absence of knowledge regarding senior stakeholder views on the processes and potential outcomes on different groups, within the communities served by school breakfast programs. The purpose of this study was to examine the views and experiences of senior level stakeholders and thereby provide an original qualitative contribution to the research. A sample of senior level stakeholders was recruited, including senior officers, directors, and elected members, from within a Local Authority (LA) involved in the leadership, implementation and delivery of a council-wide universal free school breakfast (UFSB) program, and from the senior staff body of mainstream primary and special schools, participating in the program. A grounded theory analysis of the data collected identified issues encountered in the implementation and delivery, and views on the funding and future of a USFB program, in addition to perceived outcomes for children, parents, families, schools, and the wider community. The results refer to both positive and negative issues and implications associated with the program, according to the perspectives of senior level stakeholders. Perceived positive outcomes included benefits to children, families, schools, and the community. For instance, alleviating hunger, improving health outcomes, and conferring financial benefits, with the potential to cumulate in overall improvements in educational, social, and behavioral outcomes. Reported negative implications included the absence of an effective communication strategy in implementing the USFB program; in addition to concerns about the impacts of "double-breakfasting" on obesity levels among children, particularly in less deprived communities. Findings were validated using theoretical sampling and saturation, triangulation methods, member checks, and inter-rater reliability measures. In presenting these findings, this paper provides a unique qualitative insight into the processes, issues and outcomes of a council-wide UFSB program within a socioeconomically deprived community, according to the perceptions of senior level stakeholders.

Feasibility and Effectiveness of a Pilot Health Promotion Program for Adults With Type 2 Diabetes

PubMed Central

Kluding, Patricia M.; Singh, Rupali; Goetz, Jeanine; Rucker, Jason; Bracciano, Sarah; Curry, Natasha

2013-01-01

Purpose The purpose of this pilot study was to assess the feasibility and effectiveness of an intense health promotion program in older adults with diabetes. The program combined individually prescribed and supervised exercise with nutrition and education programs on glycemic control and aerobic fitness. Methods Various recruitment and retention strategies were analyzed for effectiveness. Out of 28 potential subjects assessed for eligibility, 6 subjects with type 2 diabetes (2 male and 4 female; all white; age, 60.2 ± 4.7 years) participated in the 10-week intervention. Aerobic and resistance exercise was performed on alternate days (3-4 days per week), with individualized nutrition counseling and diabetes health education sessions once weekly. The primary outcome measures were aerobic fitness and glycemic control (A1C), and secondary outcome measures included body mass index (BMI), self-efficacy, and symptoms of neuropathy. Changes in outcomes were assessed using descriptive statistics and paired t test analysis (α = .05). Results Following the intervention, subjects had improvements that approached significance in A1C and pain, with significant improvements in self-efficacy. Conclusions A systematic approach to analysis of feasibility revealed issues with recruitment and retention that would need to be addressed for future studies or clinical implementation of this program. However, for the subset of subjects who did complete the intervention, adherence was excellent, and satisfaction with the program was confirmed by exit interview comments. Following participation in this pilot health promotion program, subjects had meaningful improvements in glycemic control, pain, and self-efficacy. PMID:20530663

Costs and Consequences of a Cash Transfer for Hospital Births in a Rural District of Uttar Pradesh, India

PubMed Central

Coffey, Diane

2014-01-01

The Janani Suraksha Yojana, India’s “safe motherhood program,” is a conditional cash transfer to encourage women to give birth in health facilities. Despite the program’s apparent success in increasing facility-based births, quantitative evaluations have not found corresponding improvements in health outcomes. This study analyses original qualitative data collected between January, 2012 and November, 2013 in a rural district in Uttar Pradesh to address the question of why the program has not improved health outcomes. It finds that health service providers are focused on capturing economic rents associated with the program, and provide an extremely poor quality care. Further, the program does not ultimately provide beneficiaries a large net monetary transfer at the time of birth. Based on a detailed accounting of the monetary costs of hospital and home deliveries, this study finds that the value of the transfer to beneficiaries is small due to costs associated with hospital births. Finally, this study also documents important emotional and psychological costs to women of delivering in the hospital. These findings suggest the need for a substantial rethinking of the program, paying careful attention to incentivizing health outcomes. PMID:24911512

Evaluating the effectiveness of reasoning training in military and civilian chronic traumatic brain injury patients: study protocol

PubMed Central

2013-01-01

Background Individuals who sustain traumatic brain injuries (TBIs) often continue to experience significant impairment of cognitive functions mediated by the prefrontal cortex well into chronic stages of recovery. Traditional brain training programs that focus on improving specific skills fall short of addressing integrative functions that draw upon multiple higher-order processes critical for social and vocational integration. In the current study, we compare the effects of two short-term, intensive, group-based cognitive rehabilitation programs for individuals with chronic TBI. One program emphasizes learning about brain functions and influences on cognition, while the other program adopts a top-down approach to improve abstract reasoning abilities that are largely reliant on the prefrontal cortex. These treatment programs are evaluated in civilian and military veteran TBI populations. Methods/design One hundred individuals are being enrolled in this double-blinded clinical trial (all measures and data analyses will be conducted by blinded raters and analysts). Each individual is randomly assigned to one of two treatment conditions, with each condition run in groups of five to seven individuals. The primary anticipated outcomes are improvement in abstract reasoning and everyday life functioning, measured through behavioral tasks and questionnaires, and attention modulation, as measured by functional neuroimaging. Secondary expected outcomes include improvements in the cognitive processes of working memory, attention, and inhibitory control. Discussion Results of this trial will determine whether cognitive rehabilitation aimed at teaching TBI-relevant information about the brain and cognition versus training in TBI-affected thinking abilities (e.g., memory, attention, and executive functioning) can improve outcomes in chronic military and civilian TBI patient populations. It should shed light on the nature of improvements and the characteristics of patients most likely to benefit. This trial will also provide information about the sustainability of treatment-related improvements 3 months post-training. Trial registration ClinicalTrials.gov Identifier: NCT01552473 PMID:23363480

Can technology and the media help reduce dysfunctional parenting and increase engagement with preventative parenting interventions?

PubMed

Calam, Rachel; Sanders, Matthew R; Miller, Chloe; Sadhnani, Vaneeta; Carmont, Sue-Ann

2008-11-01

In an evaluation of the television series "Driving Mum and Dad Mad," 723 families participated and were randomly assigned to either a standard or technology enhanced viewing condition (included additional Web-support). Parents in both conditions reported significant improvements from pre- to postintervention in their child's behavior, dysfunctional parenting, parental anger, depression, and self-efficacy. Short-term improvements were maintained at 6-months follow-up. Regressions identified predictors of program outcomes and level of involvement. Parents who watched the entire series had more severe problems at preintervention and high sociodemographic risk than parents who did not watch the entire series. Few sociodemographic, child, or parent variables assessed at preintervention predicted program outcomes or program engagement, suggesting that a wide range of parents from diverse socioeconomic status benefited from the program. Media interventions depicting evidence-based parenting programs may be a useful means of reaching hard to engage families in population-level child maltreatment prevention programs.

Meals, Mindfulness, & Moving Forward: A feasibility study to a multi-modal lifestyle approach in early psychosis.

PubMed

Usher, Craigan; Thompson, Andie; Griebeler, Meridith; Senders, Angela; Seibel, Celeste; Ly, Richard; Murchison, Charles; Hagen, Kirsten; Afong, Keith-Allen; Bourdette, Dennis; Ross, Rachel; Borgatti, Alena; Shinto, Lynne

2018-03-07

The primary aim was to demonstrate adherence to a novel 6-week lifestyle intervention program ("Meals, Mindfulness, & Moving Forward" [M 3 ]) designed to help improve lifestyle practices of youth with a history of at least 1 psychotic episode. M 3 used a non-equivalent control group design involving clients from a community early intervention program. Seventeen individuals in the active M 3 program and 16 controls were assessed for secondary outcomes at baseline, 6-weeks, and 12-weeks (6 weeks post-intervention) on cardiometabolic and symptomatic outcomes. The program met its primary aim with 88% (15/17) of participants meeting adherence criteria. Compared with the controls, M 3 participants showed significant improvement in positive psychotic symptoms (P = .002). This pilot study showed that young people involved in a community early intervention program adhered to an activity-based lifestyle program which included mindfulness meditation, yoga and nutrition education, warranting further evaluation with a larger sample size. © 2018 John Wiley & Sons Australia, Ltd.

Academic Facility Utilization and Survival Outcomes in Adult Head and Neck Sarcomas: An NCDB Analysis.

PubMed

Cannon, Richard B; Carpenter, Patrick S; Boothe, Dustin; Buchmann, Luke O; Hunt, Jason P; Lloyd, Shane; Hitchcock, Ying J; Houlton, Jeffrey J; Weis, John R; Shepherd, Hailey M; Monroe, Marcus M

2018-04-01

Objectives To investigate clinicopathologic and treatment factors associated with survival in adult head and neck sarcomas in the National Cancer Database (NCDB). To analyze whether treatment settings and therapies received influence survival outcomes and to compare trends in utilization via an aggregated national data set. Study Design Prospectively gathered data. Setting NCDB. Subjects and Methods The study comprised a total of 6944 adult patients treated for a head and neck sarcoma from January 2004 to December 2013. Overall survival (OS) was the primary outcome. Results Increased age and tumor size, nodal involvement, and poorly differentiated histology had significantly reduced OS ( P < .001). Angiosarcoma, malignant nerve sheath tumor, malignant fibrous histiocytoma, osteosarcoma, and rhabdomyosarcoma histologic subtypes had significantly reduced OS, while liposarcoma, chondrosarcoma, and chordoma had improved OS ( P < .001). Utilization of surgical therapy was associated with improved OS, while positive surgical margins were associated with treatment at a community-based cancer program and had reduced OS ( P < .001). On multivariate analysis, treatment with radiation and/or chemotherapy was not significantly associated with OS; however, primary treatment with definitive chemoradiotherapy had significantly reduced OS. Patients treated at academic/research cancer programs (n = 3874) had significantly improved 5- and 10-year OS (65% and 54%, respectively) when compared with patients treated at community-based cancer programs (n = 3027; 49% and 29%; P < .001). The percentage utilization of these programs (56% vs 44%) did not change over the study period. Conclusion For adult head and neck sarcomas, treatment at an academic/research cancer program was associated with improved survival; however, despite increasing medical specialization, the percentage utilization of these programs for this rare tumor remains constant.

Should Physical Activity Be Included in Nutrition Education? A Comparison of Nutrition Outcomes with and without In-Class Activities

ERIC Educational Resources Information Center

Palmer-Keenan, Debra M.; Corda, Kirsten

2014-01-01

Limited-resource adults' dietary intakes and nutrition behaviors improve as a result of Expanded Food and Nutrition Education Program (EFNEP)/Supplemental Nutrition Assistance Program Education (SNAP-Ed) participation; however, physical activity education is needed for improved health. The experimental study reported here assessed if spending time…

School-Based Mentoring Programs: Using Volunteers to Improve the Academic Outcomes of Underserved Students

ERIC Educational Resources Information Center

Bayer, Amanda; Grossman, Jean Baldwin; DuBois, David L.

2013-01-01

Previous research suggests that school-based mentoring programs like those offered by Big Brothers Big Sisters of America (BBBSA) yield small but statistically significant improvements in the academic performance of mentored students and in their beliefs in their own scholastic efficacy. The present study uses data from a randomized control trial…

Thinking Big: A Framework for States on Scaling Up Community College Innovation

ERIC Educational Resources Information Center

Asera, Rose; McDonnell, Rachel Pleasants; Soricone, Lisa; Anderson, Nate; Endel, Barbara

2013-01-01

It is a truism of American social policy that our nation has great success generating innovative programs that improve outcomes for participants--but that we are far less effective at moving from small, "boutique" programs into broadly applied solutions that improve the prospects of large numbers of individuals. This is certainly true in…

Development of an in-home standardized end-of-life treatment program for pediatric patients dying of brain tumors.

PubMed

Arland, Lesley C; Hendricks-Ferguson, Verna L; Pearson, Joanne; Foreman, Nicholas K; Madden, Jennifer R

2013-04-01

To evaluate an end-of-life (EOL) program related to specific outcomes (i.e., number of hospitalizations and place of death) for children with brain tumors. From 1990 to 2005, a retrospective chart review was performed related to specified outcomes for 166 children with admission for pediatric brain tumors. Patients who received the EOL program were hospitalized less often (n = 114; chi-square = 5.001 with df = 1, p <.05) than patients who did not receive the program. An EOL program may improve symptom management and decrease required hospital admissions for children with brain tumors. © 2013, Wiley Periodicals, Inc.

A Systematic Review of Interventions to Change Staff Care Practices in Order to Improve Resident Outcomes in Nursing Homes

PubMed Central

Low, Lee-Fay; Fletcher, Jennifer; Goodenough, Belinda; Jeon, Yun-Hee; Etherton-Beer, Christopher; MacAndrew, Margaret; Beattie, Elizabeth

2015-01-01

Background We systematically reviewed interventions that attempted to change staff practice to improve long-term care resident outcomes. Methods Studies met criteria if they used a control group, included 6 or more nursing home units and quantitatively assessed staff behavior or resident outcomes. Intervention components were coded as including education material, training, audit and feedback, monitoring, champions, team meetings, policy or procedures and organizational restructure. Results Sixty-three unique studies were broadly grouped according to clinical domain—oral health (3 studies), hygiene and infection control (3 studies), nutrition (2 studies), nursing home acquired pneumonia (2 studies), depression (2 studies) appropriate prescribing (7 studies), reduction of physical restraints (3 studies), management of behavioral and psychological symptoms of dementia (6 studies), falls reduction and prevention (11 studies), quality improvement (9 studies), philosophy of care (10 studies) and other (5 studies). No single intervention component, combination of, or increased number of components was associated with greater likelihood of positive outcomes. Studies with positive outcomes for residents also tended to change staff behavior, however changing staff behavior did not necessarily improve resident outcomes. Studies targeting specific care tasks (e.g. oral care, physical restraints) were more likely to produce positive outcomes than those requiring global practice changes (e.g. care philosophy). Studies using intervention theories were more likely to be successful. Program logic was rarely articulated, so it was often unclear whether there was a coherent connection between the intervention components and measured outcomes. Many studies reported barriers relating to staff (e.g. turnover, high workload, attitudes) or organizational factors (e.g. funding, resources, logistics). Conclusion Changing staff practice in nursing homes is possible but complex. Interventionists should consider barriers and feasibility of program components to impact on each intended outcome. PMID:26559675

Data for free--can an electronic medical record provide outcome data for incontinence/prolapse repair procedures?

PubMed

Steidl, Matthew; Zimmern, Philippe

2013-01-01

We determined whether a custom computer program can improve the extraction and accuracy of key outcome measures from progress notes in an electronic medical record compared to a traditional data recording system for incontinence and prolapse repair procedures. Following institutional review board approval, progress notes were exported from the Epic electronic medical record system for outcome measure extraction by a custom computer program. The extracted data (D1) were compared against a manually maintained outcome measures database (D2). This work took place in 2 phases. During the first phase, volatile data such as questionnaires and standardized physical examination findings using the POP-Q (pelvic organ prolapse quantification) system were extracted from existing progress notes. The second phase used a progress note template incorporating key outcome measures to evaluate improvement in data accuracy and extraction rates. Phase 1 compared 6,625 individual outcome measures from 316 patients in D2 to 3,534 outcome measures extracted from progress notes in D1, resulting in an extraction rate of 53.3%. A subset of 3,763 outcome measures from D1 was created by excluding data that did not exist in the extraction, yielding an accuracy rate of 93.9%. With the use of the template in phase 2, the extraction rate improved to 91.9% (273 of 297) and the accuracy rate improved to 100% (273 of 273). In the field of incontinence and prolapse, the disciplined use of an electronic medical record template containing a preestablished set of key outcome measures can provide the ideal interface between required documentation and clinical research. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

"You Think You're Helping Them, But They're Helping You Too": Experiences of Scottish Male Young Offenders Participating in a Dog Training Program.

PubMed

Leonardi, Rebecca J; Buchanan-Smith, Hannah M; McIvor, Gill; Vick, Sarah-Jane

2017-08-22

Interaction with animals can be beneficial to humans and animal-assisted interventions (AAIs) are increasingly popular in a range of contexts. Dog training programs (DTPs) are the most popular form of AAI in custodial contexts; prisoners often have multiple needs and DTPs seem to facilitate a diverse range of positive outcomes, including improvements in well-being, behavior, and offending behavior. However, evidence on the efficacy of prison-based DTPs is still limited and these evaluations often lack detail or methodological rigor. We examined the experiences of male young offenders (N = 70) using thematic analysis of semi-structured interviews conducted following completion of a DTP. The themes that emerged indicated a broad range of inter-related experiences and positive outcomes. The most prevalent theme related to their experiences with Dogs (including feelings and attitudes), and there were perceived improvements categorized as: Positive Effects (including mood and well-being), Motivation, Charitable Purpose, Self-Efficacy, Improved Skills, Impulsivity, and Emotional Management. These themes mapped well onto outcomes previously identified in research on DTPs, and to the program's core aims of improving behavior, educational engagement, employability, and well-being. The diversity and nature of these themes indicates that DTPs have considerable potential to engage and benefit those individuals with multiple needs, such as young offenders, and ultimately to achieve positive long-term outcomes with significant social, health, and economic impact.

Universal Course Shell Template Design and Implementation to Enhance Student Outcomes in Online Coursework

ERIC Educational Resources Information Center

Borgemenke, Arthur J.; Holt, William C.; Fish, Wade W.

2013-01-01

Instructors are continually looking for means to improve outcomes for students in online courses. This article examines the instructional design of courses to determine if consistent components implemented in a recently established online master's degree program can produce significant student outcomes. The authors detail the construction and…

A Comparative Analysis of the Financial Incentives of Two Distinct Experience-Rating Programs.

PubMed

Tompa, Emile; McLeod, Chris; Mustard, Cam

2016-07-01

The aim of this study was to compare the association between insurance premium incentives and claim outcomes in two different workers' compensation programs. Regression models were run for claim outcomes using data from two Canadian jurisdictions with different experience-rating programs-one with prospective (British Columbia) and another with retrospective (Ontario) adjustment of premiums. Key explanatory variables were past premium adjustments. For both programs, past premium adjustments were significantly associated with claim outcomes, suggesting adjustments provided incentives for claims reduction. The magnitudes of effects in the prospective program were smaller than the retrospective one, though relative persistence of effects over time was larger. Having large and immediate employer responses to incentives may appear desirable, but insurers should consider the time required for employers to improve and sustain good practices, and create incentives that parallel such time lines.

Pharmacoeconomics and outcomes research degree-granting PhD programs in the United States.

PubMed

Slejko, Julia F; Libby, Anne M; Nair, Kavita V; Valuck, Robert J; Campbell, Jonathan D

2013-01-01

Evidence is missing on showcasing current practices of degree programs specific to the field of pharmaceutical outcomes research. To measure current practices of pharmacoeconomics and outcomes research PhD programs in the United States and synthesize recommendations for improving the success of programs and prospective students. A 23-question online survey instrument was created and distributed to 32 program directors identified in the International Society for Pharmacoeconomics and Outcomes Research educational directory. Descriptive statistics summarized both the program characteristics (including observed and desired number of faculty and students) and training recommendations (traits of program and student success). Of 30 eligible programs that conferred a PhD in pharmacoeconomics, pharmaceutical outcomes research, or a related field, 16 respondents (53%) completed the survey. Seventy-five percent of respondents were located in a school of pharmacy. The average observed number of faculty (7.5) and students (11.5) was lower than the average desired numbers (8.1) and (14.7), respectively. Reputation of faculty research and a collaborative environment with other disciplines were rated highest for a program's success. Faculty's mentoring experience and reputation and student funding opportunities were rated highest for prospective students' success. Existing and emerging programs as well as prospective students can use these findings to further their chances of success. Copyright © 2013 Elsevier Inc. All rights reserved.

What Are Achievement Gains Worth--to Teachers?

ERIC Educational Resources Information Center

Marsh, Julie A.; McCaffrey, Daniel F.

2011-01-01

In 2007, New York City schools commenced a school-level pay-for-performance program for teachers and staff in about 200 schools. The authors found that the program didn't improve schools or student outcomes. Why? Because the program failed to create conditions that theory suggests are necessary for performance-based incentive programs to change…

Leveraging data to systematically improve care: coronary artery disease management at Geisinger.

PubMed

Graf, Thomas; Erskine, Alistair; Steele, Glenn D

2014-01-01

Coronary artery disease is complex chronic disease best managed by a team empowered by actionable data and a comprehensive approach, the ability to improve intermediate outcomes was dramatically enhanced after Geisinger created a system of care to do so. Continuous measurement of critical data elements of process and intermediate outcome measures allows the delivery of actionable information to the most appropriate team member, including the patients and family as team members. Continuous monitoring of the overall program looking for trends and opportunities across sites and regions allows for program enhancements. The comprehensive "all-or-none" bundled approach to care, which has already realized a 300% improvement, will be further enhanced by incorporating additional "Big Data" flows.

Improving Outcomes for New York City's Disconnected Youth: Lessons from the Implementation of the Young Adult Literacy Program

ERIC Educational Resources Information Center

Hossain, Farhana; Terwelp, Emily

2015-01-01

In 2008, New York City's Center for Economic Opportunity (CEO) launched the Young Adult Literacy (YAL) program to improve the academic and work-readiness skills of youth who are not in school, do not have a job, and have very low literacy skills. The YAL program targets 16- to 24-year-old young adults who read at the fourth-through eighth-grade…

STEM enrichment programs and graduate school matriculation: the role of science identity salience

PubMed Central

Serpe, Richard T.

2013-01-01

Improving the state of science education in the United States has become a national priority. One response to this problem has been the implementation of STEM enrichment programs designed to increase the number of students that enter graduate programs in science. Current research indicates enrichment programs have positive effects for student performance, degree completion, interest in science and graduate enrollment. Moreover, research suggests that beyond improving performance in STEM, and providing access to research experience and faculty mentoring, enrichment programs may also increase the degree to which students identify as scientists. However, researchers investigating the role of science identity on student outcomes have focused primarily on subjective outcomes, leaving a critical question of whether science identity also influences objective outcomes such as whether students attend graduate school. Using identity theory, this study addresses this issue by investigating science identity as a mechanism linking enrichment program participation to matriculation into graduate science programs. Quantitative results from a panel study of 694 students indicate that science identity salience, along with research experience and college GPA, mediate the effect of enrichment program participation on graduate school matriculation. Further, results indicate that although the social psychological process by which science identity salience develops operates independently from student GPA, science identity amplifies the effect of achievement on graduate school matriculation. These results indicate that policies seeking to increase the efficacy of enrichment programs and increase representation in STEM graduate programs should be sensitive to the social and academic aspects of STEM education. PMID:24578606

STEM enrichment programs and graduate school matriculation: the role of science identity salience.

PubMed

Merolla, David M; Serpe, Richard T

2013-12-01

Improving the state of science education in the United States has become a national priority. One response to this problem has been the implementation of STEM enrichment programs designed to increase the number of students that enter graduate programs in science. Current research indicates enrichment programs have positive effects for student performance, degree completion, interest in science and graduate enrollment. Moreover, research suggests that beyond improving performance in STEM, and providing access to research experience and faculty mentoring, enrichment programs may also increase the degree to which students identify as scientists. However, researchers investigating the role of science identity on student outcomes have focused primarily on subjective outcomes, leaving a critical question of whether science identity also influences objective outcomes such as whether students attend graduate school. Using identity theory, this study addresses this issue by investigating science identity as a mechanism linking enrichment program participation to matriculation into graduate science programs. Quantitative results from a panel study of 694 students indicate that science identity salience, along with research experience and college GPA, mediate the effect of enrichment program participation on graduate school matriculation. Further, results indicate that although the social psychological process by which science identity salience develops operates independently from student GPA, science identity amplifies the effect of achievement on graduate school matriculation. These results indicate that policies seeking to increase the efficacy of enrichment programs and increase representation in STEM graduate programs should be sensitive to the social and academic aspects of STEM education.

Evaluating community-based public health leadership training.

PubMed

Ceraso, Marion; Gruebling, Kirsten; Layde, Peter; Remington, Patrick; Hill, Barbara; Morzinski, Jeffrey; Ore, Peggy

2011-01-01

Addressing the nation's increasingly complex public health challenges will require more effective multisector collaboration and stronger public health leadership. In 2005, the Healthy Wisconsin Leadership Institute launched an annual, year-long intensive "community teams" program. The goal of this program is to develop collaborative leadership and public health skills among Wisconsin-based multisectoral teams mobilizing their communities to improve public health. To measure the scope of participation and program impacts on individual learning and practice, including application of new knowledge and collective achievements of teams on coalition and short-term community outcomes. End-of-year participant program evaluations and follow-up telephone interviews with participants 20 months after program completion. Community-based public health leadership training program. Sixty-eight participants in the Community Teams Program during the years 2006 to 2007 and 2007 to 2008. Professional diversity of program participants; individual learning and practice, including application of new knowledge; and collective achievements of teams, including coalition and short-term community outcomes. Participants in the Community Teams Program represent a diversity of sectors, including nonprofit, governmental, academic, business, and local public health. Participation increased knowledge across all public health and leadership competency areas covered in the program. Participating teams reported outcomes, including increased engagement of community leadership, expansion of preventive services, increased media coverage, strengthened community coalitions, and increased grant funding. Evaluation of this community-based approach to public health leadership training has shown it to be a promising model for building collaborative and public health leadership skills and initiating sustained community change for health improvement.

The Case for Diabetes Population Health Improvement: Evidence-Based Programming for Population Outcomes in Diabetes

PubMed Central

Maruthur, Nisa; Mathioudakis, Nestoras; Spanakis, Elias; Rubin, Daniel; Zilbermint, Mihail; Hill-Briggs, Felicia

2017-01-01

Purpose of Review The goal of this review is to describe diabetes within a population health improvement framework and to review the evidence for a diabetes population health continuum of intervention approaches, including diabetes prevention and chronic and acute diabetes management, to improve clinical and economic outcomes. Recent Findings Recent studies have shown that compared to usual care, lifestyle interventions in prediabetes lower diabetes risk at the population-level and that group-based programs have low incremental medial cost effectiveness ratio for health systems. Effective outpatient interventions that improve diabetes control and process outcomes are multi-level, targeting the patient, provider, and healthcare system simultaneously and integrate community health workers as a liaison between the patient and community-based healthcare resources. A multi-faceted approach to diabetes management is also effective in the inpatient setting. Interventions shown to promote safe and effective glycemic control and use of evidence-based glucose management practices include provider reminder and clinical decision support systems, automated computer order entry, provider education, and organizational change. Summary Future studies should examine the cost-effectiveness of multi-faceted outpatient and inpatient diabetes management programs to determine the best financial models for incorporating them into diabetes population health strategies. PMID:28567711

An examination of the relationship between care management with coaching for activation and patient outcomes.

PubMed

Reistroffer, Cindy; Hearld, Larry R; Szychowski, Jeff M

2017-02-01

A growing body of research has established the benefits of patient activation, which is defined as the knowledge, skills, confidence, and motivation to make effective decisions and take action to maintain or improve one's health. Consequently, healthcare stakeholders of all types continue to seek ways to improve patient activation. The purpose of this study was to empirically examine whether enrollment in a health plan-sponsored care management (CM) program that included coaching for activation (CFA) was associated with utilization, medication adherence, and clinical outcomes. Cross-sectional, quantitative study of commercially insured enrollees in a Midwest-based health plan. Poisson, logistic, and ordinary least squares regression models were used to test the relationships between CM programs and outcomes. The benefit of measuring patient activation and offering CFA was associated with reduced healthcare utilization and better clinical outcomes. Relative to respondents in the CFA CM group (ie, intervention), respondents in the usual CM group experienced 18.29% more emergency department visits, 97.78% more hospital admissions, a higher glycated hemoglobin level (β = 0.48; P <.001), and higher systolic blood pressure (β = 1.19; P <.01). These findings suggest that coaching interventions based on activation level may help care managers engage in more effective interactions that strengthen a patient's role in managing his or her healthcare. Programs that are more targeted in their application, rather than uniformly developed and implemented, may be an important factor in reducing utilization and improving clinical outcomes.

Further Validation of the Pathways Housing First Fidelity Scale.

PubMed

Goering, Paula; Veldhuizen, Scott; Nelson, Geoffrey B; Stefancic, Ana; Tsemberis, Sam; Adair, Carol E; Distasio, Jino; Aubry, Tim; Stergiopoulos, Vicky; Streiner, David L

2016-01-01

This study examined whether Housing First fidelity ratings correspond to program operation descriptions from administrative data and predict client outcomes. A multisite, randomized controlled trial (At Home/Chez Soi) in five Canadian cities included two assessments of 12 programs over two years. Outcomes for 1,158 clients were measured every six months. Associations between fidelity ratings and administrative data (Spearman correlations) and participant outcomes (mixed-effects modeling) were examined. Fidelity ratings were generally good (mean ± SD=136.6 ± 10.3 out of a possible range of 38-152; 87% of maximum value). Fidelity was significantly associated with three of four measures of program operation, with correlations between .55 and .60. Greater program fidelity was associated with improvement in housing stability, community functioning, and quality of life. Variation in program fidelity was associated with operations and outcomes, supporting scale validity and intervention effectiveness. These findings reinforced the value of using fidelity monitoring to conduct quality assurance and technical assistance activities.

Systematic Review of Programs Treating High-Need and High-Cost People With Multiple Chronic Diseases or Disabilities in the United States, 2008–2014

PubMed Central

Bleich, Sara N.; Sherrod, Cheryl; Chiang, Anne; Boyd, Cynthia; Wolff, Jennifer; DuGoff, Eva; Salzberg, Claudia; Anderson, Keely; Leff, Bruce

2015-01-01

Introduction Finding ways to provide better and less expensive health care for people with multiple chronic conditions or disability is a pressing concern. The purpose of this systematic review was to evaluate different approaches for caring for this high-need and high-cost population. Methods We searched Medline for articles published from May 31, 2008, through June 10, 2014, for relevant studies. Articles were considered eligible for this review if they met the following criteria: included people with multiple chronic conditions (behavioral or mental health) or disabilities (2 or more); addressed 1 or more of clinical outcomes, health care use and spending, or patient satisfaction; and compared results from an intervention group with a comparison group or baseline measurements. We extracted information on program characteristics, participant characteristics, and significant (positive and negative) clinical findings, patient satisfaction, and health care use outcomes. For each outcome, the number of significant and positive results was tabulated. Results Twenty-seven studies were included across 5 models of care. Of the 3 studies reporting patient satisfaction outcomes, 2 reported significant improvements; both were randomized controlled trials (RCTs). Of the 14 studies reporting clinical outcomes, 12 reported improvements (8 were RCTs). Of the 13 studies reporting health care use and spending outcomes, 12 reported significant improvements (2 were RCTs). Two models of care — care and case management and disease management — reported improvements in all 3 outcomes. For care and case management models, most improvements were related to health care use. For the disease management models, most improvements were related to clinical outcomes. Conclusions Care and case management as well as disease management may be promising models of care for people with multiple chronic conditions or disabilities. More research and consistent methods are needed to understand the most appropriate care for these high-need and high-cost patients. PMID:26564013

Systematic Review of Programs Treating High-Need and High-Cost People With Multiple Chronic Diseases or Disabilities in the United States, 2008-2014.

PubMed

Bleich, Sara N; Sherrod, Cheryl; Chiang, Anne; Boyd, Cynthia; Wolff, Jennifer; DuGoff, Eva; Chang, Eva; Salzberg, Claudia; Anderson, Keely; Leff, Bruce; Anderson, Gerard

2015-11-12

Finding ways to provide better and less expensive health care for people with multiple chronic conditions or disability is a pressing concern. The purpose of this systematic review was to evaluate different approaches for caring for this high-need and high-cost population. We searched Medline for articles published from May 31, 2008, through June 10, 2014, for relevant studies. Articles were considered eligible for this review if they met the following criteria: included people with multiple chronic conditions (behavioral or mental health) or disabilities (2 or more); addressed 1 or more of clinical outcomes, health care use and spending, or patient satisfaction; and compared results from an intervention group with a comparison group or baseline measurements. We extracted information on program characteristics, participant characteristics, and significant (positive and negative) clinical findings, patient satisfaction, and health care use outcomes. For each outcome, the number of significant and positive results was tabulated. Twenty-seven studies were included across 5 models of care. Of the 3 studies reporting patient satisfaction outcomes, 2 reported significant improvements; both were randomized controlled trials (RCTs). Of the 14 studies reporting clinical outcomes, 12 reported improvements (8 were RCTs). Of the 13 studies reporting health care use and spending outcomes, 12 reported significant improvements (2 were RCTs). Two models of care - care and case management and disease management - reported improvements in all 3 outcomes. For care and case management models, most improvements were related to health care use. For the disease management models, most improvements were related to clinical outcomes. Care and case management as well as disease management may be promising models of care for people with multiple chronic conditions or disabilities. More research and consistent methods are needed to understand the most appropriate care for these high-need and high-cost patients.

Healthy start program participation: the consumers' perspective.

PubMed

Ley, Christine E; Copeland, Valire Carr; Flint, Cheryl Squire

2011-01-01

In 1991, the federal Maternal and Child Health Bureau developed the Healthy Start Initiative as a comprehensive community-based program to eliminate the high rates of poor pregnancy outcomes among women of color. To date, few studies of the programmatic outcomes of this Initiative have examined the views of Healthy Start consumers. To understand the benefits of Healthy Start from their consumers' perspective, the Pittsburgh Allegheny County Healthy Start project conducted a survey of 202 of their Healthy Start participants in 2003. The participants completing the survey reported benefits of participating in the program including stress reduction, receiving resources and referrals, and consistent social support of program staff. According to the project's annual statistics, Healthy Start has improved pregnancy outcomes among African American women participants in the Pittsburgh community. However, and according to these participants, the quality of staff and consumer connectedness, availability and consistency of material resources, and social support are as critical as more traditional health interventions to their satisfaction, motivation to participate, and willingness to refer others to the program. Women of color will often forego health services perceived as intimidating and/or culturally insensitive, but programs such as the Healthy Start Initiative offer a critical link that encourages participation and, as a result, improves maternal and child health status.

Cognitive-behavioral based physical therapy for patients with chronic pain undergoing lumbar spine surgery: a randomized controlled trial

PubMed Central

Archer, Kristin R.; Devin, Clinton J.; Vanston, Susan W.; Koyama, Tatsuki; Phillips, Sharon; George, Steven Z.; McGirt, Matthew J.; Spengler, Dan M.; Aaronson, Oran S.; Cheng, Joseph S.; Wegener, Stephen T.

2015-01-01

The purpose of this study was to determine the efficacy of a cognitive-behavioral based physical therapy (CBPT) program for improving outcomes in patients following lumbar spine surgery. A randomized controlled trial was conducted in 86 adults undergoing a laminectomy with or without arthrodesis for a lumbar degenerative condition. Patients were screened preoperatively for high fear of movement using the Tampa Scale for Kinesiophobia. Randomization to either CBPT or an Education program occurred at 6 weeks after surgery. Assessments were completed pre-treatment, post-treatment and at 3 month follow-up. The primary outcomes were pain and disability measured by the Brief Pain Inventory and Oswestry Disability Index. Secondary outcomes included general health (SF-12) and performance-based tests (5-Chair Stand, Timed Up and Go, 10 Meter Walk). Multivariable linear regression analyses found that CBPT participants had significantly greater decreases in pain and disability and increases in general health and physical performance compared to the Education group at 3 month follow-up. Results suggest a targeted CBPT program may result in significant and clinically meaningful improvement in postoperative outcomes. CBPT has the potential to be an evidence-based program that clinicians can recommend for patients at-risk for poor recovery following spine surgery. PMID:26476267

A Review of Hazard Anticipation Training Programs for Young Drivers

PubMed Central

McDonald, Catherine C.; Goodwin, Arthur H.; Pradhan, Anuj K.; Romoser, Matthew R.E.; Williams, Allan F.

2015-01-01

Purpose Poor hazard anticipation skills are a risk factor associated with high motor vehicle crash rates of young drivers. A number of programs have been developed to improve these skills. The purpose of this review was to assess the empirical literature on hazard anticipation training for young drivers. Methods Studies were included if they: 1) included an assessment of hazard anticipation training outcomes; 2) were published between January 1, 1980 and December 31, 2013 in an English language peer-reviewed journal or conference proceeding; and 3) included at least one group that uniquely comprised a cohort of participants <21 years. Nineteen studies met inclusion criteria. Results Studies used a variety of training methods including interactive computer programs, videos, simulation, commentary driving, or a combination of approaches. Training effects were predominantly measured through computer-based testing and driving simulation with eye tracking. Four studies included an on-road evaluation. Most studies evaluated short-term outcomes (immediate or few days). In all studies, young drivers showed improvement in selected hazard anticipation outcomes, but none investigated crash effects. Conclusions Although there is promise in existing programs, future research should include long-term follow up, evaluate crash outcomes, and assess the optimal timing of hazard anticipation training taking into account the age and experience level of young drivers. PMID:26112734

The Case for Intentionally Interwoven Peer Learning Supports in Gateway-Course Improvement Efforts

ERIC Educational Resources Information Center

Dvorak, Johanna; Tucker, Kathryn

2017-01-01

This chapter describes how peer learning support programs can be used to improve learning and success in gateway courses. It provides examples from two institutions to further illustrate how this promising approach can improve student outcomes.

Course Development Cycle Time: A Framework for Continuous Process Improvement.

ERIC Educational Resources Information Center

Lake, Erinn

2003-01-01

Details Edinboro University's efforts to reduce the extended cycle time required to develop new courses and programs. Describes a collaborative process improvement framework, illustrated data findings, the team's recommendations for improvement, and the outcomes of those recommendations. (EV)

The effect of the AED and AED programs on survival of individuals, groups and populations.

PubMed

Stokes, Nathan Allen; Scapigliati, Andrea; Trammell, Antoine R; Parish, David C

2012-10-01

The automated external defibrillator (AED) is a tool that contributes to survival with mixed outcomes. This review assesses the effectiveness of the AED, consistencies and variations among studies, and how varying outcomes can be resolved. A worksheet for the International Liaison Committee on Resuscitation (ILCOR) 2010 science review focused on hospital survival in AED programs was the foundation of the articles reviewed. Articles identified in the search covering a broader range of topics were added. All articles were read by at least two authors; consensus discussions resolved differences. AED use developed sequentially. Use of AEDs by emergency medical technicians (EMTs) compared to manual defibrillators showed equal or superior survival. AED use was extended to trained responders likely to be near victims, such as fire/rescue, police, airline attendants, and casino security guards, with improvement in all venues but not all programs. Broad public access initiatives demonstrated increased survival despite low rates of AED use. Home AED programs have not improved survival; in-hospital trials have had mixed results. Successful programs have placed devices in high-risk sites, maintained the AEDs, recruited a team with a duty to respond, and conducted ongoing assessment of the program. The AED can affect survival among patients with sudden ventricular fibrillation (VF). Components of AED programs that affect outcome include the operator, location, the emergency response system, ongoing maintenance and evaluation. Comparing outcomes is complicated by variations in definitions of populations and variables. The effect of AEDs on individuals can be dramatic, but the effect on populations is limited.

The impact of care management information technology model on quality of care after Coronary Artery Bypass Surgery: "Bridging the Divides".

PubMed

Weintraub, William S; Elliott, Daniel; Fanari, Zaher; Ostertag-Stretch, Jennifer; Muther, Ann; Lynahan, Margaret; Kerzner, Roger; Salam, Tabassum; Scherrer, Herbert; Anderson, Sharon; Russo, Carla A; Kolm, Paul; Steinberg, Terri H

Reducing readmissions and improving metrics of care are a national priority. Supplementing traditional care with care management may improve outcomes. The Bridges program was an initial evaluation of a care management platform (CareLinkHub), supported by information technology (IT) developed to improve the quality and transition of care from hospital to home after Coronary Artery Bypass Surgery (CABG) and reduce readmissions. CareLink is comprised of care managers, patient navigators, pharmacists and physicians. Information to guide care management is guided by a middleware layer to gather information, PLR (ColdLight Solutions, LLC) and presented to CareLink staff on a care management platform, Aerial™ (Medecision). In addition there is an analytic engine to help evaluate and guide care, Neuron™ (Coldlight Solutions, LLC). The "Bridges" program enrolled a total of 716 CABG patients with 850 admissions from April 2013 through March 2015. The data of the program was compared with those of 1111 CABG patients with 1203 admissions in the 3years prior to the program. No impact was seen with respect to readmissions, Blood Pressure or LDL control. There was no significant improvement in patients' reported outcomes using either the CTM-3 or any of the SAQ-7 scores. Patient follow-up with physicians within 1week of discharge improved during the Bridges years. The CareLink hub platform was successfully implemented. Little or no impact on outcome metrics was seen in the short follow-up time. Copyright © 2017 Elsevier Inc. All rights reserved.

Feasibility of the Enhancing Participation In the Community by improving Wheelchair Skills (EPIC Wheels) program: study protocol for a randomized controlled trial.

PubMed

Giesbrecht, Edward M; Miller, William C; Eng, Janice J; Mitchell, Ian M; Woodgate, Roberta L; Goldsmith, Charles H

2013-10-24

Many older adults rely on a manual wheelchair for mobility but typically receive little, if any, training on how to use their wheelchair effectively and independently. Standardized skill training is an effective intervention, but limited access to clinician trainers is a substantive barrier. Enhancing Participation in the Community by Improving Wheelchair Skills (EPIC Wheels) is a 1-month monitored home training program for improving mobility skills in older novice manual wheelchair users, integrating principles from andragogy and social cognitive theory. The purpose of this study is to determine whether feasibility indicators and primary clinical outcome measures of the EPIC Wheels program are sufficiently robust to justify conducting a subsequent multi-site randomized controlled trial. A 2 × 2 factorial randomized controlled trial at two sites will compare improvement in wheelchair mobility skills between an EPIC Wheels treatment group and a computer-game control group, with additional wheelchair use introduced as a second factor. A total of 40 community-dwelling manual wheelchair users at least 55 years old and living in two Canadian metropolitan cities (n = 20 × 2) will be recruited. Feasibility indicators related to study process, resources, management, and treatment issues will be collected during data collection and at the end of the study period, and evaluated against proposed criteria. Clinical outcome measures will be collected at baseline (pre-randomization) and post-intervention. The primary clinical outcome measure is wheelchair skill capacity, as determined by the Wheelchair Skills Test, version 4.1. Secondary clinical outcome measures include wheelchair skill safety, satisfaction with performance, wheelchair confidence, life-space mobility, divided-attention, and health-related quality of life. The EPIC Wheels training program offers several innovative features. The convenient, portable, economical, and adaptable tablet-based, home program model for wheelchair skills training has great potential for clinical uptake and opportunity for future enhancements. Theory-driven design can foster learning and adherence for older adults. Establishing the feasibility of the study protocol and estimating effect size for the primary clinical outcome measure will be used to develop a multi-site randomized controlled trial to test the guiding hypotheses. Clinical Trials NCT01740635.

Long-Term Outcomes of a Dental Postbaccalaureate Program: Increasing Dental Student Diversity and Oral Health Care Access

PubMed Central

Wides, Cynthia D.; Brody, Harvey A.; Alexander, Charles J.; Gansky, Stuart A.; Mertz, Elizabeth A.

2013-01-01

The University of California, San Francisco School of Dentistry established the Dental Postbaccalaureate Program in 1998 to provide reapplication assistance to students from economically and/or educationally disadvantaged backgrounds who were previously denied admission to dental school. The goals were to increase diversity in the dental school student population and improve access to dental services for underserved populations. This article assesses the program’s short-, mid-, and long-term outcomes and is the first to examine long-term practice patterns after a dental postbaccalaureate program. Data collected on all participant (n=94) demographics, pre/post-program DAT scores, and post-program dental school admission results were used to assess short- and mid-term outcomes. Long-term outcomes and practice patterns were assessed using results of a census survey administered between 2009 and 2011 to the participants who had completed dental school and been in practice for at least two years (n=57). The survey had a response rate of 93 percent (n=53). Descriptive statistical techniques were used to examine the responses and to compare them to U.S. Census Bureau data and nationally available practice data for new dental graduates. Program participants’ DAT scores improved by an average of two points, and 98 percent were accepted to dental school. All survey respondents were practicing dentistry, and 81 percent reported serving underserved populations. These participants treat more Medicaid recipients than do most dentists, and their patient population is more diverse than the general population. The outcomes demonstrate that the program’s graduates are increasing diversity in the dental student population and that their practices are providing access to care for underserved populations. PMID:23658398

Evaluating a measure of social health derived from two mental health recovery measures: the California Quality of Life (CA-QOL) and Mental Health Statistics Improvement Program Consumer Survey (MHSIP).

PubMed

Carlson, Jordan A; Sarkin, Andrew J; Levack, Ashley E; Sklar, Marisa; Tally, Steven R; Gilmer, Todd P; Groessl, Erik J

2011-08-01

Social health is important to measure when assessing outcomes in community mental health. Our objective was to validate social health scales using items from two broader commonly used measures that assess mental health outcomes. Participants were 609 adults receiving psychological treatment services. Items were identified from the California Quality of Life (CA-QOL) and Mental Health Statistics Improvement Program (MHSIP) outcome measures by their conceptual correspondence with social health and compared to the Social Functioning Questionnaire (SFQ) using correlational analyses. Pearson correlations for the identified CA-QOL and MSHIP items with the SFQ ranged from .42 to .62, and the identified scale scores produced Pearson correlation coefficients of .56, .70, and, .70 with the SFQ. Concurrent validity with social health was supported for the identified scales. The current inclusion of these assessment tools allows community mental health programs to include social health in their assessments.

Redesigning care for patients at increased hospitalization risk: the Comprehensive Care Physician model.

PubMed

Meltzer, David O; Ruhnke, Gregory W

2014-05-01

Patients who have been hospitalized often experience care coordination problems that worsen outcomes and increase costs. One reason is that hospital care and ambulatory care are often provided by different physicians. However, interventions to improve care coordination for hospitalized patients have not consistently improved outcomes and generally have not reduced costs. We describe the rationale for the Comprehensive Care Physician model, in which physicians focus their practice on patients at increased risk of hospitalization so that they can provide both inpatient and outpatient care to their patients. We also describe the design and implementation of a study supported by the Center for Medicare and Medicaid Innovation to assess the model's effects on costs and outcomes. Evidence concerning the effectiveness of the program is expected by 2016. If the program is found to be effective, the next steps will be to assess the durability of its benefits and the model's potential for dissemination; evidence to the contrary will provide insights into how to alter the program to address sources of failure.

Evidence, Goals, and Outcomes in Stuttering Treatment: Applications With an Adolescent Who Stutters.

PubMed

Marcotte, Anne K

2018-01-09

The purpose of this clinical focus article is to summarize 1 possible process that a clinician might follow in designing and conducting a treatment program with John, a 14-year-old male individual who stutters. The available research evidence, practitioner experience, and consideration of individual preferences are combined to address goals, treatment procedures, and outcomes for John. The stuttering treatment research literature includes multiple well-designed reviews and individual studies that have shown the effectiveness of prolonged speech (and smooth speech and related variations) for improving stuttered speech and for improving social, emotional, cognitive, and related variables in adolescents who stutter. Based on that evidence, and incorporating the additional elements of practitioner experience and client preferences, this clinical focus article suggests that John would be likely to benefit from a treatment program based on prolonged speech. The basic structure of 1 possible such program is also described, with an emphasis on the goals and outcomes that John could be expected to achieve.

Improving Literacy Instruction in Kenya through Teacher Professional Development and Text Messages Support: A Cluster Randomized Trial

ERIC Educational Resources Information Center

Jukes, Matthew C. H.; Turner, Elizabeth L.; Dubeck, Margaret M.; Halliday, Katherine E.; Inyega, Hellen N.; Wolf, Sharon; Zuilkowski, Stephanie Simmons; Brooker, Simon J.

2017-01-01

We evaluated a program to improve literacy instruction on the Kenyan coast using training workshops, semiscripted lesson plans, and weekly text-message support for teachers to understand its impact on students' literacy outcomes and on the classroom practices leading to those outcomes. The evaluation ran from the beginning of Grade 1 to the end of…

Emerging Models for Mobilizing Family Support for Chronic Disease Management: A Structured Review

PubMed Central

Rosland, Ann-Marie; Piette, John D.

2015-01-01

Objectives We identify recent models for programs aiming to increase effective family support for chronic illness management and self-care among adult patients without significant physical or cognitive disabilities. We then summarize evidence regarding the efficacy for each model identified. Methods Structured review of studies published in medical and psychology databases from 1990 to the present, reference review, general Web searches, and conversations with family intervention experts. Review was limited to studies on conditions that require ongoing self-management, such as diabetes, chronic heart disease, and rheumatologic disease. Results Programs with three separate foci were identified: 1) Programs that guide family members in setting goals for supporting patient self-care behaviors have led to improved implementation of family support roles, but have mixed success improving patient outcomes. 2) Programs that train family in supportive communication techniques, such as prompting patient coping techniques or use of autonomy supportive statements, have successfully improved patient symptom management and health behaviors. 3) Programs that give families tools and infrastructure to assist in monitoring clinical symptoms and medications are being conducted, with no evidence to date on their impact on patient outcomes. Discussion The next generation of programs to improve family support for chronic disease management incorporate a variety of strategies. Future research can define optimal clinical situations for family support programs, the most effective combinations of support strategies, and how best to integrate family support programs into comprehensive models of chronic disease care. PMID:20308347

A prospective comparison of telemedicine versus in-person delivery of an interprofessional education program for adults with inflammatory arthritis.

PubMed

Kennedy, Carol A; Warmington, Kelly; Flewelling, Carol; Shupak, Rachel; Papachristos, Angelo; Jones, Caroline; Linton, Denise; Beaton, Dorcas E; Lineker, Sydney; Hogg-Johnson, Sheilah

2017-02-01

Introduction We evaluated two modes of delivery of an inflammatory arthritis education program ("Prescription for Education" (RxEd)) in improving arthritis self-efficacy and other secondary outcomes. Methods We used a non-randomized, pre-post design to compare videoconferencing (R, remote using telemedicine) versus local (I, in-person) delivery of the program. Data were collected at baseline (T 1 ), immediately following RxEd (T 2 ), and at six months (T 3 ). Self-report questionnaires served as the data collection tool. Measures included demographics, disorder-related, Arthritis Self-Efficacy Scale (SE), previous knowledge (Arthritis Community Research and Evaluation Unit (ACREU) rheumatoid arthritis knowledge questionnaire), coping efficacy, Illness Intrusiveness, and Effective Consumer Scale. Analysis included: baseline comparisons and longitudinal trends (R vs I groups); direct between-group comparisons; and Generalized Estimating Equations (GEE) analysis. Results A total of 123 persons attended the program (I: n = 36; R: n = 87) and 111 completed the baseline questionnaire (T 1 ), with follow-up completed by 95% ( n = 117) at T 2 and 62% ( n = 76) at T 3 . No significant baseline differences were found across patient characteristics and outcome measures. Both groups (R and I) showed immediate effect (improved arthritis SE, mean change (95% confidence interval (CI)): R 1.07 (0.67, 1.48); I 1.48 (0.74, 2.23)) after the program that diminished over six months (mean change (95% CI): R 0.45 (-0.1, 0.1); I 0.73 (-0.25, 1.7)). For each of the secondary outcomes, both groups showed similar trends for improvement (mean change scores (95% CI)) over time. GEE analysis did not show any meaningful differences between groups (R vs I) over time. Discussion Improvements in arthritis self-efficacy and secondary outcomes displayed similar trends for I and R participant groups.

Intermediate outcomes of a chronic disease self-management program for Spanish-speaking older adults in South Florida, 2008-2010.

PubMed

Melchior, Michael A; Seff, Laura R; Bastida, Elena; Albatineh, Ahmed N; Page, Timothy F; Palmer, Richard C

2013-08-29

The prevalence and negative health effects of chronic diseases are disproportionately high among Hispanics, the largest minority group in the United States. Self-management of chronic conditions by older adults is a public health priority. The objective of this study was to examine 6-week differences in self-efficacy, time spent performing physical activity, and perceived social and role activities limitations for participants in a chronic disease self-management program for Spanish-speaking older adults, Tomando Control de su Salud (TCDS). Through the Healthy Aging Regional Collaborative, 8 area agencies delivered 82 workshops in 62 locations throughout South Florida. Spanish-speaking participants who attended workshops from October 1, 2008, through December 31, 2010, were aged 55 years or older, had at least 1 chronic condition, and completed baseline and post-test surveys were included in analysis (N=682). Workshops consisted of six, 2.5-hour sessions offered once per week for 6 weeks. A self-report survey was administered at baseline and again at the end of program instruction. To assess differences in outcomes, a repeated measures general linear model was used, controlling for agency and baseline general health. All outcomes showed improvement at 6 weeks. Outcomes that improved significantly were self-efficacy to manage disease, perceived social and role activities limitations, time spent walking, and time spent performing other aerobic activities. Implementation of TCDS significantly improved 4 of 8 health promotion skills and behaviors of Spanish-speaking older adults in South Florida. A community-based implementation of TCDS has the potential to improve health outcomes for a diverse, Spanish-speaking, older adult population.

An Internet-Mediated Pedometer-Based Program Improves Health-Related Quality-of-Life Domains and Daily Step Counts in COPD

PubMed Central

Moy, Marilyn L.; Collins, Riley J.; Martinez, Carlos H.; Kadri, Reema; Roman, Pia; Holleman, Robert G.; Kim, Hyungjin Myra; Nguyen, Huong Q.; Cohen, Miriam D.; Goodrich, David E.; Giardino, Nicholas D.

2015-01-01

BACKGROUND: Low levels of physical activity (PA) are associated with poor outcomes in people with COPD. Interventions to increase PA could improve outcomes. METHODS: We tested the efficacy of a novel Internet-mediated, pedometer-based exercise intervention. Veterans with COPD (N = 239) were randomized in a 2:1 ratio to the (1) intervention group (Omron HJ-720 ITC pedometer and Internet-mediated program) or (2) wait-list control group (pedometer). The primary outcome was health-related quality of life (HRQL), assessed by the St. George’s Respiratory Questionnaire (SGRQ), at 4 months. We examined the SGRQ total score (SGRQ-TS) and three domain scores: Symptoms, Activities, and Impact. The secondary outcome was daily step counts. Linear regression models assessed the effect of intervention on outcomes. RESULTS: Participants had a mean age of 67 ± 9 years, and 94% were men. There was no significant between-group difference in mean 4-month SGRQ-TS (2.3 units, P = .14). Nevertheless, a significantly greater proportion of intervention participants than control subjects had at least a 4-unit improvement in SGRQ-TS, the minimum clinically important difference (53% vs 39%, respectively, P = .05). For domain scores, the intervention group had a lower (reflecting better HRQL) mean than the control group by 4.6 units for Symptoms (P = .046) and by 3.3 units for Impact (P = .049). There was no significant difference in Activities score between the two groups. Compared with the control subjects, intervention participants walked 779 more steps per day at 4 months (P = .005). CONCLUSIONS: An Internet-mediated, pedometer-based walking program can improve domains of HRQL and daily step counts at 4 months in people with COPD. TRIAL REGISTRY: Clinical Trials.gov; No.: NCT01102777; URL: www.clinicaltrials.gov PMID:25811395

The Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) collaborative quality improvement initiative in percutaneous coronary interventions.

PubMed

Moscucci, Mauro; Share, David; Kline-Rogers, Eva; O'Donnell, Michael; Maxwell-Eward, Ann; Meengs, William L; Clark, Vivian L; Kraft, Phillip; De Franco, Anthony C; Chambers, James L; Patel, Kirit; McGinnity, John G; Eagle, Kim A

2002-10-01

The past decade has been characterized by increased scrutiny of outcomes of surgical and percutaneous coronary interventions (PCIs). This increased scrutiny has led to the development of regional, state, and national databases for outcome assessment and for public reporting. This report describes the initial development of a regional, collaborative, cardiovascular consortium and the progress made so far by this collaborative group. In 1997, a group of hospitals in the state Michigan agreed to create a regional collaborative consortium for the development of a quality improvement program in interventional cardiology. The project included the creation of a comprehensive database of PCIs to be used for risk assessment, feedback on absolute and risk-adjusted outcomes, and sharing of information. To date, information from nearly 20,000 PCIs have been collected. A risk prediction tool for death in the hospital and additional risk prediction tools for other outcomes have been developed from the data collected, and are currently used by the participating centers for risk assessment and for quality improvement. As the project enters into year 5, the participating centers are deeply engaged in the quality improvement phase, and expansion to a total of 17 hospitals with active PCI programs is in process. In conclusion, the Blue Cross Blue Shield of Michigan Cardiovascular Consortium is an example of a regional collaborative effort to assess and improve quality of care and outcomes that overcome the barriers of traditional market and academic competition.

Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial

PubMed Central

Wang, Philip S.; Simon, Gregory E.; Avorn, Jerry; Azocar, Francisca; Ludman, Evette J.; McCulloch, Joyce; Petukhova, Maria Z.; Kessler, Ronald C.

2010-01-01

Context Although guideline-concordant depression treatment is clearly effective, treatment often falls short of evidence-based recommendations. Organized depression care programs significantly improve treatment quality, but employer-purchasers have been slow to demand these programs based on lack of evidence for cost-effectiveness from their perspective. Objective To evaluate the effects of a depression outreach-treatment program on workplace outcomes of concern to employers. Design Randomized controlled trial with allocation concealment and blinded assessment of depression severity and work performance at 6 and 12 months. Setting and Participants Two-stage screening of employees covered by a managed behavioral health plan identified 604 with clinically significant depression (excluding those with lifetime bipolar disorder, substance disorder, recent mental health specialty care, or suicidality). Intervention A telephonic outreach and care management program encouraged workers to enter outpatient treatment (psychotherapy and/or antidepressant medication), monitored treatment quality-continuity, and attempted to improve treatment by giving recommendations to providers. Participants reluctant to enter treatment were offered a structured telephone cognitive-behavioral psychotherapy. Main Outcome Measures Depression severity (Quick Inventory of Depressive Symptomatology, QIDS-SR) and work performance (WHO Health and Productivity Questionnaire, HPQ, a validated self-report instrument assessing job retention, time missed from work, work performance, and critical workplace incidents). Results Combining data across 6-month and 12-month assessments, the intervention group had significantly lower QIDS-SR scores (1.4 relative-odds of recovery), significantly higher job retention (1.7 relative-odds), and significantly more hours worked among the employed (equivalent to an annualized effect of approximately 2.5 weeks of work) than usual care subjects. Conclusions A systematic program to identify depression and promote effective treatment significantly improves not only clinical outcomes but also workplace outcomes. The financial value of the latter to employers in terms of recovered hiring-training and salary costs suggests that many employers would experience a positive return on investment from outreach and enhanced treatment of depressed workers. PMID:17895456

Safe patient handling in diagnostic imaging.

PubMed

Murphey, Susan L

2010-01-01

Raising awareness of the risk to diagnostic imaging personnel from manually lifting, transferring, and repositioning patients is critical to improving workplace safety and staff utilization. The aging baby boomer generation and growing bariatric population exacerbate the problem. Also, legislative initiatives are increasing nationwide for hospitals to implement safe patient handling programs. A management process designed to improve working conditions through implementing ergonomic programs can reduce losses and improve productivity and patient care outcome measures for imaging departments.

Cognitive and physical rehabilitation of intensive care unit survivors: results of the RETURN randomized controlled pilot investigation.

PubMed

Jackson, James C; Ely, E Wesley; Morey, Miriam C; Anderson, Venice M; Denne, Laural B; Clune, Jennifer; Siebert, Carol S; Archer, Kristin R; Torres, Renee; Janz, David; Schiro, Elena; Jones, Julie; Shintani, Ayumi K; Levine, Brian; Pun, Brenda T; Thompson, Jennifer; Brummel, Nathan E; Hoenig, Helen

2012-04-01

Millions of patients who survive medical and surgical general intensive care unit care every year experience newly acquired long-term cognitive impairment and profound physical and functional disabilities. To overcome the current reality in which patients receive inadequate rehabilitation, we devised a multifaceted, in-home, telerehabilitation program implemented using social workers and psychology technicians with the goal of improving cognitive and functional outcomes. This was a single-site, feasibility, pilot, randomized trial of 21 general medical/surgical intensive care unit survivors (8 controls and 13 intervention patients) with either cognitive or functional impairment at hospital discharge. After discharge, study controls received usual care (sporadic rehabilitation), whereas intervention patients received a combination of in-home cognitive, physical, and functional rehabilitation over a 3-month period via a social worker or master's level psychology technician utilizing telemedicine to allow specialized multidisciplinary treatment. Interventions over 12 wks included six in-person visits for cognitive rehabilitation and six televisits for physical/functional rehabilitation. Outcomes were measured at the completion of the rehabilitation program (i.e., at 3 months), with cognitive functioning as the primary outcome. Analyses were conducted using linear regression to examine differences in 3-month outcomes between treatment groups while adjusting for baseline scores. Patients tolerated the program with only one adverse event reported. At baseline both groups were well-matched. At 3-month follow-up, intervention group patients demonstrated significantly improved cognitive executive functioning on the widely used and well-normed Tower test (for planning and strategic thinking) vs. controls (median [interquartile range], 13.0 [11.5-14.0] vs. 7.5 [4.0-8.5]; adjusted p < .01). Intervention group patients also reported better performance (i.e., lower score) on one of the most frequently used measures of functional status (Functional Activities Questionnaire at 3 months vs. controls, 1.0 [0.0 -3.0] vs. 8.0 [6.0-11.8], adjusted p = .04). A multicomponent rehabilitation program for intensive care unit survivors combining cognitive, physical, and functional training appears feasible and possibly effective in improving cognitive performance and functional outcomes in just 3 months. Future investigations with a larger sample size should be conducted to build on this pilot feasibility program and to confirm these results, as well as to elucidate the elements of rehabilitation contributing most to improved outcomes.

Program Evaluation of Group-based Cognitive Behavioral Therapy for Insomnia: a Focus on Treatment Adherence and Outcomes in Older Adults with Co-morbidities.

PubMed

Ludwin, Brian M; Bamonti, Patricia; Mulligan, Elizabeth A

2017-11-21

To describe a program evaluation of the interrelationship of adherence and treatment outcomes in a sample of veteran older adults with co-morbidities who participated in group-based cognitive behavioral therapy for insomnia. Retrospective data extraction was performed for 14 older adults. Adherence measures and sleep outcomes were measured with sleep diaries and Insomnia Severity Index. Demographic and clinical information was extracted through chart review. Adherence with prescribed time in bed, daily sleep diaries, and maintaining consistent time out of bed and time in bed was generally high. There were moderate, though not significant, improvements in consistency of time in bed and time out of bed over time. Adherence was not significantly associated with sleep outcomes despite improvements in most sleep outcomes. The non-significant relationship between sleep outcomes and adherence may reflect the moderating influence of co-morbidities or may suggest a threshold effect beyond which stricter adherence has a limited impact on outcomes. Development of multi-method adherence measures across all treatment components will be important to understand the influence of adherence on treatment outcomes as monitoring adherence to time in bed and time out of bed had limited utility for understanding treatment outcomes in our sample.

[Effects of an intensive thalassotherapy and aquatic therapy program in stroke patients. A pilot study].

PubMed

Morer, C; Boestad, C; Zuluaga, P; Alvarez-Badillo, A; Maraver, F

2017-09-16

Stroke remains the leading cause of acquired disability. Health and social planning and management may vary and although prevention is crucial, having better treatments and strategies to reduce disability is needed. To determine the effect of an intensive program of thalassotherapy and aquatic therapy in stroke patients, valuing clinical parameters and functional validated scales. A quasi-experimental prospective study consisting of a specific program assessed pre- and post- 3 weeks treatment to 26 stroke patients with a mild-moderate disability. The outcomes measured were: Berg Balance scale, Timed Up and Go test, 10-meter walking test, 6-minute walking test and pain Visual Analogue Scale. After intervention, participants had a significant improvement in all outcomes measured. Our results suggest that an intensive program of thalassotherapy and aquatic therapy could be useful during stroke rehabilitation to improve balance, gait and pain.

The Comfortable Cafeteria Program for Promoting Student Participation and Enjoyment: An Outcome Study

PubMed Central

Demirjian, Louise; Horvath, Frances; Doxsey, Lauri

2018-01-01

A mixed-methods design was used to explore the outcomes of a 6-wk, occupational therapist–led Comfortable Cafeteria program designed to build cafeteria supervisors’ and students’ capacity to create a positive mealtime environment so that all students can successfully participate in and enjoy a healthy meal and socialization with peers. Students whose scores were in the low and mid-range at the outset had statistically significant improvements in pretest–posttest visual analog scale ratings of participation and enjoyment. Cafeteria supervisors demonstrated statistically significant improvements in their perceptions of knowledge and skills to supervise and to encourage healthy eating. Qualitative findings add further insight into the program, suggesting that students learned prosocial values (e.g., being kind, helping others), supervisors actively encouraged positive social interaction, and occupational therapists enjoyed implementing the program and recognized positive supervisor and student changes as a result of integrating services in the cafeteria. PMID:29689174

Supporting Intrapersonal Development in Substance Use Disorder Programs: A Conceptual Framework for Client Assessment.

PubMed

Turpin, Aaron; Shier, Micheal L

2017-01-01

Improvements to intrapersonal development of clients involved with substance use disorder treatment programs has widely been recognized as contributing to the intended goal of reducing substance misuse behaviors. This study sought to identify a broad framework of primary outcomes related to the intrapersonal development of clients in treatment for substance misuse. Using qualitative research methods, individual interviews were conducted with program participants (n = 41) at three treatment programs to identify the ways in which respondents experienced intrapersonal development through participation in treatment. The findings support the development of a conceptual model that captures the importance and manifestation of achieving improvements in the following outcomes: self-awareness, coping ability, self-worth, outlook, and self-determination. The findings provide a conceptual framework for client assessment that captures a broad range of the important intrapersonal development factors utilized as indicators for client development and recovery that should be measured in tandem during assessment.

Predictors of improvement in hemoglobin concentration among toddlers enrolled in the Massachusetts WIC Program.

PubMed

Altucher, Kristine; Rasmussen, Kathleen M; Barden, Elizabeth M; Habicht, Jean-Pierre

2005-05-01

Nutrition supplementation programs are generally targeted to those members of the population who are thought to be at risk of an undesirable outcome, but not all who participate in such programs respond to them. We sought to identify determinants of improvement in hemoglobin concentration among young children in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). We conducted an observational study using data from 9,930 children who were enrolled in the Massachusetts WIC program and had data available on their hemoglobin values at both 1 and 2 years of age. Predictors of change in hemoglobin concentration between these ages were studied using multivariate statistical modeling. Overall, hemoglobin concentrations increased from age 1 to 2 years in those who had been breastfed 25 or more weeks (P < .0001) and were female (P < .01), and decreased with increasing weight at 1 year of age (P < .001). The determinants of change in hemoglobin concentration differed from the determinants of hemoglobin concentration at age 1 year. The analytical approach used here could be extended to identify subgroups of WIC participants likely to improve in other outcomes. If current efforts to increase the duration of breastfeeding among WIC participants are successful, the importance of WIC in improving hemoglobin concentration among young children also will increase.

Building Faculty Community: Fellowship in Graduate Medical Education Administration

PubMed Central

Edler, Alice A.; Dohn, Ann; Davidson, Heather A.; Grewal, Daisy; Behravesh, Bardia; Piro, Nancy

2009-01-01

Introduction The Department of Graduate Medical Education at Stanford Hospital and Clinics has developed a professional training program for program directors. This paper outlines the goals, structure, and expected outcomes for the one-year Fellowship in Graduate Medical Education Administration program. Background The skills necessary for leading a successful Accreditation Council for Graduate Medical Education (ACGME) training program require an increased level of curricular and administrative expertise. To meet the ACGME Outcome Project goals, program directors must demonstrate not only sophisticated understanding of curricular design but also competency-based performance assessment, resource management, and employment law. Few faculty-development efforts adequately address the complexities of educational administration. As part of an institutional-needs assessment, 41% of Stanford program directors indicated that they wanted more training from the Department of Graduate Medical Education. Intervention To address this need, the Fellowship in Graduate Medical Education Administration program will provide a curriculum that includes (1) readings and discussions in 9 topic areas, (2) regular mentoring by the director of Graduate Medical Education (GME), (3) completion of a service project that helps improve GME across the institution, and (4) completion of an individual scholarly project that focuses on education. Results The first fellow was accepted during the 2008–2009 academic year. Outcomes for the project include presentation of a project at a national meeting, internal workshops geared towards disseminating learning to peer program directors, and the completion of a GME service project. The paper also discusses lessons learned for improving the program. PMID:21975722

Evaluating a Small-Group Counseling Program--A Model for Program Planning and Improvement in the Elementary Setting

ERIC Educational Resources Information Center

Bostick, Dee; Anderson, Ron

2009-01-01

School counselors are under increasing pressure to evaluate their programs in a manner consistent with teachers and other educators. A small-group counseling intervention was used by a school counselor as part of a three-level program planning initiative that illustrated best research practices to evaluate program outcomes. Forty-nine third-grade…

Tapping the potential of alternative medicine.

PubMed

La Puma, J; Eiler, G

1998-04-01

Interest in alternative medicine is growing among healthcare consumers. Health plans and healthcare organizations may be able to improve clinical outcomes and benefit financially by providing patients with access to alternative services. Organizations that can assess their communities' particular needs, draw on interested professional staff to help develop alternative medicine programs and protocols, and study quality outcomes will stand a better chance of making such programs successful. Educating medical staff, designing a credible program, and forging strategic alliances with respected partners can help organizations create a sharply focused brand identity in the community.

A pilot study of a combined group and individual functional remediation program for patients with bipolar I disorder.

PubMed

Zyto, Susan; Jabben, Nienke; Schulte, Peter F J; Regeer, Barbara J; Kupka, Ralph W

2016-04-01

Bipolar disorder has been associated with a decrease in cognitive functioning affecting the functional outcome of patients independent of mood states. However, there have only been few attempts to investigate the effects of functional remediation for patients with bipolar disorder. The current study investigates the feasibility and effectiveness of a combined group and individual functional remediation program for bipolar disorder, including both patients and their caregivers. Twelve participants diagnosed with bipolar I disorder, and their caregivers, were treated with a combined group and individual functional remediation program. The feasibility of the program was evaluated by dropout rates and participants' evaluations of the program. The effectiveness of the program was explored through the assessment of functional outcome at baseline, immediately post-treatment, and follow-up three months later. The results indicate a high degree of satisfaction and a low dropout rate with the current program. Assessment of outcomes suggests improved functioning in the areas of autonomy and occupational functioning, evolving from baseline to follow-up. Due to a small sample size and the lack of a control group the results are preliminary. This relatively brief intervention offers a more tailor-made approach to functional remediation and shows good feasibility, acceptability and improvement of functioning in patients with bipolar I disorder. Copyright © 2016 Elsevier B.V. All rights reserved.

The effect of increasing the supply of skilled health providers on pregnancy and birth outcomes: evidence from the midwives service scheme in Nigeria.

PubMed

Okeke, Edward; Glick, Peter; Chari, Amalavoyal; Abubakar, Isa Sadeeq; Pitchforth, Emma; Exley, Josephine; Bashir, Usman; Gu, Kun; Onwujekwe, Obinna

2016-08-23

Limited availability of skilled health providers in developing countries is thought to be an important barrier to achieving maternal and child health-related MDG goals. Little is known, however, about the extent to which scaling-up supply of health providers will lead to improved pregnancy and birth outcomes. We study the effects of the Midwives Service Scheme (MSS), a public sector program in Nigeria that increased the supply of skilled midwives in rural communities on pregnancy and birth outcomes. We surveyed 7,104 women with a birth within the preceding five years across 12 states in Nigeria and compared changes in birth outcomes in MSS communities to changes in non-MSS communities over the same period. The main measured effect of the scheme was a 7.3-percentage point increase in antenatal care use in program clinics and a 5-percentage point increase in overall use of antenatal care, both within the first year of the program. We found no statistically significant effect of the scheme on skilled birth attendance or on maternal delivery complications. This study highlights the complexity of improving maternal and child health outcomes in developing countries, and shows that scaling up supply of midwives may not be sufficient on its own.

Building Parental Capacity to Improve Child Development: Impact Evaluation of an Early Childhood Stimulation Program in Bangladesh

ERIC Educational Resources Information Center

Chinen, Marjorie; Bos, Hans; Murray, Matthew; Hamadani, Jena; Hossain, Najmul; Mahmud, Minhaj

2015-01-01

Globally, at least 200 million children younger than five years old are falling short of their potential for development and growth. There is some evidence that improvements to children's health, nutrition, and development outcomes can be made through programs that provide direct learning experiences to children and families; are targeted toward…

How Schools and Students Respond to School Improvement Programs: The Case of Brazil's PDE

ERIC Educational Resources Information Center

Carnoy, Martin; Gove, Amber K.; Loeb, Susanna; Marshall, Jeffrey H.; Socias, Miguel

2008-01-01

This study uses rich empirical data from Brazil to assess how a government program (PDE) that decentralizes school management decisions changes what goes on in schools and how these changes affect student outcomes. It appears that the PDE resulted in some improvements in management and learning materials, but little change in other areas including…

Coupons for Success: A Marketing Incentive in Academic Support

ERIC Educational Resources Information Center

Potacco, Donna R.; Chen, Peter; Desroches, Danielle; Chisholm, Daniel R.; De Young, Sandra

2013-01-01

How does a Coupon Incentive Program motivate students to seek academic support in high-risk courses? Results from this study demonstrated that the Coupon Incentive Program was effective in motivating voluntary student attendance and improving student outcomes. Recommendations related to implementation of the Coupon Incentive Program are discussed.…

Evaluating a Nutrition Education Program for Pregnant Teen-Agers: Cognitive vs. Behavioral Outcomes.

ERIC Educational Resources Information Center

Perkin, Judy

1983-01-01

A manual on nutrition during pregnancy and lactation was developed and used with pregnant teenagers. Evaluation of the program showed that, while participants' knowledge of nutrition improved, their eating habits did not. The need for behavioral assessment of nutrition education programs is pointed out. (Author/PP)

Nursing and therapy: partnering for successful niche programs.

PubMed

Samson, Barbara; Anderson, Lisa

2007-02-01

Changing market environment, increased patient expectations, and emphasis on improving functional outcomes led to the development of orthopedic and cardiac niche programs at one agency. Through these programs, it was learned how to best utilize the strengths of nursing and therapy to achieve maximum success for both patients and the organization.

Continuous Improvement and Employee Engagement, Part 2: Design, Implementation, and Outcomes of a Daily Management System.

PubMed

Maurer, Marsha; Browall, Pamela; Phelan, Cynthia; Sanchez, Sandra; Sulmonte, Kimberlyann; Wandel, Jane; Wang, Allison

2018-04-01

A daily management system (DMS) can be used to implement continuous quality improvement and advance employee engagement. It can empower staff to identify problems in the care environment that impact quality or work flow and to address them on a daily basis. Through a DMS, improvement becomes the work of everyone, every day. The authors of this 2-part series describe their work to develop a DMS. Part 2 describes the implementation and outcomes of the program.

A Pilot Study of the Effects of Internet-Based Cognitive Stimulation on Neuropsychological Function in HIV Disease

PubMed Central

Becker, James T.; Dew, Mary Amanda; Aizenstein, Howard J.; Lopez, Oscar L.; Morrow, Lisa; Saxton, Judith; Tarraga, Lluis

2012-01-01

Purpose Mild cognitive deficits associated with HIV disease can affect activities of daily living, so interventions that reduce them may have a long-term effect on quality of life. We evaluated the feasibility of a cognitive stimulation program (CSP) to improve neuropsychological test performance in HIV disease. Methods 60 volunteers (30 HIV-infected) participated. The primary outcome was the change in neuropsychological test performance as indexed by the Global Impairment Rating; secondary outcomes included mood (Brief Symptom Inventory subscales) and quality of life rating (Medical Outcomes Survey-HIV) scales. Results 52 participants completed all 24 weeks of the study, and 54% of the participants in the CSP group successfully used the system via internet access from their home or other location. There was a significant interaction between usage and study visit such that the participants who used the program most frequently showed significantly greater improvements in cognitive functioning (F(3,46.4)=3.26, p =.030); none of the secondary outcomes were affected by the dose of CSP. Conclusions We found it possible to complete an internet-based CSP in HIV-infected individuals; ease of internet access was a key component for success. Participants who used the program most showed improvements in cognitive function over the 24-week period, suggesting that a larger clinical trial of CSP may be warranted. PMID:22458375

Design and Operation of the Transformed National Healthy Start Evaluation.

PubMed

Banks, Jamelle E; Dwyer, Maura; Hirai, Ashley; Ghandour, Reem M; Atrash, Hani K

2017-12-01

Purpose Improving pregnancy outcomes for women and children is one of the nation's top priorities. The Healthy Start (HS) program was created to address factors that contribute to high infant mortality rates (IMRs) and persistent disparities in IMRs. The program began in 1991 and was transformed in 2014 to apply lessons from emerging research, past evaluation findings, and expert recommendations. To understand the implementation and impact of the transformed program, there is a need for a robust and comprehensive evaluation. Description The national HS evaluation will include an implementation evaluation, which will describe program components that affect outcomes; a utilization evaluation, which will examine the characteristics of women and infants who did and did not utilize the program; and an outcome evaluation, which will assess the program's effectiveness with regard to producing expected outcomes among the target population. Data sources include the National HS Program Survey, a HS participant survey, and individual-level program data linked to vital records and the Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Assessment Descriptive analyses will be used to examine differences in risk profiles between participants and non-participants, as well as to calculate penetration rates for high-risk women in respective service areas. Multivariable analyses will be used to determine the impact of the program on key outcomes and will explore variation by dose, type of services received, and grantee characteristics. Conclusion Evaluation findings are expected to inform program decisions and direction, including identification of effective program components that can be spread and scaled.

A specialist peer mentoring program for university students on the autism spectrum: A pilot study

PubMed Central

2017-01-01

Introduction The provision of peer mentoring may improve tertiary education outcomes of students with autism spectrum disorder (ASD). This study evaluated the pilot year of the Curtin Specialist Mentoring Program (CSMP), a specialised peer mentoring program for university students with ASD aimed at improving self-reported well-being, academic success and retention in university studies. Methods A single group pre-test, post-test design was employed. Quantitative and qualitative evaluations were undertaken with 10 young adults with ASD to explore the effectiveness and acceptability of the CSMP program. Students completed a battery of questionnaires focused on general anxiety, state communication apprehension, perceived communication competence, and communication apprehension both prior to, and five months after commencing enrolment in the CSMP. Information regarding academic success and retention was also obtained. Interviews with participants provided further insight into their experience of the program. Results Students enrolled in the CSMP showed significant improvement in social support and general communication apprehension assessment scores. Interviews revealed key features of the CSMP that may have contributed to these positive outcomes. Conclusions The current study provides preliminary evidence that a specialised peer mentoring program can improve the well-being of students with ASD, and highlights the importance of interventions which are individualised, flexible, based on a social model, and target environmental factors such as social support. PMID:28704446

Measuring conflict management, emotional self-efficacy, and problem solving confidence in an evaluation of outdoor programs for inner-city youth in Baltimore, Maryland.

PubMed

Caldas, Stephanie V; Broaddus, Elena T; Winch, Peter J

2016-08-01

Substantial evidence supports the value of outdoor education programs for promoting healthy adolescent development, yet measurement of program outcomes often lacks rigor. Accurately assessing the impacts of programs that seek to promote positive youth development is critical for determining whether youth are benefitting as intended, identifying best practices and areas for improvement, and informing decisions about which programs to invest in. We generated brief, customized instruments for measuring three outcomes among youth participants in Baltimore City Outward Bound programs: conflict management, emotional self-efficacy, and problem solving confidence. Measures were validated through exploratory and confirmatory factor analyses of pilot-testing data from two groups of program participants. We describe our process of identifying outcomes for measurement, developing and adapting measurement instruments, and validating these instruments. The finalized measures support evaluations of outdoor education programs serving urban adolescent youth. Such evaluations enhance accountability by determining if youth are benefiting from programs as intended, and strengthen the case for investment in programs with demonstrated success. Copyright © 2016 Elsevier Ltd. All rights reserved.

Developing Common Measures in Evaluation Capacity Building: An Iterative Science and Practice Process

ERIC Educational Resources Information Center

Labin, Susan N.

2014-01-01

A fundamental reason for doing evaluation capacity building (ECB) is to improve program outcomes. Developing common measures of outcomes and the activities, processes, and factors that lead to these outcomes is an important step in moving the science and the practice of ECB forward. This article identifies a number of existing ECB measurement…

Adult Literacy and Parenting Outcomes of a Rural, Home-Based Program.

ERIC Educational Resources Information Center

Meehan, Merrill L.; Walsh, Sandra; Spring, Janet; Swisher, Angie; Lewis, Harry

The Even Start Family Literacy Program is a national program designed to break the cycle of poverty and illiteracy by working with low-income families to improve adult literacy, parenting skills, and developmental and preschool readiness of young children in the family. The Monongalia County (West Virginia) Even Start Program is unusual in that…

Participants' perceptions of the 1997-1998 Missouri State Parks Passport Program

Treesearch

Yi-Jin Ye; Jaclyn Card

2002-01-01

Service quality is increasingly important to park managers. Recreation and park evaluation measures the implementation and outcome of programs for decision-making. Decisions based on evaluations are often concerned with improving the quality of the program for participants. The purpose of the study was to evaluate the Missouri State Parks Passport Program (MSPPP) by...

The role of disease management in pay-for-performance programs for improving the care of chronically ill patients.

PubMed

Beich, Jeff; Scanlon, Dennis P; Ulbrecht, Jan; Ford, Eric W; Ibrahim, Ibrahim A

2006-02-01

To date, pay-for-performance programs targeting the care of persons with chronic conditions have primarily been directed at physicians and provide an alternative to health plan-sponsored chronic disease management (DM) programs. Both approaches require similar infrastructure, and each has its own advantages and disadvantages for program implementation. Pay-for-performance programs use incentives based on patient outcomes; however, an alternative system might incorporate measures of structure and process. Using a conceptual framework, the authors explore the variation in 50 diabetes DM programs using data from the 2002 National Business Coalition on Health's eValue8 Request for Information (RFI). The authors raise issues relevant to the assignment of accountability for patient outcomes to either health plans or physicians. They analyze the association between RFI scores measuring structures and processes, and HEDIS diabetes intermediate outcome measures. Finally, the strengths and weaknesses of using the RFI scores as an alternative metric for pay-for-performance programs are discussed.

Translation of lifestyle modification programs focused on physical activity and dietary habits delivered in community settings.

PubMed

Stoutenberg, Mark; Stanzilis, Katie; Falcon, Ashley

2015-06-01

Lifestyle modification programs (LMPs) can provide individuals with behavioral skills to sustain long-term changes to their physical activity (PA) levels and dietary habits. Yet, there is much work to be done in the translation of these programs to community settings. This review identified LMPs that focused on changing both PA and dietary behaviors and examined common features and barriers faced in their translation to community settings. A search of multiple online databases was conducted to identify LMPs that included participants over the age of 18 who enrolled in LMPs, offered in community settings, and had the goal of improving both PA and dietary behaviors. Data were extracted on participant demographics, study design characteristics, and study outcome variables including changes in PA, dietary habits, body weight, and clinical outcomes. We identified 27 studies that met inclusion criteria. Despite high levels of retention and adherence to the interventions, varying levels of success were observed in increasing PA levels, improving dietary habits, reducing body weight, and improving clinic outcomes. LMPs addressing issues of PA and dietary habits can be successfully implemented in a community setting. However, inconsistent reporting of key components in the translation of these studies (participant recruitment, utilization of behavioral strategies) may limit their replication and advancement of future programs. Future efforts should better address issues such as identifying barriers to participation and program implementation, utilization of community resources, and evaluating changes across multiple health behaviors.

Intensive exercise program after spinal cord injury ("Full-On"): study protocol for a randomized controlled trial.

PubMed

Galea, Mary P; Dunlop, Sarah A; Davis, Glen M; Nunn, Andrew; Geraghty, Timothy; Hsueh, Ya-seng Arthur; Churilov, Leonid

2013-09-11

Rehabilitation after spinal cord injury (SCI) has traditionally involved teaching compensatory strategies for identified impairments and deficits in order to improve functional independence. There is some evidence that regular and intensive activity-based therapies, directed at activation of the paralyzed extremities, promotes neurological improvement. The aim of this study is to compare the effects of a 12-week intensive activity-based therapy program for the whole body with a program of upper body exercise. A multicenter, parallel group, assessor-blinded randomized controlled trial will be conducted. One hundred eighty-eight participants with spinal cord injury, who have completed their primary rehabilitation at least 6 months prior, will be recruited from five SCI units in Australia and New Zealand. Participants will be randomized to an experimental or control group. Experimental participants will receive a 12-week program of intensive exercise for the whole body, including locomotor training, trunk exercises and functional electrical stimulation-assisted cycling. Control participants will receive a 12-week intensive upper body exercise program. The primary outcome is the American Spinal Injuries Association (ASIA) Motor Score. Secondary outcomes include measurements of sensation, function, pain, psychological measures, quality of life and cost effectiveness. All outcomes will be measured at baseline, 12 weeks, 6 months and 12 months by blinded assessors. Recruitment commenced in January 2011. The results of this trial will determine the effectiveness of a 12-week program of intensive exercise for the whole body in improving neurological recovery after spinal cord injury. NCT01236976 (10 November 2010), ACTRN12610000498099 (17 June 2010).

Improving health and safety conditions in agriculture through professional training of Florida farm labor supervisors.

PubMed

Morera, Maria C; Monaghan, Paul F; Tovar-Aguilar, J Antonio; Galindo-Gonzalez, Sebastian; Roka, Fritz M; Asuaje, Cesar

2014-01-01

Because farm labor supervisors (FLSs) are responsible for ensuring safe work environments for thousands of workers, providing them with adequate knowledge is critical to preserving worker health. Yet a challenge to offering professional training to FLSs, many of whom are foreign-born and have received different levels of education in the US and abroad, is implementing a program that not only results in knowledge gains but meets the expectations of a diverse audience. By offering bilingual instruction on safety and compliance, the University of Florida Institute of Food and Agricultural Sciences (UF/IFAS) FLS Training program is helping to improve workplace conditions and professionalize the industry. A recent evaluation of the program combined participant observation and surveys to elicit knowledge and satisfaction levels from attendees of its fall 2012 trainings. Frequency distributions and dependent- and independent-means t-tests were used to measure and compare participant outcomes. The evaluation found that attendees rated the quality of their training experience as either high or very high and scored significantly better in posttraining knowledge tests than in pretraining knowledge tests across both languages. Nonetheless, attendees of the trainings delivered in English had significantly higher posttest scores than attendees of the trainings delivered in Spanish. As a result, the program has incorporated greater standardization of content delivery and staff development. Through assessment of its program components and educational outcomes, the program has documented its effectiveness and offers a replicable approach that can serve to improve the targeted outcomes of safety and health promotion in other states.

Changes in quality of care and costs induced by implementation of a diabetes program in a social security entity of Argentina.

PubMed

González, Lorena; Elgart, Jorge F; Calvo, Héctor; Gagliardino, Juan J

2013-01-01

To measure the impact of a diabetes and cardiovascular risk factors program implemented in a social security institution upon short- and long-term clinical/metabolic outcomes and costs of care. Observational longitudinal cohort analysis of clinical/metabolic data and resource use of 300 adult male and female program participants with diabetes before (baseline) and 1 and 3 years after implementation of the program. Data were obtained from clinical records (Qualidiab) and the administration's database. The implementation of the program in "real world" conditions resulted in an immediate and sustainable improvement of the quality of care provided to people with diabetes incorporated therein. We also recorded a more appropriate oral therapy prescription for hyperglycemia and cardiovascular risk factors (CVRFs), as well as a decrease of events related to chronic complications. This improvement was associated with an increased use of diagnostic and therapeutic resources, particularly those related to pharmacy prescriptions, not specifically used for the control of hyperglycemia and other CVRFs. The implementation of a diabetes program in real-world conditions results in a significant short- and long-term improvement of the quality of care provided to people with diabetes and other CVRFs, but simultaneously increased the use of resources and the cost of diagnostic and therapeutic practices. Since controlled studies have shown improvement in quality of care without increasing costs, our results suggest the need to include management-control strategies in these programs for appropriate medical and administrative feedback to ensure the simultaneous improvement of clinical outcomes and optimization of the use of resources.

Does the addition of hip strengthening exercises improve outcomes following total knee arthroplasty? A study protocol for a randomized trial.

PubMed

Schache, Margaret B; McClelland, Jodie A; Webster, Kate E

2016-06-13

Total knee arthroplasty (TKA) is effective in reducing pain and improving function for end-stage knee osteoarthritis. However, muscle weakness and functional limitations persist despite assistance from post-operative rehabilitation programs that traditionally focus on quadriceps strengthening and range of movement exercises. Hip abductor muscle weakness is evident in knee osteoarthritis and hip muscle strengthening reduces knee pain in this group. Following TKA, people with weak hip abductor strength perform more poorly on measures of physical function. However, very little is known of the effectiveness of including hip abductor strengthening exercises in post-operative rehabilitation. The aim of this trial is to compare the effects of targeted hip abductor strengthening to those of traditional care in a TKA rehabilitation program on muscle strength, patient reported outcomes and functional performance measures. This protocol describes a single-blinded randomized controlled trial, where 104 participants referred for inpatient rehabilitation following TKA will be recruited. Participants will be randomized using computer-generated numbers to one of two groups: usual care or usual care with additional hip strengthening exercises. Participants will attend physiotherapy daily during their inpatient length of stay, and will then attend between six and eight physiotherapy sessions as an outpatient. Primary outcomes are isometric hip abductor strength and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes are stair climb test, 6 min walk test, timed up and go, 40 m fast-paced walk test, 30 second chair stand test, isometric quadriceps strength, Lower Extremity Functional Scale (LEFS) and SF-12. Outcome measures will be recorded at baseline (admission to inpatient rehabilitation), and then 3 weeks, 6 weeks and 6 months post admission to rehabilitation. The findings of this study will determine whether the addition of targeted hip strengthening to usual care rehabilitation improves physical performance and patient reported outcomes following TKA when compared to usual care rehabilitation. This will then determine whether targeted hip strengthening exercises should be included in traditional rehabilitation programs to improve the outcomes following total knee arthroplasty. The trial protocol was registered with the Australian Clinical Trial Registry ( ACTRN12615000863538 ) on 18 August 2015.

Disease management in Canada: surmounting barriers to adoption.

PubMed

Gallant, Christopher R; MacKinnon, Neil J; Sprague, Denise A

2007-01-01

Disease Management (DM) programs are used to optimize economic outcomes and improve patient outcomes. Despite this, relative to the United States, Canadian health care organizations have been slow to adopt them. The objective of this article is to examine the concept of DM programs, the existing evidence to support their use and the barriers to their adoption in Canada. Several solutions aimed at overcoming the barriers to DM in Canada are proposed.

Improving ethical knowledge and sensemaking from cases through elaborative interrogation and outcome valence.

PubMed

Johnson, James F; Bagdasarov, Zhanna; MacDougall, Alexandra E; Steele, Logan; Connelly, Shane; Devenport, Lynn D; Mumford, Michael D

2014-01-01

The case-based approach to learning is popular among many applied fields. However, results of case-based education vary widely on case content and case presentation. This study examined two aspects of case-based education-outcome valence and case elaboration methods-in a two-day case-based Responsible Conduct of Research (RCR) ethics education program. Results suggest that outcome information is an integral part of a quality case. Furthermore, valence consistent outcomes may have certain advantages over mixed valence outcome information. Finally, students enjoy and excel working with case material, and the use of elaborative interrogation techniques can significantly improve internally-focused ethical sensemaking strategies associated with personal biases, constraints, and emotions.

A randomized clinical trial on the effectiveness of a reintegration training program versus booster sessions after short-term inpatient psychotherapy.

PubMed

Thunnissen, Moniek; Duivenvoorden, Hugo; Busschbach, Jan; Hakkaart-van Roijen, Leona; van Tilburg, Willem; Verheul, Roel; Trijsburg, Wim

2008-10-01

Although several studies show symptomatic improvements in patients with personality disorders after short-term inpatient psychotherapy, reintegration remains difficult. In this study the effectiveness of a specifically designed reintegration training program is investigated. One hundred twenty-eight patients were randomized to either a reintegration training program aimed at improving general functioning and work resumption, or booster sessions. Outcome measures used were symptom level, work status, absence from and impediments at work. The results showed that compliance in the booster session group was significantly better than in the reintegration training program. The percentage of persons with a paid job increased during the booster sessions from 64 to 87%, but not during the reintegration training (76%). There were no differences in the other outcome measures. We concluded that reintegration training was not more (cost)-effective than booster sessions. Our hypothesis is that continuity of care (same therapists and program) explains the favorable results of the booster sessions.

Adaptive Programming Improves Outcomes in Drug Court: An Experimental Trial

PubMed Central

Marlowe, Douglas B.; Festinger, David S.; Dugosh, Karen L.; Benasutti, Kathleen M.; Fox, Gloria; Croft, Jason R.

2011-01-01

Prior studies in Drug Courts reported improved outcomes when participants were matched to schedules of judicial status hearings based on their criminological risk level. The current experiment determined whether incremental efficacy could be gained by periodically adjusting the schedule of status hearings and clinical case-management sessions in response to participants’ ensuing performance in the program. The adjustments were made pursuant to a priori criteria specified in an adaptive algorithm. Results confirmed that participants in the full adaptive condition (n = 62) were more than twice as likely as those assigned to baseline-matching only (n = 63) to be drug-abstinent during the first 18 weeks of the program; however, graduation rates and the average time to case resolution were not significantly different. The positive effects of the adaptive program appear to have stemmed from holding noncompliant participants more accountable for meeting their attendance obligations in the program. Directions for future research and practice implications are discussed. PMID:22923854

How do drug users define their progress in harm reduction programs? Qualitative research to develop user-generated outcomes

PubMed Central

Ruefli, Terry; Rogers, Susan J

2004-01-01

Background Harm reduction is a relatively new and controversial model for treating drug users, with little formal research on its operation and effectiveness. In order to advance the study of harm reduction programs and our understanding of how drug users define their progress, qualitative research was conducted to develop outcomes of harm reduction programming that are culturally relevant, incremental, (i.e., capable of measuring change), and hierarchical (i.e., capable of showing how clients improve over time). Methods The study used nominal group technique (NGT) to develop the outcomes (phase 1) and focus group interviews to help validate the findings (phase 2). Study participants were recruited from a large harm-reduction program in New York City and involved approximately 120 clients in 10 groups in phase 1 and 120 clients in 10 focus groups in phase 2. Results Outcomes of 10 life areas important to drug users were developed that included between 10 to 15 incremental measures per outcome. The outcomes included ways of 1) making money; 2) getting something good to eat; 3) being housed/homeless; 4) relating to families; 5) getting needed programs/benefits/services; 6) handling health problems; 7) handling negative emotions; 8) handling legal problems; 9) improving oneself; and 10) handling drug-use problems. Findings also provided insights into drug users' lives and values, as well as a window into understanding how this population envisions a better quality of life. Results challenged traditional ways of measuring drug users based solely on quantity used and frequency of use. They suggest that more appropriate measures are based on the extent to which drug users organize their lives around drug use and how much drug use is integrated into their lives and negatively impacts other aspects of their lives. Conclusions Harm reduction and other programs serving active drug users and other marginalized people should not rely on institutionalized, provider-defined solutions to problems in living faced by their clients. PMID:15333130

Is voluntary certification of tropical agricultural commodities achieving sustainability goals for small-scale producers? A review of the evidence

NASA Astrophysics Data System (ADS)

DeFries, Ruth S.; Fanzo, Jessica; Mondal, Pinki; Remans, Roseline; Wood, Stephen A.

2017-03-01

Over the last several decades, voluntary certification programs have become a key approach to promote sustainable supply chains for agricultural commodities. These programs provide premiums and other benefits to producers for adhering to environmental and labor practices established by the certifying entities. Following the principles of Cochrane Reviews used in health sciences, we assess evidence to evaluate whether voluntary certification of tropical agricultural commodities (bananas, cocoa, coffee, oil palm, and tea) has achieved environmental benefits and improved economic and social outcomes for small-scale producers at the level of the farm household. We reviewed over 2600 papers in the peer-review literature and identified 24 cases of unique combinations of study area, certification program, and commodity in 16 papers that rigorously analyzed differences between treatment (certified households) and control groups (uncertified households) for a wide range of response variables. Based on analysis of 347 response variables reported in these papers, we conclude that certification is associated on average with positive outcomes for 34% of response variables, no significant difference for 58% of variables, and negative outcomes for 8% of variables. No significant differences were observed for different categories of responses (environmental, economic and social) or for different commodities (banana, coffee and tea), except negative outcomes were significantly less for environmental than other outcome categories (p = 0.01). Most cases (20 out of 24) investigated coffee certification and response variables were inconsistent across cases, indicating the paucity of studies to conduct a conclusive meta-analysis. The somewhat positive results indicate that voluntary certification programs can sometimes play a role in meeting sustainable development goals and do not support the view that such programs are merely greenwashing. However, results also indicate that certification is not a panacea to improve social outcomes or overall incomes of smallholder farmers. Rigorous analysis, standardized criteria, and independent evaluation are needed to assess effectiveness of certification programs in the future.

Randomized Controlled Trial of Exercise for ADHD and Disruptive Behavior Disorders.

PubMed

Bustamante, Eduardo Esteban; Davis, Catherine Lucy; Frazier, Stacy Lynn; Rusch, Dana; Fogg, Louis F; Atkins, Marc S; Marquez, David Xavier

2016-07-01

The objective of this study is to test the feasibility and impact of a 10-wk after-school exercise program for children with attention deficit hyperactivity disorder and/or disruptive behavior disorders living in an urban poor community. Children were randomized to an exercise program (n = 19) or a comparable but sedentary attention control program (n = 16). Cognitive and behavioral outcomes were collected pre-/posttest. Intent-to-treat mixed models tested group-time and group-time-attendance interactions. Effect sizes were calculated within and between groups. Feasibility was evidenced by 86% retention, 60% attendance, and average 75% maximum HR. Group-time results were null on the primary outcome, parent-reported executive function. Among secondary outcomes, between-group effect sizes favored exercise on hyperactive symptoms (d = 0.47) and verbal working memory (d = 0.26), and controls on visuospatial working memory (d = -0.21) and oppositional defiant symptoms (d = -0.37). In each group, within-group effect sizes were moderate to large on most outcomes (d = 0.67 to 1.60). A group-time-attendance interaction emerged on visuospatial working memory (F[1,33] = 7.42, P < 0.05), such that attendance to the control program was related to greater improvements (r = 0.72, P < 0.01), whereas attendance to the exercise program was not (r = 0.25, P = 0.34). Although between-group findings on the primary outcome, parent-reported executive function, were null, between-group effect sizes on hyperactivity and visuospatial working memory may reflect adaptations to the specific challenges presented by distinct formats. Both groups demonstrated substantial within-group improvements on clinically relevant outcomes. Findings underscore the importance of programmatic features, such as routines, engaging activities, behavior management strategies, and adult attention, and highlight the potential for after-school programs to benefit children with attention deficit hyperactivity disorder and disruptive behavior disorder living in urban poverty where health needs are high and services resources few.

Caregiver outcomes of partners in dementia care: effect of a care coordination program for veterans with dementia and their family members and friends.

PubMed

Bass, David M; Judge, Katherine S; Snow, A Lynn; Wilson, Nancy L; Morgan, Robert; Looman, Wendy J; McCarthy, Catherine A; Maslow, Katie; Moye, Jennifer A; Randazzo, Ronda; Garcia-Maldonado, Maurilio; Elbein, Richard; Odenheimer, Germaine; Kunik, Mark E

2013-08-01

The objective is to test the effectiveness of Partners in Dementia Care (PDC), a care-coordination program that integrates and improves access to medical and nonmedical services, while strengthening the informal care network and providing information, coaching, and emotional support. PDC was delivered via a partnership between Veterans Affairs (VA) Medical Centers (VAMCs) and Alzheimer's Association chapters, for caregivers of veterans with dementia living in the community and receiving primary care from the VA. The initial sample was 486 caregivers of 508 veterans with diagnosed dementia. Outcomes were evaluated for 394 and 324 caregivers who completed 6- and 12- month follow-up, respectively. PDC had a standardized protocol that included assessment and reassessment, action planning, and ongoing monitoring. It was delivered by telephone and e-mail for cost efficiency and the ability to handle caseloads of 100 to 125. Care coordinators from VAMCs and Alzheimer's Association chapters worked as a team using a shared computerized record. A variety of caregiver outcomes was measured after 6 and 12 months. Intervention group caregivers had significant improvements in outcomes representing unmet needs, three types of caregiver strains, depression, and two support resources. Most improvements were evident after 6 months, with more-limited improvements from Months 6 to 12. Some outcomes improved for all caregivers, whereas some improved for caregivers experiencing more initial difficulties or caring for veterans with more-severe impairments. PDC is a promising model that improves linkages between healthcare services and community services, which is a goal of several new national initiatives such as the National Plan to Address Alzheimer's Disease and a proposed amendment to the Older Americans Act. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Conceptual model of comprehensive research metrics for improved human health and environment.

PubMed

Engel-Cox, Jill A; Van Houten, Bennett; Phelps, Jerry; Rose, Shyanika W

2008-05-01

Federal, state, and private research agencies and organizations have faced increasing administrative and public demand for performance measurement. Historically, performance measurement predominantly consisted of near-term outputs measured through bibliometrics. The recent focus is on accountability for investment based on long-term outcomes. Developing measurable outcome-based metrics for research programs has been particularly challenging, because of difficulty linking research results to spatially and temporally distant outcomes. Our objective in this review is to build a logic model and associated metrics through which to measure the contribution of environmental health research programs to improvements in human health, the environment, and the economy. We used expert input and literature research on research impact assessment. With these sources, we developed a logic model that defines the components and linkages between extramural environmental health research grant programs and the outputs and outcomes related to health and social welfare, environmental quality and sustainability, economics, and quality of life. The logic model focuses on the environmental health research portfolio of the National Institute of Environmental Health Sciences (NIEHS) Division of Extramural Research and Training. The model delineates pathways for contributions by five types of institutional partners in the research process: NIEHS, other government (federal, state, and local) agencies, grantee institutions, business and industry, and community partners. The model is being applied to specific NIEHS research applications and the broader research community. We briefly discuss two examples and discuss the strengths and limits of outcome-based evaluation of research programs.

Prevention of Weight Gain Following a Worksite Nutrition and Exercise Program

PubMed Central

Thorndike, Anne N.; Sonnenberg, Lillian; Healey, Erica; Myint-U, Khinlei; Kvedar, Joseph C.; Regan, Susan

2012-01-01

Background Many employers are now providing wellness programs to help employees make changes in diet and exercise behaviors. Improving health outcomes and reducing costs will depend on whether employees sustain lifestyle changes and maintain a healthy weight over time. Purpose To determine if a 9-month maintenance intervention immediately following a 10-week worksite exercise and nutrition program would prevent regain of the weight lost during the program. Design RCT. Setting/participants In 2008, a total of 330 employees from 24 teams completed a 10-week exercise and nutrition program at a large hospital worksite and were randomized by team to maintenance or control (usual care) for 9 months. Intervention Internet support with a website for goal-setting and self-monitoring of weight and exercise plus minimal personal support. Main outcome measures Weight loss, percentage weight loss, time spent in physical activity, and frequency of consumption of fruits/vegetables, fatty foods, and sugary foods at 1 year compared to baseline. One-year follow-up was completed in 2010, and data were analyzed in 2011. Results At 1 year, 238 subjects (72%) completed follow-up assessments. Mean baseline BMI was 27.6 and did not differ between intervention and control. Compared to baseline, both groups lost weight during the 10-week program and maintained 65% of weight loss at 1 year (p<0.001). There was no difference in weight loss between groups at end of the 10-week program (4.8 lbs vs 4.3 lbs, p=0.53 for group×time interaction) or end of maintenance at 1 year (3.4 lbs vs 2.5 lbs, p=0.40 for group×time interaction). All subjects had improvements in physical activity and nutrition (increased fruits/vegetables and decreased fat and sugar intake) at 1 year but did not differ by group. Conclusions An intensive 10-week team-based worksite exercise and nutrition program resulted in moderate weight loss and improvements in diet and exercise behaviors at 1 year, but an Internet-based maintenance program immediately following the 10-week program did not improve these outcomes. PMID:22704742

International collaboration in health promotion and disease management: implications of U.S. health promotion efforts on Japan's health care system.

PubMed

Pelletier, Kenneth R

2005-01-01

For more than 25 years, health promotion and disease management interventions have been conducted by large employers in the United States. Today there are more than 100 studies of such multifactorial, comprehensive interventions that all demonstrate positive clinical outcomes. For those interventions that have also been evaluated for return on investment, all but one have demonstrated cost-effectiveness. This article is an evidence-based overview of the clinical and cost outcomes research to elaborate on the insights gained from this research in the areas of implementation and evaluation of such programs; integration of health promotion and disease management programs into conventional, occupational medicine; accessing difficult to reach populations, such as mobile workers, retirees, and/or dependents; areas of potential conflict of interest and privacy/confidentiality issues; health consequences of downsizing and job strain; and, finally, recommendations for improved integration and evaluation of such programs for both clinical and cost outcomes. With medical costs rapidly escalating again on a global scale, these interventions with evidence of both clinical and cost outcomes can provide the foundation to improve the health, performance, and productivity of both individuals and their corporations.

Programs and policies to assist high school dropouts in the transition to adulthood.

PubMed

Bloom, Dan

2010-01-01

Dan Bloom of MDRC examines policies and programs designed to help high school dropouts improve their educational attainment and labor market outcomes. So called "second-chance" programs, he says, have long provided some combination of education, training, employment, counseling, and social services. But the research record on their effectiveness is fairly thin, he says, and the results are mixed. Bloom describes eleven employment- or education-focused programs serving high school dropouts that have been rigorously evaluated over the past thirty years. Some relied heavily on paid work experience, while others focused more on job training or education. Some programs, especially those that offered paid work opportunities, generated significant increases in employment or earnings in the short term, but none of the studies that followed participants for more than a couple of years found lasting improvements in economic outcomes. Nevertheless, the findings provide an important foundation on which to build. Because of the high individual and social costs of ignoring high school dropouts, the argument for investing more public funds in services, systems, and research for these young people is strong. The paucity of conclusive evidence, however, makes it hard to know how to direct resources and magnifies the importance of ensuring that all new initiatives provide for rigorous evaluation of their impacts. Bloom concludes with recommendations for policy and research aimed at building on current efforts to expand and improve effective programs for dropouts while simultaneously developing and testing new approaches that might be more effective and strengthening local systems to support vulnerable young people. He stresses the importance of identifying and disseminating strategies to engage young people who are more seriously disconnected and unlikely to join programs. A recurring theme is that providing young people with opportunities for paid work may be useful both as an engagement tool and as a strategy for improving long-term labor market outcomes.

A virtual patient software program to improve pharmacy student learning in a comprehensive disease management course.

PubMed

Douglass, Mark A; Casale, Jillian P; Skirvin, J Andrew; DiVall, Margarita V

2013-10-14

To implement and assess the impact of a virtual patient pilot program on pharmacy students' clinical competence skills. Pharmacy students completed interactive software-based patient case scenarios embedded with drug-therapy problems as part of a course requirement at the end of their third year. Assessments included drug-therapy problem competency achievement, performance on a pretest and posttest, and pilot evaluation survey instrument. Significant improvements in students' posttest scores demonstrated advancement of clinical skills involving drug-therapy problem solving. Students agreed that completing the pilot program improved their chronic disease management skills and the program summarized the course series well. Using virtual patient technology allowed for assessment of student competencies and improved learning outcomes.

Improved health behaviors persist over two years for employees in a worksite wellness program.

PubMed

LeCheminant, James D; Merrill, Ray M

2012-10-01

This study evaluates whether improvements in health behaviors related to a worksite wellness program persist through 2 years. The program was designed to build behavioral capability and self-efficacy by yielding immediately applicable skills and tools and segmenting the behavior change process into weekly, manageable doses. Analyses are based on 267 individuals employed from 2009 through 2011. Significant improvements were observed in the frequency and volume of exercise, and the consumption of vegetables and fruits over 12 and 24 months. Requests for health coaching significantly increased over the study period. Thus, the type of wellness program evaluated in this study produced sustainable health behaviors through 24 months, which likely will translate into future positive health outcomes and improved employee productivity.

Exploring Outcome Measures for Exercise Intervention in People with Parkinson's Disease

PubMed Central

King, L. A.; Salarian, A.; Mancini, M.; Priest, K. C.; Nutt, J.; Serdar, A.; Wilhelm, J.; Schlimgen, J.; Smith, M.; Horak, F. B.

2013-01-01

Background. It is widely believed that exercise improves mobility in people with Parkinson's disease (PD). However, it is difficult to determine whether a specific type of exercise is the most effective. The purpose of this study was to determine which outcome measures were sensitive to exercise intervention and to explore the effects of two different exercise programs for improving mobility in patients with PD. Methods. Participants were randomized into either the Agility Boot Camp (ABC) or treadmill training; 4x/week for 4 weeks. Outcome measures were grouped by the International Classification of Function/Disability (ICF). To determine the responsiveness to exercise, we calculated the standardized response means. t-tests were used to compare the relative benefits of each exercise program. Results. Four of five variables at the structure/function level changed after exercise: turn duration (P = 0.03), stride velocity (P = 0.001), peak arm speed (P = 0.001), and horizontal trunk ROM during gait (P = 0.02). Most measures improved similarly for both interventions. The only variable that detected a difference between groups was postural sway in ABC group (F = 4.95; P = 0.03). Conclusion. Outcome measures at ICF body structure/function level were most effective at detecting change after exercise and revealing differences in improvement between interventions. PMID:23738230

Training and action for patient safety: embedding interprofessional education for patient safety within an improvement methodology.

PubMed

Slater, Beverley L; Lawton, Rebecca; Armitage, Gerry; Bibby, John; Wright, John

2012-01-01

Despite an explosion of interest in improving safety and reducing error in health care, one important aspect of patient safety that has received little attention is a systematic approach to education and training for the whole health care workforce. This article describes an evaluation of an innovative multiprofessional, team-based training program that embeds patient safety within quality improvement methods. Kirkpatrick's "levels of evaluation" model was adopted to evaluate the program in health organizations across one city in the north of England. Questionnaires were used to assess reaction of participants to the program (Level 1). Improvements in patient safety knowledge and patient safety culture (Level 2) were assessed using a 12-item multiple-choice questionnaire and a culture questionnaire. Interviews and project-specific quantitative measurements were used to assess changes in professional practice and patient outcomes (Levels 3 and 4). All aspects of the program were positively received by participants. Few participants completed the MCQ at both time points, but those who did showed improvement in knowledge. There were some small but significant improvements in patient safety culture. Interviews revealed a number of additional benefits beyond the specific problems addressed. Most importantly, 8 of the 11 teams showed improvements in patient safety practices and/or outcomes. This program is an example of interprofessional education in practice and demonstrates that team-based learning using quality improvement methods is feasible and can be effective in improving patient safety, but requires time and space for participants. Alignment with continuing education arrangements could support mainstream adoption of this approach within organizations. Copyright © 2012 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Postoperative rehabilitation for chronic subdural hematoma in the elderly. An observational study focusing on balance, ambulation and discharge destination.

PubMed

Carlisi, Ettore; Feltroni, Lucia; Tinelli, Carmine; Verlotta, Mariarosaria; Gaetani, Paolo; Dalla Toffola, Elena

2017-02-01

Chronic subdural hematoma (CSDH) can have a negative impact on autonomy of the elderly. Ambulatory and functional status may remain limited despite successful surgical evacuation. To evaluate the outcome of a postoperative assisted rehabilitation program. Single-institution short-term observational study. Inpatient (Neurosurgery Unit of a University Hospital). Thirty-five patients, aged 65 or older, who underwent burr-hole drainage for chronic subdural hematoma. Postoperatively all participants underwent a rehabilitation program, described in details, aimed at recovering standing position and gait as soon as possible. The program involved daily 30-minute individual sessions assisted by a physiotherapist, until discharge from hospital. The Markwalder's Grading Scale was used to assess the neurological status preoperatively and at discharge. The Trunk Control Test, the Standing Balance by Bohannon Scale and the Modified Rankin Scale were used to evaluate balance and general function (primary outcome) in the immediate postoperative and at discharge. We also recorded the rate of pre-CSDH walking patients who maintained ambulation at discharge and the discharge destination (secondary outcome). Total scores of Markwalder's Grading Scale, Trunk Control Test, Standing Balance by Bohannon Scale and Modified Rankin Scale improved (P<0.05), indicating a global favorable outcome, especially for balance. Excluding the patients who were dependent pre-CSDH, the others maintained gait function in 74.2% of cases. Only 45.7% of the patients were discharged home, the others being divided between inpatient medical settings and rehabilitation. The rehabilitation program was well tolerated by the patients. Our study showed a clear improvement in trunk control and standing balance and an overall favorable outcome for neurological and ambulatory status at discharge. Despite an assisted postoperative rehabilitation program, the residual impairment in general function was the main factor that prevents us to discharge more elderly patients home rather than to assisted settings. The results of this descriptive study suggest that an assisted rehabilitation program may be helpful in improving short-term postoperative balance and ambulatory status (more than functional status), but further studies, with a randomized controlled design, are certainly justified to understand the efficacy of rehabilitation in this context.

Prevalence, effectiveness, and characteristics of pharmacy-based medication synchronization programs.

PubMed

Krumme, Alexis A; Isaman, Danielle L; Stolpe, Samuel F; Dougherty, Samantha; Choudhry, Niteesh K

2016-03-01

The burden of visiting pharmacies to fill medications is a central contributor to nonadherence to maintenance medications. Recently, pharmacies have begun offering services that align prescription fill dates to allow patients to pick up all medications on a single visit. We evaluated the prevalence and structure of synchronization programs and evidence of their impact on adherence and clinical outcomes. Mixed-methods approach consisting of semi-structured interviews, data from surveillance activities, and a systematic literature review. We conducted interviews with opinion leaders from nonprofit advocacy organizations and exemplary synchronization programs. Program prevalence was determined using data from regular surveillance efforts. A literature review included Medline, EMBASE, Google Scholar, and general Internet searches. Synchronization programs exist in approximately 10% of independent, 6% of stand-alone chain, and 11% of retail store pharmacies. The majority of programs include a monthly pharmacist appointment and reminder communication. Programs reported the importance of pharmacist buy-in, technology to track and recruit patients, links to other healthcare services, and flexible solutions for managing costs and communication preferences. Although existing peer-reviewed literature suggests that synchronization improves adherence, more evidence is needed to evaluate its impact on patient-centered outcomes. As medication synchronization programs shift directions and compete for patients and payer resources, it will be more important than ever to rigorously evaluate their ability to improve clinical outcomes while also providing the growing number of patients managing multiple chronic conditions with the highest level of patient engagement and consumer choice.

Opportunities for improving maternal nutrition and birth outcomes: synthesis of country experiences.

PubMed

Mason, John B; Saldanha, Lisa S; Ramakrishnan, Usha; Lowe, Alyssa; Noznesky, Elizabeth A; Girard, Amy Webb; McFarland, Deborah A; Martorell, Reynaldo

2012-06-01

Undernutrition in women in poor countries remains prevalent and affects maternal, neonatal and child health (MNCH) outcomes. Improving MNCH outcomes requires better policies and programs that enhance women's nutrition. The studies aimed to better understand awareness, perceptions, barriers to intervention, and policy and program priorities and approaches, through different platforms, addressing three related priority problems: anemia, intra-uterine growth retardation (IUGR), and maternal thinness and stunting (including incomplete growth with early pregnancy). Results of a global literature review on program effectiveness, and from case studies in Ethiopia, India, and Nigeria, were synthesized. Anemia can be reduced by iron-folate supplementation, but all aspects for successful implementation, from priority to resources to local capacity, require strengthening. For IUGR, additional interventions, offood supplementation or cash transfers, may be required for impact, plus measures to combat early pregnancy. Breaking the intergenerational cycle of women's undernutrition may also be helped by child nutrition programs. Potential interventions exist and need to be built on: iron-folate and multiple micronutrient supplementation, food fortification (including iodized salt),food supplementation and/or cash transfer programs, combatting early pregnancy, infant and young child nutrition. Potential platforms are: the health system especially antenatal care, community-based nutrition programs (presently usually child-oriented but can be extended to women), child health days, safety net programs, especially cash transfer and conditional cash transfer programs. Making these more effective requires system development and organization, capacity and training, technical guidelines and operational research, and advocacy (who takes the lead?), information, monitoring and evaluation.

Depression following traumatic brain injury: Impact on post-hospital residential rehabilitation outcomes.

PubMed

Lewis, Frank D; Horn, Gordon J

2017-01-01

A need exists to better understand the impact of depression on functional outcomes following TBI. To evaluate the prevalence and severity of depression among a large group of chronic TBI adults; to determine the impact of depression on outcomes of post-hospital residential rehabilitation programs; and to assess effectiveness of post-hospital residential rehabilitation programs in treating depression. 820 adults with moderate to severe traumatic brain injury (TBI) were assigned to one of four groups based on MPAI- 4 depression ratings: (1) Not Depressed, (2) Mildly Depressed, (3) Moderately Depressed, and (4) Severely Depressed. Functional status was assessed at admission and discharge with the MPAI-4 Participation Index. Differences among groups were evaluated using conventional parametric tests. Rasch analysis established reliability and validity of MPAI-4 data. Rasch analysis demonstrated satisfactory construct validity and internal consistency (Person reliability = 0.89-0.92, Item reliability = 0.99). Of the 820 subjects, 39% presented with moderate to severe depressive symptoms at admission, These subjects demonstrated significantly higher MPAI-4 Participation scores than the mild and not depressed groups. Depressed groups realized significant improvement in symptoms, but, those remaining depressed at discharge had significantly greater disability than those who improved. Depressive symptoms had a deleterious impact on outcome. Remediation of symptoms during rehabilitation significantly improved outcomes.

Financial implications of glycemic control: results of an inpatient diabetes management program.

PubMed

Newton, Christopher A; Young, Sandra

2006-01-01

(1) To determine the financial implications associated with changes in clinical outcomes resulting from implementation of an inpatient diabetes management program and (2) to describe the strategies involved in the formation of this program. The various factors that influence financial outcomes are examined, and previous and current outcomes are compared. Associations exist between hyperglycemia, length of stay, and hospital costs. Implementation of an inpatient diabetes management program, based on published guidelines, has been shown to increase the use of scheduled medications to treat hyperglycemia and increase the frequency of physician intervention for glucose readings outside desired ranges. Results from implementing this program have included a reduction in the average glucose level in the medical intensive care unit through use of protocols driven to initiate intravenous insulin once the glucose level exceeds 140 mg/dL. Additionally, glucose levels have been reduced throughout the hospital, primarily because of interactions between diabetes nurse care managers and the primary care team. Associated with these lower glucose levels are a decreased prevalence of central line infections and shorter lengths of stay. The reduction in the length of stay for patients with diabetes has resulted in a savings of more than 2 million dollars for the year and has yielded a 467% return on investment for the hospital. Improved blood glucose control during the hospitalization of patients with known hyperglycemia is associated with reduced morbidity, reduced hospital length of stay, and cost savings. The implementation of an inpatient diabetes management program can provide better glycemic control, thereby improving outcomes for hyperglycemic patients while saving the hospital money.

Integrating Health Education in Core Curriculum Classrooms: Successes, Challenges, and Implications for Urban Middle Schools.

PubMed

Rajan, Sonali; Roberts, Katherine J; Guerra, Laura; Pirsch, Moira; Morrell, Ernest

2017-12-01

School-based health education efforts can positively affect health behaviors and learning outcomes; however, there is limited available time during the school day for separate health education classes. The purpose of this study was to assess the feasibility and sustainability of implementing a classroom-based health education program that integrates skill development with health learning. A wait-list control study design was conducted among 168 6th graders in 2 urban schools. Data on program implementation, feasibility, and health outcomes were collected from students at 3 time points and from 5 teachers across the implementation of the 10-week program. There were barriers to implementation, including time limitations, unexpected school-wide disruptions, and variations in student reading ability and teacher preparedness. However, analyses revealed there were significant increases in self-efficacy regarding fruit and vegetable consumption and outcome expectations following program implementation, which were also sustained post-program implementation. Despite inconsistent implementation in the wait-list control school, small gains were also noted following the completion of the program. Integrating health education efforts within core curricula classes can lead to favorable outcomes. However, implementation barriers must be actively addressed by schools and program developers to improve program fidelity and maximize the sustainability of program gains. © 2017, American School Health Association.

Commentary: Learning from Variations in Fidelity of Implementation.

PubMed

Balu, Rekha; Doolittle, Fred

2016-12-01

The articles in this special issue discuss efforts to improve academic reading outcomes for students and ways to achieve high implementation fidelity of promising strategies. At times the authors discuss if-and how-strong fidelity is associated with strong outcomes and potentially even impacts (the difference between program and control group outcomes). We want to explore this theme in two ways: (a) learning from the variation in fidelity to think about potential points of entry and levers for improvement in implementation, and (b) broadening the evaluation focus to include "service contrast" as a factor driving impacts on student outcomes. We conclude with suggestions for future research. © 2016 Wiley Periodicals, Inc.

Multistakeholder Perspectives on Maternal Text Messaging Intervention in Uganda: Qualitative Study.

PubMed

Ilozumba, Onaedo; Dieleman, Marjolein; Van Belle, Sara; Mukuru, Moses; Bardají, Azucena; Broerse, Jacqueline Ew

2018-05-10

Despite continued interest in the use of mobile health for improving maternal health outcomes, there have been limited attempts to identify relevant program theories. This study had two aims: first, to explicate the assumptions of program designers, which we call the program theory and second, to contrast this program theory with empirical data to gain a better understanding of mechanisms, facilitators, and barriers related to the program outcomes. To achieve the aforementioned objectives, we conducted a retrospective qualitative study of a text messaging (short message service) platform geared at improving individual maternal health outcomes in Uganda. Through interviews with program designers (n=3), we elicited 3 main designers' assumptions and explored these against data from qualitative interviews with primary beneficiaries (n=26; 15 women and 11 men) and health service providers (n=6), as well as 6 focus group discussions with village health team members (n=50) who were all involved in the program. Our study results highlighted that while the program designers' assumptions were appropriate, additional mechanisms and contextual factors, such as the importance of incentives for village health team members, mobile phone ownership, and health system factors should have been considered. Our results indicate that text messages could be an effective part of a more comprehensive maternal health program when context and system barriers are identified and addressed in the program theories. ©Onaedo Ilozumba, Marjolein Dieleman, Sara Van Belle, Moses Mukuru, Azucena Bardají, Jacqueline EW Broerse. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 10.05.2018.

Short and long-term outcomes from a multisession diabetes education program targeting low-income minority patients: a six-month follow up.

PubMed

Ryan, John G; Jennings, Terri; Vittoria, Isabel; Fedders, Mark

2013-01-01

A diabetes self-management education (DSME) program was offered to patients at a primary care clinic serving low-income people. The purpose of the analyses presented here was to understand the feasibility of the program and effectiveness of the intervention. The program was facilitated by a nurse and licensed dietician. Data were collected at baseline, after each class, and after 6 months. Patients were interviewed to identify diabetes self-care behaviors before the first class, after the fourth class, and at 6 months. Knowledge related to content areas was measured before and after each class. Glycosylated hemoglobin (HbA(1c)), blood pressure, weight, and body mass index (BMI) were collected at baseline and after 6 months. Medical records were reviewed for LDL levels, co-morbidity, and diabetes management. Frequencies, χ(2) and t tests, and repeated measures t tests were used to analyze data. Patients were mostly non-Hispanic black or Hispanic (93.1%); mean BMI was 34.89 kg/m(2). About one-half (41.95%) completed the program. Significant improvements were observed for knowledge related to each of the 4 content areas: diet (P < 0.001), diabetes management (P = 0.003), monitoring blood glucose (P < 0.001), and preventing complications (P = 0.001). Among long-term outcomes, mean HbA(1c) was significantly reduced (0.82%), from 8.60% to 7.78% (P = 0.007), with 26.67% of patients reducing HbA(1c) from ≥7.0% at baseline to <7% at follow up (P < 0.001). Patients demonstrated a significant improvement in readiness to improve dietary behaviors (P = 0.016). Outcomes suggested that minority patients with a high risk for poor diabetes outcomes might be retained in a multisession DSME program and benefit from increasing knowledge of diabetes content. Further evaluation is necessary to determine the cost-effectiveness of this intervention. Copyright © 2013 Elsevier HS Journals, Inc. All rights reserved.

Improving Student Performance Outcomes and Graduation Rates through Institutional Partnerships

ERIC Educational Resources Information Center

Roggow, Michael J.

2014-01-01

This chapter explores a grant-sponsored program and examines the role of departmental and institutional collaborations in advancing student performance outcomes. It provides a theoretical framework and a description of best practices for ensuring the success of first-generation urban community college students.

A systematic review highlights a knowledge gap regarding the effectiveness of health-related training programs in journalology.

PubMed

Galipeau, James; Moher, David; Campbell, Craig; Hendry, Paul; Cameron, D William; Palepu, Anita; Hébert, Paul C

2015-03-01

To investigate whether training in writing for scholarly publication, journal editing, or manuscript peer review effectively improves educational outcomes related to the quality of health research reporting. We searched MEDLINE, Embase, ERIC, PsycINFO, and the Cochrane Library for comparative studies of formalized, a priori-developed training programs in writing for scholarly publication, journal editing, or manuscript peer review. Comparators included the following: (1) before and after administration of a training program, (2) between two or more training programs, or (3) between a training program and any other (or no) intervention(s). Outcomes included any measure of effectiveness of training. Eighteen reports of 17 studies were included. Twelve studies focused on writing for publication, five on peer review, and none fit our criteria for journal editing. Included studies were generally small and inconclusive regarding the effects of training of authors, peer reviewers, and editors on educational outcomes related to improving the quality of health research. Studies were also of questionable validity and susceptible to misinterpretation because of their risk of bias. This review highlights the gaps in our knowledge of how to enhance and ensure the scientific quality of research output for authors, peer reviewers, and journal editors. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Child Health in Elementary School Following California’s Paid Family Leave Program.

PubMed

Lichtman-Sadot, Shirlee; Bell, Niryvia Pillay

We evaluate changes in elementary school children health outcomes following the introduction of California’s Paid Family Leave (PFL) program, which provided parents with paid time off following the birth of a child. Our health outcomes--overweight, ADHD, and hearing-related problems--are characterized by diagnosis rates that only pick up during early elementary school. Moreover, our health outcomes have been found to be negatively linked with many potential implications of extended maternity leave--increased breastfeeding, prompt medical checkups at infancy, reduced prenatal stress, and reduced non-parental care during infancy. Using the Early Childhood Longitudinal Studies (ECLS) within a difference-in-differences framework, our results suggest improvements in health outcomes among California elementary school children following PFL’s introduction. Furthermore, the improvements are driven by children from less advantaged backgrounds, which is consistent with the notion that California’s PFL had the greatest effect on leave-taking duration after childbirth mostly for less advantaged mothers who previously could not afford to take unpaid leave.

Using Stakeholder Input to Inform an Innovative Research and Policy Initiative to Improve Depression in Safety Net Communities.

PubMed

Khodyakov, Dmitry; Williams, Pluscedia; Bromley, Elizabeth; Chung, Bowen; Wells, Kenneth

Depression quality improvement programs based on chronic disease management models have been shown to improve depression outcomes. Nonetheless, access to and the use of such programs is limited in minority, under-resourced communities. We report on the outcomes of a Delphi-based consensus exercise conducted by our partnership at a community-wide conference in Los Angeles. Participants identified and prioritized the needs of depressed individuals that should be addressed in a county-wide Health Neighborhood Initiative designed to increase existing mental health, substance use, healthcare, and social services for individuals with low socioeconomic position. Participants agreed that housing is the number one priority. Delphi results also illustrate the importance of addressing social, spiritual, and healthcare access needs of depressed individuals. Our study shows how to systematically engage community-based organizations, patients, families, and community members in the process of improving the design of community-wide health policy initiatives.

Effects of a Program for Improving Biomechanical Characteristics During Walking and Running in Children Who Are Obese.

PubMed

Steinberg, Nili; Rubinstein, Meron; Nemet, Dan; Ayalon, Moshe; Zeev, Aviva; Pantanowitz, Michal; Brosh, Tamar; Eliakim, Alon

2017-10-01

To investigate the influence of a weight-reduction program with locomotion-emphasis on improving biomechanical characteristics of children who are obese (OW). Ten children who are OW participated in a 6-month multidisciplinary childhood obesity management program (GRP1); another 10 children who are OW participated in the same multidisciplinary childhood obesity management program with additional locomotion-emphasis exercises for improving biomechanical characteristics (GRP2); and 10 control children who are OW with no intervention program. Outcomes were anthropometric measurements and temporal and foot pressure parameters. GRP2 had significantly improved foot pressure in the different walking/running speeds compared with GRP1. In the temporal parameters, pretests by speed by group interactions were significantly improved for GRP2 compared with GRP1. We found evidence to support beneficial effects of combined dietary and physical activity/locomotion-emphasis exercises on the movement characteristics of children who are OW.

Pay for performance in thoracic surgery.

PubMed

Varela, Gonzalo

2007-08-01

In the context of improving the quality of the medical practice, PFP programs have been developed to reward best medical practice. Early studies showed little gain in quality after implementing PFP family practice programs and some unintended consequences, like excluding high-risk patients from medical services when good outcomes were linked to payment. To date, no PFP programs have been implemented in surgical practice, but it is expected that value-based purchasing philosophy will be extended to surgical specialties in the near future. Quality initiatives in surgery can be based on outcome or process measures. Outcomes-focused quality approaches rely on accurate information obtained from multiinstitutional clinical databases for calculation of risk-adjusted models. Primary outcomes such surgical mortality are uncommon in modern thoracic surgery and outcome measures should rely on more prevalent intermediate outcomes such as specific postoperative morbidities or emergency readmission. Process-based quality approaches need to be based on scientific evidence linking process to outcomes. It is our responsibility to develop practice guidelines or international practice consensus to facilitate the parameters to be evaluated in the near future.

A Review of Effective Youth Engagement Strategies for Mental Health and Substance Use Interventions.

PubMed

Dunne, Tom; Bishop, Lisa; Avery, Susan; Darcy, Stephen

2017-05-01

The majority of adult mental health and substance use (MH&SU) conditions emerge in adolescence. Prevention, diagnosis, and treatment programs targeting this age group have a unique opportunity to significantly impact the well-being of the future generation of adults. At the same time, youth are reluctant to seek treatment and have high rates of dropout from interventions. An emphasis on youth engagement in prevention and treatment interventions for MH&SU results in better health outcomes for those youth. This literature review was undertaken to evaluate opportunities to improve youth engagement in MH&SU programs. The intent was to determine best practices in the field that combined community-level improvement in clinical outcomes with proven strategies in engagement enhancement to inform program development at a local level. The results discuss 40 studies, reviews, and program reports demonstrating effective youth engagement. These have been grouped into six themes based on the underlying engagement mechanism: youth participation in program development, parental relationships, technology, the health clinic, school, and social marketing. A broad range of tools are discussed that intervention developers can leverage to improve youth engagement in prevention or treatment programs. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Effectiveness of health and wellness initiatives for seniors.

PubMed

Coberley, Carter; Rula, Elizabeth Y; Pope, James E

2011-02-01

Given the increasing prevalence of obesity and lifestyle-related chronic diseases in the United States and abroad, senior wellness initiatives have emerged as a means to stem the troubling trends that threaten the well-being and the economy of many nations. Seniors are an important demographic for such programs because this age group is growing, both as a proportion of the overall population and as a contributor to health care cost escalation. The goal of senior wellness programs is to improve the overall health of seniors through a variety of approaches, including increased physical activity, better nutrition, smoking cessation, and support of other healthy behaviors. Outcome metrics of particular interest are the effects of participation in these programs on health care utilization and expenditures. This review describes several studies that demonstrate reduced inpatient admissions and health care costs, as well as improved health-related quality of life as a direct result of participation in large-scale senior wellness programs. Programs that effectively engage seniors in, and change behavior as a direct result of, participation provide strong evidence that health improvements and decreased health care expenditures can be achieved. However, solutions to the challenges of broader enrollment and sustained participation in these programs would increase the impact of their outcomes and health-related benefits.

American Organization of Nurse Executives Care Innovation and Transformation program: improving care and practice environments.

PubMed

Oberlies, Amanda Stefancyk

2014-09-01

The American Organization of Nurse Executives conducted an evaluation of the hospitals participating in the Care Innovation and Transformation (CIT) program. A total of 24 hospitals participated in the 2-year CIT program from 2012 to 2013. Reported outcomes include increased patient satisfaction, decreased falls, and reductions in nurse turnover and overtime. Nurses reported statistically significant improvements in 4 domains of the principles and elements of a healthful practice environment developed by the Nursing Organizations Alliance.

Establishment of an effective acute stroke telemedicine program for Australia: protocol for the Victorian Stroke Telemedicine project.

PubMed

Cadilhac, Dominique A; Moloczij, Natasha; Denisenko, Sonia; Dewey, Helen; Disler, Peter; Winzar, Bruce; Mosley, Ian; Donnan, Geoffrey A; Bladin, Christopher

2014-02-01

Urgent treatment of acute stroke in rural Australia is problematic partly because of limited access to medical specialists. Utilization of telemedicine could improve delivery of acute stroke treatments in rural communities. The study aims to demonstrate enhanced clinical decision making for use of thrombolysis within 4·5 h of ischemic stroke symptom onset in a rural setting using a telemedicine specialist support model. A formative program evaluation research design was used. The Victorian Stroke Telemedicine program was developed and will be evaluated over five stages to ensure successful implementation. The phases include: (a) preimplementation phase to establish the Victorian Stroke Telemedicine program including the clinical pathway, data collection tools, and technology processes; (b) pilot clinical application phase to test the pathway in up to 10 patients; (c) modification phase to refine the program; (d) full clinical implementation phase where the program is maintained for one-year; and (e) a sustainability phase to assess project outcomes over five-years. Qualitative (clinician interviews) and quantitative data (patient, clinician, costs, and technology processes) are collected in each phase. The primary outcome is to achieve a minimum 10% absolute increase in eligible patients treated with thrombolysis. Secondary outcomes are utilization of the telestroke pathway and improvements in processes of stroke care (e.g., time to brain scan). We will report door to telemedicine consultation time, length of telemedicine consultation, clinical utility and acceptability from the perspective of clinicians, and 90-day patient outcomes. This research will provide evidence for an effective telestroke program for use in regional Australian hospitals. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

Targeting Parenting in Early Childhood: A Public Health Approach to Improve Outcomes for Children Living in Poverty.

PubMed

Morris, Amanda Sheffield; Robinson, Lara R; Hays-Grudo, Jennifer; Claussen, Angelika H; Hartwig, Sophie A; Treat, Amy E

2017-03-01

In this article, the authors posit that programs promoting nurturing parent-child relationships influence outcomes of parents and young children living in poverty through two primary mechanisms: (a) strengthening parents' social support and (b) increasing positive parent-child interactions. The authors discuss evidence for these mechanisms as catalysts for change and provide examples from selected parenting programs that support the influence of nurturing relationships on child and parenting outcomes. The article focuses on prevention programs targeted at children and families living in poverty and closes with a discussion of the potential for widespread implementation and scalability for public health impact. © 2017 The Authors. Child Development © 2017 Society for Research in Child Development, Inc.

"Using Data" to Inform Decisions: How Teachers Use Data to Inform Practice and Improve Student Performance in Mathematics. Results from a Randomized Experiment of Program Efficacy

ERIC Educational Resources Information Center

Cavalluzzo, Linda; Geraghty, Thomas M.; Steele, Jennifer L.; Holian, Laura; Jenkins, Frank; Alexander, Jane M.; Yamasaki, Kelsey Y.

2014-01-01

The purpose of this study is to evaluate, using a randomized experimental design, the efficacy of TERC's "Using Data" program to change teacher behavior and improve student learning outcomes. The "Using Data" intervention provides professional development and technical assistance to teachers to help them use data…

Planning Considerations for Afterschool Professional Development

ERIC Educational Resources Information Center

Bradshaw, L. Daniele

2015-01-01

Professional development is vital to the success of afterschool programs. Effective professional development enhances afterschool program quality by facilitating staff performance and knowledge; in addition, professional development is vital for improving student learning outcomes (Bouffard & Little, 2004; Hall & Surr, 2005; Joyce &…

Closing the gap-cardiovascular risk and primary prevention: results from the American College of Physicians quality improvement program.

PubMed

Snow, Vincenza; Reynolds, Cara Egan; Bennett, Lia; Weiss, Kevin B; Snooks, Qianna; Qaseem, Amir

2010-01-01

The objective was to study the impact of a practice-based quality improvement program on practice teams' care for patients who have increased risk of cardiovascular disease. A total of 54 team members from 18 internal medicine practices participated in an educational program that used a pre-post intervention study design and focused on measures related to cardiovascular risk factors. The program involved live instruction, faculty-led conference calls, practice data collection, and progress reports detailing practices' improvement strategies. Data on 817 patients were reported. Practices showed significant improvement in counseling for diet (70% to 78%), exercise (67% to 74%), and weight loss (64% to 72%). Use of aspirin (53% to 64%) and statins (83% to 89%) also showed significant improvement. Administration of flu vaccine increased significantly from 51% to 54%. Improvements in patient counseling and medication management, if sustained, should lead to fewer cardiovascular events. However, program duration did not allow the capture of outcomes measures improvement.

Impact of a Pharmacy-Cardiology Collaborative Practice on Dofetilide Safety Monitoring.

PubMed

Quffa, Lieth H; Panna, Mark; Kaufmann, Michael R; McKillop, Matthew; Dietrich, Nicole Maltese; Franck, Andrew J

2017-01-01

Limited studies have been published examining dofetilide's postmarketing use and its recommended monitoring. To evaluate the impact of a collaborative pharmacy-cardiology antiarrhythmic drug (AAD) monitoring program on dofetilide monitoring. This retrospective cohort study was performed to assess if a novel monitoring program improved compliance with dofetilide-specific monitoring parameters based on the Food and Drug Administration's Risk Evaluation and Mitigation Strategy. A total of 30 patients were included in the analysis. The monitoring parameters evaluated included electrocardiogram, serum potassium, serum magnesium, and kidney function. The primary outcome evaluated was the composite of these dofetilide monitoring parameters obtained in each cohort. In the standard cohort, 245 of 352 (69.6%) monitoring parameters were completed versus 134 of 136 (98.5%) in the intervention group ( P < 0.05). A collaborative pharmacy-cardiology AAD monitoring program was associated with a significant improvement in dofetilide monitoring. This improvement could potentially translate into enhanced patient safety outcomes, such as prevention of adverse drug reactions and decreased hospitalizations.

Prognostic factors of a favorable outcome following a supervised exercise program for soldiers with sub-acute and chronic low back pain.

PubMed

Perron, Marc; Gendron, Chantal; Langevin, Pierre; Leblond, Jean; Roos, Marianne; Roy, Jean-Sébastien

2018-04-02

Low back pain (LBP) encompasses heterogeneous patients unlikely to respond to a unique treatment. Identifying sub-groups of LBP may help to improve treatment outcomes. This is a hypothesis-setting study designed to create a clinical prediction rule (CPR) that will predict favorable outcomes in soldiers with sub-acute and chronic LBP participating in a multi-station exercise program. Military members with LBP participated in a supervised program comprising 7 stations each consisting of exercises of increasing difficulty. Demographic, impairment and disability data were collected at baseline. The modified Oswestry Disability Index (ODI) was administered at baseline and following the 6-week program. An improvement of 50% in the initial ODI score was considered the reference standard to determine a favorable outcome. Univariate associations with favorable outcome were tested using chi-square or paired t-tests. Variables that showed between-group (favorable/unfavorable) differences were entered into a logistic regression after determining the sampling adequacy. Finally, continuous variables were dichotomized and the sensitivity, specificity and positive and negative likelihood ratios were determined for the model and for each variable. A sample of 85 participants was included in analyses. Five variables contributed to prediction of a favorable outcome: no pain in lying down (p = 0.017), no use of antidepressants (p = 0.061), FABQ work score < 22.5 (p = 0.061), fewer than 5 physiotherapy sessions before entering the program (p = 0.144) and less than 6 months' work restriction (p = 0.161). This model yielded a sensitivity of 0.78, specificity of 0.80, LR+ of 3.88, and LR- of 0.28. A 77.5% probability of favorable outcome can be predicted by the presence of more than three of the five variables, while an 80% probability of unfavorable outcome can be expected if only three or fewer variables are present. The use of prognostic factors may guide clinicians in identifying soldiers with LBP most likely to have a favorable outcome. Further validation studies are needed to determine if the variables identified in our study are treatment effect modifiers that can predict success following participation in the multi-station exercise program. ClinicalTrials.gov Identifier: NCT03464877 registered retrospectively on 14 March 2018.

Implementation and Early Outcomes of the Comprehensive School Reform Demonstration (CSRD) Program. Doc # 2004-15

ERIC Educational Resources Information Center

LaPointe, Michelle; Stullich, Stephanie

2004-01-01

The Comprehensive School Reform (CSR) program provides financial assistance to help schools develop and implement systematic approaches to schoolwide improvement that are grounded in scientifically based research and effective practices. The goal of the program is to enable all children to meet challenging state academic content and achievement…

Improving Outcome Assessment in Information Technology Program Accreditation

ERIC Educational Resources Information Center

Goda, Bryan S.; Reynolds, Charles

2010-01-01

As of March 2010, there were fourteen Information Technology programs accredited by the Accreditation Board for Engineering and Technology, known as ABET, Inc (ABET Inc. 2009). ABET Inc. is the only recognized institution for the accreditation of engineering, computing, and technology programs in the U.S. There are currently over 128 U.S. schools…

A Model to Build Capacity through a Multi-Program Curriculum Review Process

ERIC Educational Resources Information Center

Dyjur, Patti; Lock, Jennifer

2016-01-01

Curriculum reviews are becoming more prevalent in higher educational institutions as a means to address quality assurance and improve program offerings. However, the review process can be structured so that instructors experience professional learning benefits as they work with program-level learning outcomes, map their courses, and analyze…

Universitywide Program Review: Evolving a Process for Program Improvement and Institutional Planning. Professional File. Number 128, Winter 2012

ERIC Educational Resources Information Center

Nelson, Kristi A.; Nicholas, Mark C.

2012-01-01

The President of the University of Cincinnati charged the Academic Coordinating Committee (ACC), a universitywide governance body, to conduct a comprehensive review of degree programs by designing a process with multiple outcomes: building an academically stronger university; ensuring consistency with the institution's capacity and academic…

The Assessment of Doctoral Education: Emerging Criteria and New Models for Improving Outcomes

ERIC Educational Resources Information Center

Maki, Peggy L., Ed.; Borkowski, Nancy A., Ed.

2006-01-01

Following the growing commitment to assessment at the undergraduate level, doctoral programs are now grappling with what accountability means for them. This book provides a foundation for faculty and academic leaders of doctoral programs to promote inquiry into the educational practices that define their programs and contribute to graduate…

Alternatives to Traditional EMS Dispatch and Transport: A Scoping Review of Reported Outcomes.

PubMed

Jensen, Jan L; Carter, Alix J E; Rose, Jennifer; Visintini, Sarah; Bourdon, Emmanuelle; Brown, Ryan; McVey, Jennifer; Travers, Andrew H

2015-09-01

Emergency medical services (EMS) programs, which provide an alternative to traditional EMS dispatch or transport to the emergency department (ED), are becoming widely implemented. This scoping review identified and catalogued all outcomes used to measure such alternative EMS programs. Data Source Broad systematized bibliographic and grey literature searches were conducted. Study Selection Inclusion criteria were 911 callers/EMS patients, reported on alternatives to traditional EMS dispatch OR traditional EMS transport to the ED, and reported an outcome measure. Data Extraction The reports were categorized as either alternative to dispatch or to EMS transport, and outcome measures were categorized and described. Data Synthesis The bibliographic search retrieved 13,215 records, of which 34 articles met the inclusion criteria, with an additional 10 added from reference list hand-searching (n=44 included). In the grey literature search, 31 websites were identified, from which four met criteria and were retrieved (n=4 included). Fifteen reports (16 studies) described alternatives to EMS dispatch, and 33 reports described alternatives to EMS transport. The most common outcomes reported in the alternatives to EMS dispatch reports were service utilization and decision accuracy. Twenty-four different specific outcomes were reported. The most common outcomes reported in the alternatives to EMS transport reports were service utilization and safety, and 50 different specific outcomes were reported. Numerous outcome measures were identified in reports of alternative EMS programs, which were catalogued and described. Researchers and program leaders should achieve consensus on uniform outcome measures, to allow benchmarking and improve comparison across programs.

Does the Animal Fun program improve social-emotional and behavioural outcomes in children aged 4-6 years?

PubMed

Piek, Jan P; Kane, Robert; Rigoli, Daniela; McLaren, Sue; Roberts, Clare M; Rooney, Rosanna; Jensen, Lynn; Dender, Alma; Packer, Tanya; Straker, Leon

2015-10-01

Animal Fun was designed to enhance motor and social development in young children. Its efficacy in improving motor skills was presented previously using a randomised controlled trial and a multivariate nested cohort design. Based on the Environmental Stress Hypothesis, it was argued that the program would also result in positive mental health outcomes, investigated in the current study. Pre-intervention scores were recorded for 511 children aged 4.83-6.17 years (M=5.42, SD=.30). Intervention and control groups were compared 6 months following intervention, and again in their first school year. Changes in teacher-rated prosocial behaviour and total difficulties were assessed using the Strengths and Difficulties Questionnaire, and data analysed using Generalised Linear Mixed Models. There was a significant improvement in prosocial behaviour of children in the intervention group six months after initial testing, which remained at 18-month follow-up. Total difficulties decreased at 6 months for the intervention group, with no change at 18 months. This effect was present only for the hyperactivity/inattention subscale. The only significant change for the control group was an increase in hyperactivity/inattention scores from pre-intervention to 18-month follow-up. The Animal Fun program appears to be effective in improving social and behavioural outcomes. Copyright © 2015 Elsevier B.V. All rights reserved.

The history of quality measurement in home health care.

PubMed

Rosati, Robert J

2009-02-01

Quality improvement is as central to home health care as to any other field of health care. With the mandated addition in 2000 of Outcome Assessment and Information Set (OASIS) and outcome-based quality improvement (OBQI), Medicare home health agencies entered a new era of documenting, tracking, and systematically improving quality. OBQI is augmented by the Medicare Quality Improvement Organization (QIO) program, which is now entering the ninth in a series of work assignments, with the tenth scope in the planning stages. Evidence has shown that applied quality improvement methods can drive better outcomes using important metrics, such as acute care hospitalization. This article reviews key findings from the past 2 decades of home care quality improvement research and public policy advances, describes specific examples of local and regional programmatic approaches to quality improvement, and forecasts near-future trends in this vital arena of home health care.

Organizational Wellness Program Implementation and Evaluation: A Holistic Approach to Improve the Wellbeing of Middle Managers.

PubMed

Medina, Maria Del Consuelo; Calderon, Angelica; Blunk, Dan I; Mills, Brandy W; Leiner, Marie

2018-06-01

: Employee wellness programs can provide benefits to institutions as well as employees and their families. Despite the attempts of some organizations to implement programs that take a holistic approach to improve physical, mental, and social wellness, the most common programs are exclusively comprised of physical and nutritional components. In this study, we implemented a wellness program intervention, including training using a holistic approach to improve the wellbeing of middle managers in several multinational organizations. We included control and experimental groups to measure wellness and teamwork with two repeated measures. Our results indicated that employees receiving the intervention had improved measures of wellness and teamwork. A positive relationship was found between wellness and teamwork in the experimental group when compared with the control group. Taken together, the data suggest that implementation of these programs would provide valuable outcomes for both employees and organizations.

Human Services Program Evaluation: "How to Improve Your Accountability and Program Effectiveness"

ERIC Educational Resources Information Center

Barrett, Thomas; Sorensen, James

2015-01-01

The term "outcome evaluation" has become one of the most popular terms among human service providers and those whose job it is to evaluate the impact of human service programs. In the public sector alone, there are over a hundred instruments in use to evaluate the impact of state human service programs. Most states, many providers, and…

Getting Ready for College: An Implementation and Early Impacts Study of Eight Texas Developmental Summer Bridge Programs. NCPR Brief

ERIC Educational Resources Information Center

Wathington, Heather D.; Barnett, Elisabeth A.; Weissman, Evan; Teres, Jedediah; Pretlow, Joshua; Nakanishi, Aki

2011-01-01

In 2009, the National Center for Postsecondary Research (NCPR) launched an evaluation of eight developmental summer bridge programs in Texas to assess whether these programs reduce the need for developmental coursework and improve student outcomes in college. The evaluation uses an experimental design to measure the effects of these programs on…

Take Charge of Pain: evaluating a community-targeted self-management education program for people with musculoskeletal pain.

PubMed

Hoon, Elizabeth; Smith, Karen; Black, Julie; Burnet, Simon; Hill, Catherine; Gill, Tiffany K

2017-03-01

Issue addressed Musculoskeletal conditions are highly prevalent, affecting 28% of the Australian population. Given the persistent nature of many musculoskeletal conditions self-management is recognised as an important aspect of effective disease management. However, participant recruitment and retention for formal self-management programs is a challenge. Methods Arthritis SA (Arthritis Foundation of South Australia, a non-profit community health organisation) redesigned a shorter, community-orientated self-management education program delivered by health professionals. The program utilises aspects of the Stanford model of chronic disease self-management and motivational interviewing as well as principles of adult learning to create an effective learning environment. The program aims to guide participants to learn and practise a range of pain management strategies that are known to be effective in improving quality of life. This study used a pre- and post-test (at 6 weeks) design to determine whether this program achieved benefits in self-reported health outcomes. Outcomes that were measured included pain, fatigue, health distress, self-efficacy and communication. Results A response rate of 47% (n=102) was achieved and small but statistically significant improvements in mean [s.d.] pain scores (6.1 [2.3] to 5.4 [2.4], P=0.001), health distress (2.3 [1.3] to 2.0 [1.3], P=0.002) and self-efficacy (6.2 [2.1] to 6.8 [2.2], P=0.002) were found. Conclusion Community-based participants of this shorter, focused program recorded small but significant improvements in self-reported pain, health distress and self-efficacy. For those who completed the current program, Arthritis SA is currently exploring the potential of developing a booster session to promote sustainable positive health outcomes. So what? Supporting self-management through education is recognised as important but also as a key challenge for effective management of musculoskeletal conditions. Using a pre-post evaluation design, this study demonstrated effectiveness (short-term improvements for self-reported pain, health distress and self-efficacy) for a redesigned and shortened community-targeted program focusing on musculoskeletal pain.

Trainee participation is associated with adverse outcomes in emergency general surgery: an analysis of the National Surgical Quality Improvement Program database.

PubMed

Kasotakis, George; Lakha, Aliya; Sarkar, Beda; Kunitake, Hiroko; Kissane-Lee, Nicole; Dechert, Tracey; McAneny, David; Burke, Peter; Doherty, Gerard

2014-09-01

To identify whether resident involvement affects clinically relevant outcomes in emergency general surgery. Previous research has demonstrated a significant impact of trainee participation on outcomes in a broad surgical patient population. We identified 141,010 patients who underwent emergency general surgery procedures in the 2005-2010 Surgeons National Surgical Quality Improvement Program database. Because of the nonrandom assignment of complex cases to resident participation, patients were matched (1:1) on known risk factors [age, sex, inpatient status, preexisting comorbidities (obesity, diabetes, smoking, alcohol, steroid use, coronary artery disease, chronic renal failure, pulmonary disease)] and preoperatively calculated probability for morbidity and mortality. Clinically relevant outcomes were compared with a t or χ test. The impact of resident participation on outcomes was assessed with multivariable regression modeling, adjusting for risk factors and operative time. The most common procedures in the matched cohort (n = 83,790) were appendectomy (39.9%), exploratory laparotomy (8.8%), and adhesiolysis (6.6%). Trainee participation is independently associated with intra- and postoperative events, wound, pulmonary, and venous thromboembolic complications, and urinary tract infections. Trainee participation is associated with adverse outcomes in emergency general surgery procedures.

Barriers to cure for children with cancer in India and strategies to improve outcomes: a report by the Indian Pediatric Hematology Oncology Group.

PubMed

Yadav, Satya Prakash; Rastogi, Neha; Kharya, Gaurav; Misra, Ruchira; Ramzan, Mohammed; Katewa, Satyendra; Dua, Vikas; Bhat, Sunil; Kellie, Stewart J; Howard, Scott C

2014-04-01

The survival of children with cancer in India is inferior to that of children in high-income countries. The Indian Pediatric Hematology Oncology Group (IPHOG) held a series of online meetings via www.Cure4kids.org to identify barriers to cure and develop strategies to improve outcomes. Five major hurdles were identified: delayed diagnosis, abandonment, sepsis, lack of co-operative groups, and relapse. Development of regional networks like IPHOG has allowed rapid identification of local causes of treatment failure for children with cancer in India and identification of strategies likely to improve care and outcomes in the participating centers. Next steps will include interventions to raise community awareness of childhood cancer, promote early diagnosis and referral, and reduce abandonment and toxic death at each center. Starting of fellowship programs in pediatric hemato-oncology, short training programs for pediatricians, publishing outcome data, formation of parent and patient support groups, choosing the right and effective treatment protocol, and setting up of bone marrow transplant services are some of the effective steps taken in the last decade, which needs to be supported further.

Reforming Dutch substance abuse treatment services.

PubMed

Schippers, Gerard M; Schramade, Mark; Walburg, Jan A

2002-01-01

The Dutch substance abuse treatment system is in the middle of a major reorganization. The goal is to improve outcomes by redesigning all major primary treatment processes and by implementing a system of regular monitoring and feedback of clinical outcome data. The new program includes implementing standardized psychosocial behavior-oriented treatment modalities and a stepped-care patient placement algorithm in a core-shell organizational model. This article outlines the new program and presents its objectives, developmental stages, and current status.

A Review of Hazard Anticipation Training Programs for Young Drivers.

PubMed

McDonald, Catherine C; Goodwin, Arthur H; Pradhan, Anuj K; Romoser, Matthew R E; Williams, Allan F

2015-07-01

Poor hazard anticipation skills are a risk factor associated with high motor vehicle crash rates of young drivers. A number of programs have been developed to improve these skills. The purpose of this review was to assess the empirical literature on hazard anticipation training for young drivers. Studies were included if they (1) included an assessment of hazard anticipation training outcomes; (2) were published between January 1, 1980 and December 31, 2013 in an English language peer-reviewed journal or conference proceeding; and (3) included at least one group that uniquely comprised a cohort of participants aged <21 years. Nineteen studies met inclusion criteria. Studies used a variety of training methods including interactive computer programs, videos, simulation, commentary driving, or a combination of approaches. Training effects were predominantly measured through computer-based testing and driving simulation with eye tracking. Four studies included an on-road evaluation. Most studies evaluated short-term outcomes (immediate or few days). In all studies, young drivers showed improvement in selected hazard anticipation outcomes but none investigated crash effects. Although there is promise in existing programs, future research should include long-term follow-up, evaluate crash outcomes, and assess the optimal timing of hazard anticipation training taking into account the age and experience level of young drivers. Copyright © 2015 Society for Adolescent Health and Medicine. All rights reserved.

[Healthy eating: implementation of a practice-oriented training program].

PubMed

Kulakova, E N; Nastausheva, T L; Usacheva, E A

2016-01-01

Health professionals need to have current knowledge and skills in nutrition. The knowledge and skills have to be acquired in programs of continuing medical education, but also in undergraduate medical education. The main purpose of this work was to develop and implement a practice-oriented training program in nutrition and healthy eating for medical students. The subject named "Nutrition" was implemented into second-year medical curriculum. We defined a theoretical framework and terms such as nutrition, healthy eating, and evidence-based nutrition. In order to get learning outcomes we constructed a method of patients counseling and training "Individual food pyramid". The making of "Individual food pyramid" is a key integrate element of the program. It helps to memorize, understand and apply the basic principles of healthy eating in real life contexts. The final program consists of two sections: "General Nutrition" and "Special Nutrition". The most important intended learning outcome is student's lifestyle improvement. The program is practice-oriented and outcome-based.

A Multifaceted Approach to Improving Outcomes in the NICU: The Pediatrix 100 000 Babies Campaign.

PubMed

Ellsbury, Dan L; Clark, Reese H; Ursprung, Robert; Handler, Darren L; Dodd, Elizabeth D; Spitzer, Alan R

2016-04-01

Despite advances in neonatal medicine, infants requiring neonatal intensive care continue to experience substantial morbidity and mortality. The purpose of this initiative was to generate large-scale simultaneous improvements in multiple domains of care in a large neonatal network through a program called the "100,000 Babies Campaign." Key drivers of neonatal morbidity and mortality were identified. A system for retrospective morbidity and mortality review was used to identify problem areas for project prioritization. NICU system analysis and staff surveys were used to facilitate reengineering of NICU systems in 5 key driver areas. Electronic health record-based automated data collection and reporting were used. A quality improvement infrastructure using the Kotter organizational change model was developed to support the program. From 2007 to 2013, data on 422 877 infants, including a subset with birth weight of 501 to 1500 g (n = 58 555) were analyzed. Key driver processes (human milk feeding, medication use, ventilator days, admission temperature) all improved (P < .0001). Mortality, necrotizing enterocolitis, retinopathy of prematurity, bacteremia after 3 days of life, and catheter-associated infection decreased. Survival without significant morbidity (necrotizing enterocolitis, severe intraventricular hemorrhage, severe retinopathy of prematurity, oxygen use at 36 weeks' gestation) improved. Implementation of a multifaceted quality improvement program that incorporated organizational change theory and automated electronic health record-based data collection and reporting program resulted in major simultaneous improvements in key neonatal processes and outcomes. Copyright © 2016 by the American Academy of Pediatrics.

The Transgender Women of Color Initiative: Implementing and Evaluating Innovative Interventions to Enhance Engagement and Retention in HIV Care.

PubMed

Rebchook, Gregory; Keatley, JoAnne; Contreras, Robert; Perloff, Judy; Molano, Luis Freddy; Reback, Cathy J; Ducheny, Kelly; Nemoto, Tooru; Lin, Royce; Birnbaum, Jeffrey; Woods, Tiffany; Xavier, Jessica

2017-02-01

To improve health outcomes among transgender women of color living with HIV, the Health Resources and Services Administration's Special Programs of National Significance program funded the Enhancing Engagement and Retention in Quality HIV Care for Transgender Women of Color Initiative in 2012. Nine demonstration projects in four US urban areas implemented innovative, theory-based interventions specifically targeting transgender women of color in their jurisdictions. An evaluation and technical assistance center was funded to evaluate the outcomes of the access to care interventions, and these findings will yield best practices and lessons learned to improve the care and treatment of transgender women of color living with HIV infection.

The Development of NOAA Education Common Outcome Performance Measures (Invited)

NASA Astrophysics Data System (ADS)

Baek, J.

2013-12-01

The National Oceanic and Atmospheric Administration (NOAA) Education Council has embarked on an ambitious Monitoring and Evaluation (M&E) project that will allow it to assess education program outcomes and impacts across the agency, line offices, and programs. The purpose of this internal effort is to link outcome measures to program efforts and to evaluate the success of the agency's education programs in meeting the strategic goals. Using an outcome-based evaluation approach, the NOAA Education Council is developing two sets of common outcome performance measures, environmental stewardship and professional development. This presentation will examine the benefits and tradeoffs of common outcome performance measures that collect program results across a portfolio of education programs focused on common outcomes. Common outcome performance measures have a few benefits to our agency and to the climate education field at large. The primary benefit is shared understanding, which comes from our process for writing common outcome performance measures. Without a shared and agreed upon set of definitions for the measure of an outcome, the reported results may not be measuring the same things and would incorrectly indicate levels of performance. Therefore, our writing process relies on a commitment to developing a shared set of definitions based on consensus. We hope that by taking the time to debate and coming to agreement across a diverse set of programs, the strength of our common measures can indicate real progress towards outcomes we care about. An additional benefit is that these common measures can be adopted and adapted by other agencies and organizations that share similar theories of change. The measures are not without their drawbacks, and we do make tradeoffs as part of our process in order to continue making progress. We know that any measure is necessarily a narrow slice of performance. A slice that may not best represent the unique and remarkable contribution of an individual program, but does reflect a variety of contributions along a single dimension across a large portfolio of programs. The process has ended up pushing our working group to call for even more measures, to capture an increasing number of dimensions that reflect the nature of the portfolio of programs. This past year we have been working on developing two sets of common outcome performance measures for professional development (PD) and stewardship education programs. The outcome we chose for PD programs was the use of what was learned in the educator's practice. The outcome we chose for stewardship programs was the stewardship behaviors that participants learn and practice. The measurement of these outcomes will inform whether our strategies are having their intended impact. By knowing how and how much these outcomes are occurring as a result of our program, we can improve program performance over time. The common outcome performance measures help demonstrate how these programs engage audiences in supporting NOAA's mission. As AGU climate literacy community continues to grow, it is important to consider an approach to demonstrate the community's contribution to the Nation's climate literacy. Development of common outcome performance measures is one approach that could help focus the community in meeting its goals.

Do Savings Mediate Changes in Adolescents' Future Orientation and Health-Related Outcomes? Findings From Randomized Experiment in Uganda.

PubMed

Karimli, Leyla; Ssewamala, Fred M

2015-10-01

This present study tests the proposition that an economic strengthening intervention for families caring for AIDS-orphaned adolescents would positively affect adolescent future orientation and psychosocial outcomes through increased asset accumulation (in this case, by increasing family savings). Using longitudinal data from the cluster-randomized experiment, we ran generalized estimating equation models with robust standard errors clustering on individual observations. To examine whether family savings mediate the effect of the intervention on adolescents' future orientation and psychosocial outcomes, analyses were conducted in three steps: (1) testing the effect of intervention on mediator; (2) testing the effect of mediator on outcomes, controlling for the intervention; and (3) testing the significance of mediating effect using Sobel-Goodman method. Asymmetric confidence intervals for mediated effect were obtained through bootstrapping-to address the assumption of normal distribution. Results indicate that participation in a matched Child Savings Account (CSA) program improved adolescents' future orientation and psychosocial outcomes by reducing hopelessness, enhancing self-concept, and improving adolescents' confidence about their educational plans. However, the positive intervention effect on adolescent future orientation and psychosocial outcomes was not transmitted through saving. In other words, participation in the matched CSA program improved adolescent future orientation and psychosocial outcomes regardless of its impact on reported savings. Further research is necessary to understand exactly how participation in economic strengthening interventions, for example, those that employ matched CSAs, shape adolescent future orientation and psychosocial outcomes: what, if not savings, transmits the treatment effect and how? Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Do savings mediate changes in adolescents’ future orientation and health-related outcomes? Findings from randomized experiment in Uganda

PubMed Central

Karimli, Leyla; Ssewamala, Fred M.

2015-01-01

Purpose This present study tests the proposition that an economic strengthening intervention for families caring for AIDS-orphaned adolescents would positively affect adolescent future orientation and psychosocial outcomes through increased asset-accumulation (in this case, by increasing family savings). Methods Using longitudinal data from the cluster-randomized experiment we ran generalized estimating equation (GEE) models with robust standard errors clustering on individual observations. To examine whether family savings mediate the effect of the intervention on adolescents’ future orientation and psychosocial outcomes, analyses were conducted in three steps: (1) testing the effect of intervention on mediator; (2) testing the effect of mediator on outcomes, controlling for the intervention; and (3) testing the significance of mediating effect using Sobel-Goodman method. Asymmetric confidence intervals for mediated effect were obtained through bootstrapping—to address the assumption of normal distribution. Results Results indicate that participation in a matched Child Savings Account program improved adolescents’ future orientation and psychosocial outcomes by reducing hopelessness, enhancing self-concept, and improving adolescents’ confidence about their educational plans. However, the positive intervention effect on adolescent future orientation and psychosocial outcomes was not transmitted through saving. In other words, participation in the matched Child Savings Account program improved adolescent future orientation and psychosocial outcomes regardless of its impact on reported savings. Conclusions Further research is necessary to understand exactly how participation in economic strengthening interventions, for example, those that employ matched Child Savings Accounts, shape adolescent future orientation and psychosocial outcomes: what, if not savings, transmits the treatment effect and how? PMID:26271162

Resident-Specific Morbidity Reduced Following ACS NSQIP Data-Driven Quality Program.

PubMed

Turrentine, Florence E; Hanks, John B; Tracci, Megan C; Jones, R Scott; Schirmer, Bruce D; Smith, Philip W

2018-04-16

The Accreditation Council for Graduate Medical Education Milestone Project for general surgery provided a more robust method for developing and tracking residents' competence. This framework enhanced systematic and progressive development of residents' competencies in surgical quality improvement. A 22-month interactive, educational program based on resident-specific surgical outcomes data culminated in a quality improvement project for postgraduate year 4 surgery residents. Self- assessment, quality knowledge test, and resident-specific American College of Surgeons National Surgical Quality Improvement Program Quality In-Training Initiative morbidity were compared before and after the intervention. Quality in-training initiative morbidity decreased from 25% (82/325) to 18% (93/517), p = 0.015 despite residents performing more complex cases. All participants achieved level 4 competency (4/4) within the general surgery milestones improvement of care, practice-based learning and improvement competency. Institutional American College of Surgeons National Surgical Quality Improvement Program general surgery morbidity improved from the ninth to the sixth decile. Quality assessment and improvement self-assessment postintervention scores (M = 23.80, SD = 4.97) were not significantly higher than preintervention scores (M = 19.20, SD = 5.26), p = 0.061. Quality Improvement Knowledge Application Tool postintervention test scores (M = 17.4, SD = 4.88), were not significantly higher than pretest scores (M = 13.2, SD = 1.92), p = 0.12. Sharing validated resident-specific clinical data with participants was associated with improved surgical outcomes. Participating fourth year surgical residents achieved the highest score, a level 4, in the practice based learning and improvement competency of the improvement of care practice domain and observed significantly reduced surgical morbidity for cases in which they participated. Copyright © 2018. Published by Elsevier Inc.

Communicating Learning Outcomes and Student Performance through the Student Transcript

ERIC Educational Resources Information Center

Kenyon, George; Barnes, Cynthia

2010-01-01

The university accreditation process now puts more emphasis on self assessment. This change requires universities to identify program objectives, performance indicators, and areas for improvement. Many accrediting institutions are requiring that institutions communicate clearly to constituents: 1) what learning outcomes were achieved by students,…

The effectiveness of education in the recognition and management of deteriorating patients: A systematic review.

PubMed

Connell, Clifford J; Endacott, Ruth; Jackman, Jennifer A; Kiprillis, Noelleen R; Sparkes, Louise M; Cooper, Simon J

2016-09-01

Survival from in-hospital cardiac arrest is poor. Clinical features, including abnormal vital signs, often indicate patient deterioration prior to severe adverse events. Early warning systems and rapid response teams are commonly used to assist the health profession in the identification and management of the deteriorating patient. Education programs are widely used in the implementation of these systems. The effectiveness of the education is unknown. The aims of this study were to identify: (i) the evidence supporting educational effectiveness in the recognition and management of the deteriorating patient and (ii) outcome measures used to evaluate educational effectiveness. A mixed methods systematic review of the literature was conducted using studies published between 2002 and 2014. Included studies were assessed for quality and data were synthesized thematically, while original data are presented in tabular form. Twenty-three studies were included in the review. Most educational programs were found to be effective reporting significant positive impacts upon learners, patient outcomes and organisational systems. Outcome measures related to: i learners, for example knowledge and performance, ii systems, including activation and responses of rapid response teams, and iii patients, including patient length of stay and adverse events. All but one of the programs used blended teaching with >87% including medium to high fidelity simulation. In situ simulation was employed in two of the interventions. The median program time was eight hours. The longest program lasted 44h however one of the most educationally effective programs was based upon a 40min simulation program. Educational interventions designed to improve the recognition and management of patient deterioration can improve learner outcomes when they incorporate medium to high-fidelity simulation. High-fidelity simulation has demonstrated effectiveness when delivered in brief sessions lasting only forty minutes. In situ simulation has demonstrated sustained positive impact upon the real world implementation of rapid response systems. Outcome measures should include knowledge and skill developments but there are important benefits in understanding patient outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

Assessing faculty integration of adult learning needs in second-degree nursing education.

PubMed

Robert, Tracey E; Pomarico, Carole A; Nolan, Mary

2011-01-01

The limited research data available on effective teaching strategies for accelerated baccalaureate nursing programs has generated interest in identifying and assessing successful teaching tools and strategies in current programs. Most data have been anecdotal and have not emphasized the effectiveness of accelerated programs. This study used a qualitative research design to determine the effectiveness of an integrative learning model in improving nursing student outcomes of second-degree students. Overall data from focus groups in the beginning and end of the study indicated that the use focus groups enhanced the learning process and outcomes.

The effects of a prelicensure extern program and nurse residency program on new graduate outcomes and retention.

PubMed

Friday, Laura; Zoller, James S; Hollerbach, Ann D; Jones, Katherine; Knofczynski, Greg

2015-01-01

Organizations are looking to new graduate nurses to fill expected staffing shortages over the next decade. Creative and effective onboarding programs will determine the success or failure of these graduates as they transition from student to professional nurse. This longitudinal quantitative study with repeated measures used the Casey-Fink Graduate Nurse Experience Survey to investigate the effects of offering a prelicensure extern program and postlicensure residency program on new graduate nurses and organizational outcomes versus a residency program alone. Compared with the nurse residency program alone, the combination of extern program and nurse residency program improved neither the transition factors most important to new nurse graduates during their first year of practice nor a measure important to organizations, retention rates. The additional cost of providing an extern program should be closely evaluated when making financially responsible decisions.

Implementing an anti-smoking program in rural-remote communities: challenges and strategies.

PubMed

Tall, Julie A; Brew, Bronwyn K; Saurman, Emily; Jones, Therese C

2015-01-01

Rural-remote communities report higher smoking rates and poorer health outcomes than that of metropolitan areas. While anti-smoking programs are an important measure for addressing smoking and improving health, little is known of the challenges faced by primary healthcare staff implementing those programs in the rural-remote setting. The aim of this study was to explore the challenges and strategies of implementing an anti-smoking program by primary healthcare staff in rural-remote Australia. Guided by a phenomenological approach, semi-structured interviews and focus groups were conducted with health service managers, case managers and general practitioners involved in program implementation in Australian rural-remote communities between 2008 and 2010. Program implementation was reported to be challenged by limited primary and mental healthcare resources and client access to services; limited collaboration between health services; the difficulty of accessing staff training; high levels of community distress and disadvantage; the normalisation of smoking and its deleterious impact on smoking abstinence among program clients; and low morale among health staff. Strategies identified to overcome challenges included appointing tobacco-dedicated staff; improving health service collaboration, access and flexibility; providing subsidised pharmacotherapies and boosting staff morale. Findings may assist health services to better tailor anti-smoking programs for the rural-remote setting, where smoking rates are particularly high. Catering for the unique challenges of the rural-remote setting is necessary if anti-smoking programs are to be efficacious, cost-effective and capable of improving rural-remote health outcomes.

An ethical leadership program for nursing unit managers.

PubMed

Jeon, Sang Hee; Park, Mihyun; Choi, Kyungok; Kim, Mi Kyoung

2018-03-01

The aims of this study were to evaluate the effect of an ethical leadership program (ELP) on ethical leadership, organizational citizenship behavior (OCB), and job outcomes of nursing unit managers (UMs) and to examine changes in staff nurses' perception about UMs' EL, OCB, job outcomes, and ethical work environments (EWEs) post-ELP. A quasi-experimental (pre- and post-test design) study conducted six-month intervention (ELP) using self-reported UM survey (n=44), and staff nurses (n=158) were randomly extracted by two steps. The Korean version of Ethical Leadership at Work for UMs' self-ethical leadership, the Ethical Leadership Scale for staff nurses' perceived ethical leadership, a 19-item OCB scale, and six dimensions of the medium-sized Copenhagen Psychosocial Questionnaire II for job outcomes and EWEs were administered at baseline and post-intervention. UMs' ethical leadership scores differed significantly over time in people orientation (p=0.041) and concern for ethical leadership sustainability (p=0.002) adjusting for UM experience duration and nursing unit type. Total mean and level of power-sharing of ethical leadership among UMs with <5years of UM experience improved significantly over time. Of staff nurses' perception changes about UMs' ethical leadership, OCB, job outcomes, and EWEs, significant improvement over time appeared only in EWEs' work influence level (p=0.007). This study provides useful information for clinical ELP development and examining the program's effect on leadership skills and followers' outcomes. Program facilitation relies on practical training methods, participant motivation, and assessment outcome designs by controlling clinical confounding factors. Findings have implications as an attempt for intervention to promote competencies related to ethical leadership of nursing unit managers. Copyright © 2017 Elsevier Ltd. All rights reserved.

Effectiveness of focused meditation for patients with chronic low back pain-A randomized controlled clinical trial.

PubMed

Michalsen, Andreas; Kunz, Natalie; Jeitler, Michael; Brunnhuber, Stefan; Meier, Larissa; Lüdtke, Rainer; Büssing, Arndt; Kessler, Christian

2016-06-01

We aimed to evaluate the effectiveness of an 8-week meditation program (focused meditation) in patients with chronic low-back pain. A randomized clinical trial was conducted on 68 patients (55 years;75% female) with chronic low-back pain who scored >40mm on a 100mm Visual-Analogue-Scale. Subjects were allocated to an 8-week meditation program (focused meditation) with weekly 75min classes or to a self-care exercise program with a wait-list offer for meditation. Both groups were instructed to practice at home. Outcomes were assessed baseline and after 4 and 8 weeks. The primary outcome measure was the change in mean back pain at rest after 8 weeks. Secondary outcomes included function, pain-related bothersomeness, perceived stress, quality-of-life (QOL), and psychological outcomes. Twelve (meditation) and 4 (exercise) patients were lost to follow-up. The primary outcome, pain at rest after 8 weeks, was reduced from 59.3±13.9mm to 40.8±21.8mm with meditation vs. 52.9±11.8mm to 37.3±18.2mm with exercise (adjusted group difference: -1.4 (95%CI:11.6;8.8;p=n.s.) Perceived stress was significantly more reduced with meditation (p=0.011). No significant treatment effects were found for other secondary outcomes as pain-related bothersomeness, function, quality-of-life and psychological scores, although the meditation group consistently showed non-significant better improvements compared to the exercise group. Focused meditation and self-care exercise lead to comparable, symptomatic improvements in patients with chronic low back pain. Future studies should include longer-term follow-ups and develop guided meditation programs to support compliance. Copyright © 2016 Elsevier Ltd. All rights reserved.

Enhancing Social Responsibility and Prosocial Leadership to Prevent Aggression, Peer Victimization, and Emotional Problems in Elementary School Children.

PubMed

Leadbeater, Bonnie J; Thompson, Kara; Sukhawathanakul, Paweena

2016-12-01

Testing the theories that form the basis of prevention programs can enhance our understanding of behavioral change and inform the development, coordination, and adaptation of prevention programs. However, theories of change showing the linkages from intervention program components to risk or protective factors to desired outcomes across time are rarely specified or tested. In this 2-year longitudinal study, we test the theory that increases in two protective factors (i.e., children's prosocial leadership and their teachers' expectations of social responsibility) targeted by the WITS Programs (Walk Away, Ignore, Talk it Out, and Seek Help) would be associated with declines in peer victimization, aggression, and emotional problems. Participants included Canadian students, in grades 1-4 at baseline (n = 1329) and their parents and teachers. Consistent with our theory of change, variability in program implementation (adherence and integration) and in children's use of program skills (child responsiveness) are related to increases in both protective factors. Increases in these protective factors are associated with subsequent declines in children's aggression, victimization, and emotional problems. We discuss how enhancement of these protective factors may operate to improve child outcomes and the need for theory-based research to refine and improve the effectiveness of intervention strategies and to improve program scale-up. © Society for Community Research and Action 2016.

Creation of a competency-based professional development program for infection preventionists guided by the APIC Competency Model: steps in the process.

PubMed

Bernard, Heather; Hackbarth, Diana; Olmsted, Russell N; Murphy, Denise

2018-06-07

Infection Preventionists have varying levels of educational preparation. Many have no prior experience in IP. The diversity makes design of professional development programs challenging. Recent surveys suggest that only about half of practicing IPs are board certified. There is an urgent need to employ competent IP's to drive improvement in patient outcomes. This is a project that utilized the APIC Competency Model to create a professional development program characterizing three career stages. Methods included a review of literature on professional development; a survey of IP competence; an assessment of job descriptions and performance evaluations; and a crosswalk of IP competencies. The professional development program includes competency - based IP job descriptions and performance evaluations for each career stage; a professional portfolio; and a toolkit for supervisors. Participants agreed that application of the model resulted in tools which are more closely aligned with current roles for IPs; and increased satisfaction and motivation with the new program. Competent and knowledgeable IP's are crucial to optimizing efficacy of IPC programs. A professional development program has the potential to guide staff orientation, improve satisfaction and retention, improve patient outcomes and promote a positive trajectory in advancing practice. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Performance Funding in Tennessee: Stimulus for Program Improvement.

ERIC Educational Resources Information Center

Banta, Trudy W.; Moffett, Marian S.

1987-01-01

All postsecondary institutions in Tennessee have the opportunity to earn an annual budget supplement for instruction from the state if certain criteria, based on educational outcomes, are obtained. A comprehensive assessment program at the University of Tennessee at Knoxville is described. (MLW)

76 FR 79193 - Medicare Program; Independence at Home Demonstration Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-21

... physician and nurse practitioner directed home-based primary care teams aimed at improving health outcomes... Demonstration will test a service delivery model that utilizes physician and nurse practitioner directed primary... physicians, nurse practitioners, physician assistants, pharmacists, social workers, and other supporting...

Learn about Smart Sectors

EPA Pesticide Factsheets

about the Smart Sectors program including: Meaningful Collaboration with Regulated Sectors; Sensible Policies to Improve Environmental Outcomes; Better EPA Practices and Streamlined Operations; Historical Context

Randomized Controlled Trial Investigating the Role of Exercise in the Workplace to Improve Work Ability, Performance, and Patient-Reported Symptoms Among Older Workers With Osteoarthritis.

PubMed

Chopp-Hurley, Jaclyn N; Brenneman, Elora C; Wiebenga, Emily G; Bulbrook, Brittany; Keir, Peter J; Maly, Monica R

2017-06-01

The aim of this study was to evaluate the effectiveness of a 12-week workplace exercise program on work ability, performance, and patient-reported symptoms in older university employees with knee and/or hip osteoarthritis. Twenty-four participants with clinical hip and/or knee osteoarthritis were randomized to exercise or no exercise. At baseline and follow-up, several work (work ability, resilience), patient-reported (pain, physical function, depressive symptoms, self-efficacy), and performance outcomes (hip and knee strength, mobility performance) were measured. Significant improvements in work ability (P < 0.049) and patient-reported outcomes (pain, function, depressive symptoms) existed in the exercise group. No improvements were demonstrated in the no exercise group. Exercise in the workplace improved work ability and patient-reported symptoms in older workers with osteoarthritis. The benefits of workplace exercise programs should be studied in a larger sample in which attention is given to improving exercise adherence.

Heart failure patient adherence: epidemiology, cause, and treatment.

PubMed

Corotto, Paul S; McCarey, Melissa M; Adams, Suzanne; Khazanie, Prateeti; Whellan, David J

2013-01-01

Poor adherence to therapeutic regimens is a significant impediment to improving clinical outcomes in the HF population. Typical rates of adherence to prescribed medications, low-sodium diets, and aerobic exercise programs remain lower than that needed to decrease morbidity and mortality associated with HF. Factors contributing to poor adherence include multiple comorbidities, clinical depression, and decreased cognitive functioning. HF education and programs to enhance self-management skills have improved patient quality of life but have yet to decrease mortality or rehospitalization rates significantly. Telemonitoring to improve adherence behaviors and self-management interventions within broader HF management programs have demonstrated significant clinical improvements in this population. Copyright © 2013 Elsevier Inc. All rights reserved.

Cardiovascular self-management support program for preventing cardiovascular complication behaviors and clinical outcomes in the elderly with poorly controlled type 2 diabetes mellitus in Indonesia: A pilot study.

PubMed

Hisni, Dayan; Rukmaini, Rukmaini; Saryono, Saryono; Chinnawong, Tippamas; Thaniwattananon, Ploenpit

2018-03-06

The aim of the study was to determine the feasibility, and to evaluate the effect of, a cardiovascular self-management support program by applying the 5A's self-management support program on preventing cardiovascular complication behaviors and to assess the clinical outcomes in the elderly with poorly controlled type 2 diabetes mellitus (DM). This pilot study used a quasi-experimental study design. Twelve elderly persons with poorly controlled type 2 DM were assigned into either a control or experimental group, with six participants in each group. The Preventing Cardiovascular Complication Behaviors (PCCB) was measured by the Preventing Cardiovascular Complication Behaviors Questionnaire, while the clinical outcomes were measured by clinical devices that were provided. These measurements were conducted and compared at baseline and 6 weeks after the completion of the program. The self-management support program was a 6 week program with several implementation methods, based on the 5A's self-management support program. The participants who received the cardiovascular self-management support program reported a significant improvement in their PCCB and clinical outcomes, compared to those receiving the usual care. This study revealed that a cardiovascular self-management support program that applies the 5A's self-management support program is feasible for implementation. © 2018 Japan Academy of Nursing Science.

Project (inverted exclamation mark)EXITO!: success through diversity and universality for outcomes improvement among Hispanic home care patients.

PubMed

Woerner, Louise; Espinosa, Javier; Bourne, Susan; O'Toole, Marie; Ingersoll, Gail L

2009-01-01

The National Health Disparities Report notes that Hispanics have poorer quality of care in 23 of 38 core measures. The result of this disparity is great personal and health system costs, which could be reduced. Prior studies have focused on access and language. We studied outcomes improvement. The purpose of this project was to develop a replicable theory-based outcomes improvement model for delivery of nursing care to Hispanic patients. The Leininger Sunrise Enabler approach was used to design a program specific to the cultural needs of a home care population. Outcome and Assessment Information Set (OASIS) data from 125 unduplicated home care patients were tracked. Nursing care delivery was analyzed using ethnographic research techniques. Delivery of nursing care using a culturally congruent approach reduced acute hospitalization and emergent care visits. Medication management and customer and nursing satisfaction also improved. National standards for culturally and linguistically appropriate services in health care help reduce healthcare disparities, but improving Hispanic outcomes requires moving beyond symptoms and symptom management to transcultural care. The estimated savings to the health care system are significant.