Program evaluation as an impression management tool: the role of the program director.
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Evaluation Studies as Topic↗
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The Behavior Observation Instrument: a method of direct observation for program evaluation.
The background and development of a multicategory direct observation system, the Behavior Observation Instrument (BOI), is described. This time-sampling procedure for recording the behavior of persons is demonstrated in several treatment settings and the results applied to issues of program evaluation. Elements that have prevented direct observation from being widely adopted, such as costs, manpower, and training requirements, are systematically analyzed. A basic psychometric analysis of the instrument is used to determine optimum frequency and duration of observation intervals as well as observer agreement. The results imply that direct observation methods, once assumed by some to belong to the special province of the single-subject design, can be used to assess the effects of programs on groups of psychiatric clients in an efficient and economic manner.
Activities of Daily Living↗
Drug-use evaluation programs in short-term-care general hospitals.
The results of a survey to assess drug-use evaluation (DUE) programs in short-term-care general U.S. hospitals are reported. During February 1992, questionnaires were mailed to pharmacy directors at 491 randomly selected short-term-care general hospitals with 100 or more beds. The questionnaire was designed to collect information on the characteristics of surveyed hospitals and their pharmacies, DUE program characteristics, and the perceptions of pharmacists about the DUE programs. The net response rate was 66.6% (327 usable replies). Pharmacists involvement in DUE program activities was found to be very high, with two thirds of respondents indicating they participated in all five ASHP-recommended activities. Pharmacists rated the effectiveness of current DUE programs as moderate, while the importance of pharmacist participation was perceived to be very high. Pharmacists were members of 97.9% of the respondents' DUE committees, but only 65.5% of the pharmacist members held voting privileges. Pharmacists reported devoting an average of 11.27 hours weekly to DUE-related tasks. Reasons used to select drugs for DUEs, interventions employed, uses of DUE results, and methods of evaluating the effectiveness of DUE programs all varied widely. In short-term-care general hospitals with 100 or more beds, pharmacists assigned to DUE activities were highly involved in DUE committees and programs. The effectiveness of these activities needs to be assessed in more detail.
Data Collection↗
Readmission discount factors in program evaluation. An output value analysis of an adult psychiatry program.
The application of output value analysis, a type of benefit/cost analysis, to a psychiatric patient population is reported. A method for discounting the value of the program if a patient was readmitted within a year after discharge was introduced. The application of this discount factor reduces the value produced by the program and thereby reduces both productivity and effectiveness indices. When applied to groups known to differ in readmission rates, such as first admissions and readmissions or voluntary and involuntary admissions, the discount factor can accentuate group differences markedly. When selected diagnostic groups were compared, the discount factor could even reverse the relative standing of the groups.
Brain Damage, Chronic↗
Drug interactions evaluation program.
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Drug Interactions↗
Some issues in evaluating programs.
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Evaluation Studies as Topic↗
Health-care performance measurement systems and the ACHS Care Evaluation Program. Australian Council on Healthcare Standards.
The call for evidence-based medicine and information on health outcomes has brought with it performance measurement systems. The necessary attributes of these systems are now being addressed as are the attributes of the measures themselves. In this paper the Australian Council on Healthcare Standards Care Evaluation Program is reviewed in relation to these various attributes. The more focused systems should prove useful in achieving change in clinical practice.
Australia↗
A clinical advancement program: evaluating 10 years of progressive change.
OBJECTIVE: To report the evolution of a clinical advancement program, UEXCEL, at a western teaching hospital and the outcomes associated with evaluation over time. BACKGROUND: The clinical ladder program was initiated in 1989 to provide a professional framework for developing, evaluating, and promoting registered nurses. The program is derived from Benner's Novice to Expert model. Over a 10-year period, the program has undergone three significant revisions. Program evaluation data have been used to guide institutional change. METHODS: Structure and progression of program development and change are outlined. Evaluation data were collected using a 23-item clinical ladder satisfaction scale developed by Strzelecki. Data were collected in 1993, 1994, 1996, and 1998 using standard survey methods after institutional review board approval. Subjects were registered nurses holding clinical positions at the University of Colorado Hospital. Data were trended across units and time periods and were compared with other institutional evaluation data sets. RESULTS: Improvement in nurse satisfaction with the UEXCEL program has been steady and incremental, after low baseline measurement. Satisfaction has improved after each program revision. A significant demographic variable over time is the correlation between higher registered nurse education and program satisfaction. Human resources issues are reported with data results. CONCLUSIONS: Sustaining a clinical advancement program represents a challenge in the current health-care environment. Institutional commitment, staff involvement in revisions, and activities to improve professional nurse development are critical strategies so progress can be achieved.
Career Mobility↗
Using PERT/CPM (Program Evaluation and Review Technique/Critical Path Method) to design and improve clinical processes.
Recent changes in health care have focused attention on new tools for planning and managing clinical processes. The use of one tool in particular, clinical pathways, has increased dramatically. Pathways employ a concept long used in other industries: the explicit design and documentation of a process. However, the most common tools used in other industries to perform process design, the Program Evaluation and Review Technique (PERT) and the Critical Path Method (CPM), have not migrated to health care. This article presents a methodology for incorporating PERT/CPM into the design and management of clinical processes.
Analysis of Variance↗
Assessment of an itinerant medical evaluation program for school dysfunction.
This paper describes an itinerant medical evaluation (IME) project and reports on the outcome of 108 consecutive referrals made in the first year. Subjects were of ages 5 to 17 years. Most students had been evaluated by the schools but were not receiving special education or related services. IME led to clinical diagnosis of ADHD in 70% of the sample, and specific learning disabilities were diagnosed in 26%. Several other clinically significant and educationally relevant diagnoses were made. As a result of the IME, many students were placed in special education and/or began to receive related services. At three-month follow-up, classroom accommodations were being made for 97% of the students. Teachers reported they felt more capable of teaching challenging students as a result of the IME. Significant improvements occurred in hyperactivity, conduct problems, and inattention, and grades improved in 31% of the sample. Reasons for the project's success are discussed.
Adolescent↗
How to develop a successful DUE (drug usage evaluation) program: experience of a teaching medical center.
A drug usage evaluation (DUE) program was successfully implemented in a busy teaching medical center within 12 months of adding a full-time coordinator. The success of this program was due largely to its approval by hospital administration, the recruitment of a pharmacist with the necessary background, and the creation of a structure and process that encouraged participation by leaders of the medical staff. Although the primary objective of hiring the coordinator was to meet Joint Commission on Accreditation of Healthcare Organizations requirements for accreditation, another achievement was confirmed cost savings. Techniques used in selecting DUE subjects and the steps taken in implementing and managing the program are presented.
California↗
Report of the Cancer Therapy Evaluation Program monitoring plan for secondary acute myeloid leukemia following treatment with epipodophyllotoxins.
BACKGROUND: Recent reports have documented the occurrence of treatment-related acute myeloid leukemia (AML) following therapy with epipodophyllotoxins. These reports have led to growing concern among oncologists, which could lead to premature abandonment of these agents at a time when the relationship between cumulative dose of epipodophyllotoxin and risk of treatment-related AML has not been determined. PURPOSE: Because of the increasingly important role of epipodophyllotoxins in the treatment of several types of adult and pediatric tumors, the Cancer Therapy Evaluation Program (CTEP) of the National Cancer Institute (NCI) has developed a monitoring plan to obtain reliable estimates of the risk of treatment-related AML following epipodophyllotoxin treatment. METHODS: We identified 12 NCI-supported Cooperative Group clinical trials in which patients with solid tumors are being treated with epipodophyllotoxins at different cumulative doses. One trial is using a moderate dose of teniposide (900 mg/m2), and 11 trials are using etoposide at a low dose (< 1500 mg/m2), a moderate dose (1500-3999 mg/m2), or a high dose (> or = 4000 mg/m2). Cases of treatment-related AML and treatment-related myelodysplastic syndrome (MDS) (hereafter referred to as treatment-related AML/MDS) occurring in these trials are reported to CTEP, with initial analysis for each cumulative dose group triggered by the reporting of four cases of treatment-related AML/MDS in that group. For each analysis, total patient follow-up for the group is determined and cumulative 6-year incidence rate is calculated. RESULTS: Three cases of treatment-related AML and one case of treatment-related MDS (with documented monosomy 7) were reported in a group of 207 patients who received etoposide at a low cumulative dose. The calculated 6-year rate of development of treatment-related AML/MDS was 3.2% (95% upper confidence interval bounded by 7.2%). CONCLUSIONS: The 6-year cumulative rate of treatment-related AML/MDS (3.2%) is within the range previously reported for alkylator-based regimens that did not include epipodophyllotoxins. IMPLICATIONS: Previous reports have suggested that higher cumulative doses of alkylators are associated with increased risk of treatment-related AML, and a critical goal of the monitoring plan is to determine whether a similar relationship exists for the epipodophyllotoxins. Estimates will be developed for leukemogenic risk for the moderate- and high-cumulative-dose groups when four cases of treatment-related AML/MDS have been identified within each group.
Acute Disease↗
American College of Emergency Physicians: Research fellowship program evaluation.
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Emergency Medicine↗
Vaccination practices, policies, and management factors associated with high vaccination coverage levels in Georgia public clinics. Georgia Immunization Program Evaluation Team.
BACKGROUND: Controlling vaccine-preventable diseases by achieving high childhood vaccination coverage levels is a national priority. However, there are few, if any, comprehensive evaluations of state immunization programs in the United States, and little attention has been given to the importance of vaccination clinic management style and staff motivation. OBJECTIVE: To evaluate the factors associated with the increase in childhood vaccination coverage levels from 53% in 1988 to 89% in 1994 in Georgia's public health clinics. DESIGN: A 1994 mail survey obtaining information on clinic vaccination policies and practices and management practices. SETTING: All 227 public health clinics in Georgia. PARTICIPANTS: Clinic nurses responsible for vaccination services. OUTCOME MEASURE: The 1994 clinic-specific coverage level for 21- to 23-month-old children for 4 doses of diphtheria and tetanus toxoids and pertussis vaccine, 3 doses of polio vaccine, and 1 dose of a measles-containing vaccine as determined by an independent state assessment of clinic coverage levels. RESULTS: Univariate analysis showed that higher coverage levels were significantly (P<.05) associated with smaller clinic size, higher proportions of clientele enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), being a nonurban clinic, and numerous vaccination practices and policies. Multivariable analysis showed that only 8 of greater than 150 factors remained associated with higher coverage levels, including having no waiting time to be seen, having telephone reminder systems, conducting home visits for defaulters, and restricting WIC vouchers when a child was undervaccinated. Motivational factors related to higher coverage included clinic lead nurses receiving an incentive to raise coverage and lead nurses participating in assessments of clinic coverage levels by state immunization staff. CONCLUSIONS: No single factor is responsible for raising vaccination coverage levels. Efforts to improve coverage should include local assessment to provide feedback on performance and identify appropriate local solutions. Coordinating with WIC, conducting recall and reminder activities, motivating clinic staff, and having staff participate in decisions are important in raising vaccination levels.
Ambulatory Care Facilities↗
The Southern California Kaiser-Permanente Chemical Dependency Recovery Program evaluation: results of a treatment outcome study in an HMO setting.
This report presents the methodology and outcomes of an evaluation of the Chemical Dependency Recovery Program (CDRP) of Southern California Kaiser-Permanente, a large group model HMO. CDRP treatment includes specialized detoxification inpatient facilities, day treatment and outpatient services. Substance use outcomes in a population of 1,986 patients consecutively entering treatment were obtained via telephone at six and twelve months post intake. For patients who consumed only alcohol at baseline (N = 621), significantly higher six month point prevalence abstinence rates were found among those who remained in treatment for a minimum of three months (89%), compared to those patients who failed to return for treatment after their intake (31%). For polydrug users (N = 1365), as contrasted with patients who utilized services only on their intake date, significantly higher six month point prevalence rates were restricted to those who remained in treatment for a minimum of six months (74% versus 21%). The evaluation documented the need for CDRP services, validated program effectiveness and highlighted areas for systematic improvement.
Adult↗
Performance evaluation programs for determining HIV-1 viral loads, testing for HIV p24 antigen, and identifying Mycobacterium tuberculosis using nucleic acid amplification tests.
CDC's Division of Laboratory Systems, Public Health Practice Program Office, is implementing three new laboratory performance evaluation (PE) programs. The first assesses the performance of laboratories that perform tests to determine the viral RNA copy number (viral load) in the blood of persons infected with human immunodeficiency virus type 1 (HIV-1); the second assesses the performance of laboratories that perform HIV p24 antigen (Ag) testing; and the third assesses the performance of laboratories that perform nucleic acid amplification (NAA) tests for Mycobacterium tuberculosis.
Clinical Laboratory Techniques↗
Preceptor program evaluation demonstrates improved orientation.
Although the preceptor method of orientation is generally accepted as an effective mechanism for orienting newly employed nurses, very few evaluation studies of preceptor programs have been reported in the literature. This article describes a study designed prior to implementing a preceptor program at the University of Wisconsin Hospital and Clinics in order to measure the outcomes of the program. Data were collected on the satisfaction of orientees, preceptors, other staff nurses, and nurse managers. The preceptor role and preceptor's level of comfort and skill were studied. To quantify the economic impact, both length of orientation and nursing turnover were considered.
Education, Nursing, Continuing↗
[Outpatient insulin therapy in type II diabetes: program evaluation and calculation of cost saving].
BACKGROUND: Evaluation of the results of a program of outpatient insulinization in type II diabetes and the resulting saving in cost. METHODS: Data from 39 patients with that disease (mean age 62 years) were evaluated four months after the beginning of insulin therapy and diabetic education. The economic cost of the outpatient program was calculated and compared with the cost if patients had been admitted. RESULTS: A good metabolic control was achieved with a significant reduction (p less than 0.001) of the glycemic levels from 281 +/- 43 mg/dl (15.6 +/- 2.4 mmol/l) to 156 +/- 22 mg/dl (8.6 +/- 1.5 mmol/l). Fructose levels were reduced from 4.7 +/- 0.54 mmol/l to 3.29 +/- 0.51 mmol/l. Seventeen patients had some episode of mild hypoglycemia. The insulin dose was increased from 0.27 +/- 0.06 U per kg and day to 0.42 +/- 0.1 (11 patients required two insulin doses). At onset, no patient controlled the glycemia at home, while at the end of the program 46% did so. The evaluation of each educational end-point showed a mean of 4.8 +/- 0.3 (from 0 to 5); the end-point with the best score were the technical aspects. The economic cost of the program was 230.39 ptas per patient and day, versus 1351.75 ptas per patient and day if the patients had been admitted. CONCLUSIONS: Outpatient insulinization in type II diabetes has very good results and is economically effective provided the adequate equipment and facilities are available.
Adult↗