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Rejoinder to Mordock's critique of the Fort Bragg Evaluation Project: the sample is generalizable and the outcomes are clear.

The Fort Bragg Evaluation Project (FBEP) showed that children in a well implemented and expensive continuum of care had no better clinical outcomes than those experiencing more traditional and fragmented services. In an article published in this journal that was critical of the evaluation, Mordock argued that the FBEP results be viewed with skepticism because of what he perceived to be methodological, design, measurement, and analytic failures of this study. We think it is important to respond to Mordock's critique since it contributes to the great reluctance to seriously consider the study's findings and their implications.

Adolescent↗

Development of level of institutionalization scales for health promotion programs.

This study was conducted to test an instrument for measuring the level of institutionalization (LoIn) of health promotion programs. Institutionalization occurs when a program becomes an integral part of an organization, and the LoIn instrument is a beginning effort to measure the extent of program integration into organizations. The instrument is based on theory that holds that organizations are composed of production, maintenance, supportive, and managerial subsystems. Institutionalization occurs when a program becomes imbedded into these subsystems. A questionnaire designed to test this construct was mailed to 453 administrators in 141 organizations that operate health promotion programs. Based on 322 usable responses (71%), a confirmatory factor analysis was conducted. The results support the hypothesis of an eight-factor model: four factors concern how routinized the program was in each subsystem and four factors concern the degree of program saturation within each subsystem. Correlations of the eight factors with the number of years the programs had been in operation, and managers' perceptions of program permanency, indicated that the four routinization factors were more highly correlated with program longevity than the four niche saturation factors, and the niche saturation factors were more highly correlated with managers' perceptions of program permanence than the routinization factors. The instrument, which is available from the authors, may be used as both a research instrument and a diagnostic tool in assessing the institutionalization of health promotion programs.

Community Health Services↗

Organized family planning services in the United States, 1976-1977.

In 1977, an estimated 4.2 million women received contraceptive services from organized family planning programs in the United States. The number of patients has grown each year since the late 1960s, but since 1973, growth has slowed concurrently with a diminished increase in the level of federal funding for family planning services. The proportion of clinic patients who are teenagers increased from 20 percent in 1969 to 31 percent in 1977. An estimated 1.3 million adolescents received services in 1977, compared with just 214,000 in 1969. Contraceptive services were provided during 1977 by 2,574 agencies at some 5,300 clinic sites. Health departments served 42 percent of all family planning patients; Planned Parenthood affiliates served 27 percent; hospitals served 13 percent; and community action groups, free clinics, neighborhood health centers and women's health programs together served 18 percent. Federal expenditures for medical family planning services provided by organized clinics and private physicians rose from an estimated $13.5 million in 1968 to $239.1 million in 1977. Estimated federal expenditures for clinic services were $192.5 million--three-quarters of the total $252.6 million in public and private expenditures for such programs. Federal project grant funds under Title X of the Public Health Services Act accounted for 42 percent of all medical family planning expenditures in clinics, and for 55 percent of all federal funds expended for this purpose. These findings are based on data from the most recent study of the organized family planning service network conducted by The Alan Guttmacher Institute (AGI) for 1977.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Indigenous perceptions and quality of care of family planning services in Haiti.

This paper presents a method for evaluating and monitoring the quality of care of family planning services. The method was implemented in Haiti by International Planned Parenthood Federation Western Hemisphere Region (IPPF/WHR), the managerial agency for the Private Sector Family Planning Project (PSFPP), which is sponsored by the USAID Mission. The process consists of direct observations of family planning services and clinic conditions by trained Haitian housewives playing the role of 'mystery clients', who visit clinics on a random basis without prior notice. Observations conducted by mystery clients during one year, from April 1990 to April 1991, are presented and illustrate the use of the method. In addition, measurements for rating the acceptability of the services were developed, providing a quantitative assessment of the services based on mystery clients' terms. Statistical results demonstrate that simulated clients ranked some criteria of acceptability higher than others. These criteria are: the interaction provider/client, information adequacy, and competence of the promoter. Likewise, simulated clients' direct observations of the services permitted the identification of deficiencies regarding the quality of care such as the paternalistic attitudes of the medical staff; the lack of competence of promoters; and the lack of informed choice. Based on its reliability since its implementation in 1990 the method has proven to be a useful tool in programme design and monitoring.

Community Health Centers↗

The role of home care in integrated delivery systems.

The health care field is moving rapidly toward integrated delivery systems (IDS). The role of home care in such system is unclear. This study seeks to describe the current status of home care in IDS and to examine health care administrators' perceptions about the importance of IDS components. A random sample of 1600 administrators was surveyed, 400 each from home care agencies, hospitals, nursing homes, and medical groups. Results reveal that hospitals lead integration, nursing homes are least involved, and home care agencies and medical groups fall in between. Administrator's opinions vary considerably about the importance of select services and integrating mechanisms.

Administrative Personnel↗

A model for forecasting intermittent skilled home nursing needs.

The problem of forecasting the need and the cost for post-discharge skilled home nursing services is addressed by a simple statistical model. The model, assumptions, and simple calculations are described. Use of the model is illustrated with 7598 cancer patients and 2337 myocardial infarction patients. Simulation of the impact of changes in the health care delivery system toward greater and lesser severity of hospitalized patients is carried out. Two key projections illustrating the model's output are the number of patients with these diseases who will need care and the cost of that care.

Costs and Cost Analysis↗

Health information system.

Outline of selected ones among a number of nationwide surveys related to health and welfare services (90 surveys as of 1995) conducted mainly by the Ministry of Health and Welfare periodically in Japan is described. That is, history, purpose, coverage, date, contents, data collection procedure, tabulation and publication were explained in regard to : (1) Population Census, (2) Vital Statistics, (3) Patient Survey, (4) Infectious Disease Surveillance System, (5) Comprehensive Survey of Living Conditions of People on Health and Welfare, (6) Census on Medical Care Institutions, (7) Hospital Report, (8) Survey on Physicians, Dentists and Pharmacists, (9) Statistical Report on Public Health Administration Services, (10) Survey on Social Welfare Institutions, and (11) National Nutrition Survey. On-line data service system of the Ministry of Health and Welfare is also briefly mentioned.

Demography↗

The impact of drug education and prevention programs. Disparity between impressionistic and empirical assessments.

In the course of evaluating drug prevention programs for youth, we observed that although staff perceived the programs had quite favorably affected youths' attitudes and behavior, responses from these youths showed little significant impact on their use or attitudes related to drugs. This article explores several explanations for the disparity between staff impressions of the impact of these programs and results from attempts to measure impact objectivity. The analysis considers (a) clients' risk-level for drug use, (b) expectations as to how programs affect client behavior and attitudes, and (c) the sensitivity of empirical measures to ascertain changes reflecting impact of the program.

Adolescent↗

Measuring productivity in medical social work.

Our purpose was to discuss the need for measuring and documenting social work services, as well as to discuss the data and statistical collection method used in Mayo Clinic's Section of Medical Social Services, which may be useful to other social service departments. The lack of empirical data showing the value of social work services may lead to decreases in staffing in medical social work departments. Mayo Clinic uses a computer application called MedSoc to gather case information and measure productivity, which is based on demand and capacity. Through use of MedSoc, our section improved communication among social work staff members and justified an increase in staffing of 38% from late 1997 to 2002.

Benchmarking↗

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