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PubMed1997

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); Program for Persons with Disabilities; basic program--DoD. Final rule; administrative corrections.

The Department of Defense published a final rule concerning the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) on June 30, 1997 (62 FR 35086). There were incorrect amendments published to the Program for Persons with Disabilities section of the CHAMPUS rule. This document corrects the administrative error.

Persons with Disabilities↗

PubMed1982

Medicaid program; entitlement of children for whom payments are made under the foster care maintenance payments program or the adoption assistance program--HCFA. Final rule.

These final regulations implement the Medicaid provisions of the Adoption Assistance and Child Welfare Act of 1980 (Pub. L. 96-272). That law established a new title IV-E of the Social Security Act, providing for adoption subsidies for certain hard-to-place children and for an expanded foster care program. Under the law, children for whom adoption assistance of foster care maintenance payments are made are entitled to Medicaid. These final regulations specify that the State making payments for a child under its title IV-E program is also responsible for Medicaid for that child.

Adoption↗

PubMed1998

The Program Environment Scale: assessing client perceptions of community-based programs for the severely mentally ill.

The Program Environment Scale (PES) was developed for use with clients of community-based programs for the severely mentally ill. It is intended to fill the gap in available tools for assessing clients' perceptions of program functioning as it affects their "quality of life" in a program. Formal pretests were conducted with 121 clients at 12 randomly selected programs near Washington, DC. The final field test used a revised form (29 domains; 129 items) with 221 clients in 22 programs selected randomly throughout the U.S., including Clubhouse, day treatment, psychosocial rehabilitation, and social club programs. Twenty-three subscales met at least five of eight psychometric criteria for internal consistency and discriminant validity. A 24th subscale was retained because of its substantive importance. Successful subscales cover program atmosphere and interactions (program cares about me, energy level, friendliness, openness, staff-client and client-client respect, reasonable rules, availability of positive physical contact, protection from bad touch, staff investment in their jobs, and confidentiality), client empowerment/staff-client equality (program and treatment empowerment, egalitarian space use), and service components (support for paid work, work importance, emergency access, family activities, housing, public benefits, community activities, medications, substance abuse, and continuity). Subscale validity is indicated by associations of specific service offerings with scores on scales measuring client perceptions of those services, and by an ability to differentiate among program models (i.e., Clubhouses, day treatment programs, and psychosocial rehabilitation programs look different from each other). Subscale scores were not influenced by client characteristics (gender, race, age, diagnosis, number of hospitalizations, length of time in program). The final scale has 97 items and takes about 25 minutes to complete. The PES succeeds in measuring different aspects of programs as clients perceive them. In the programs we visited, directors felt the PES covers the important things they want to know about how clients perceive their program. The PES should become a useful tool both for researchers interested in how client responses to programs may influence their therapeutic outcomes, and for practitioners interested in improving their clients' program experiences and/or increasing convergence of staff and client views of their program.

Environment↗

PubMed2000

Eligibility for the Medicare buy-in programs, based on a survey of income and program participation simulation.

Medicare buy-in programs are designed to reduce out-of-pocket expenses of beneficiaries with modest income and assets. This article provides estimates of the size of the Medicare beneficiary population eligible for the Qualified Medicare Beneficiary (QMB) program, the Specified Low-Income Medicare Beneficiary (SLMB) program, and the Qualified Individual-1 (QI-1) program. The buy-in programs use the same resource limits (twice those used in the Supplemental Security Income (SSI) program) but different thresholds for determining income eligibility. The QMB program uses 100 percent of the poverty line as the cutoff, QI-1 covers persons above 120 percent but at or below 135 percent of the poverty line, and the SLMB program is in between. Making informed judgments about the rate of participation in the buy-in programs and the need for outreach requires an accurate estimate of the size of the eligible population. If that population is underestimated, policymakers might come to unduly optimistic conclusions about current buy-in participation. In contrast, an overestimate may make current participation seem too low. If policymakers react to an upwardly biased estimate of the eligible population by increasing outreach, they are bound to be disappointed by the results of that effort. Estimates of the eligible population from past studies of the QMB and SLMB programs range from 5.1 million to 9.1 million. In the absence of new information, it is difficult to judge the accuracy of those estimates because the methodologies had substantial shortcomings that might bias the results. The most common shortcomings include the lack of high-quality, monthly income data and the lack of information on assets from the same data file that was used to estimate participation and income eligibility for Medicare. The current study uses the most recently available (as of August 2000) Survey of Income and Program Participation (SIPP) file that is matched to the Social Security Administration's (SSA's) administrative records. The data file covers 1995 information. Estimates were also obtained using 1991 data to assess the sensitivity of eligibility estimates to the year chosen. The SIPP has several major advantages over other data sources because it contains relevant, high-quality information on both income and assets for establishing financial eligibility for the buy-in programs. First, the SIPP collects detailed and conceptually appropriate information on monthly, rather than annual, income and therefore has more complete information about income than do other surveys. As a result, SIPP-based estimates of poverty are substantially lower than estimates based on the Current Population Survey. Second, the SIPP also collects information on assets at the individual level. Thus, the survey provides enough detail to measure the major income and asset exclusions directly. Finally, the SIPP data are matched to SSA administrative records: Medicare eligibility can therefore be accurately measured, and self-reported data on Social Security and SSI benefits can be replaced with more accurate monthly information. Our 1995 simulation estimates that approximately 4.8 million persons in the U.S. noninstitutionalized population were eligible for the QMB program and an additional 1.6 million for the SLMB program. The total--roughly 6.5 million--is within the range of estimates from past studies but is closer to the lower end, suggesting that the eligible population is smaller than was previously believed. When the estimated QI-1 eligible population of 0.9 million is added, the total for the three buy-in programs is 7.4 million. Because the QI-1 program did not exist in 1995, only the estimated 6.5 million QMBs and SLMBs would actually have been eligible to receive benefits. The 7.4 million figure represents the 1995 Medicare beneficiaries who would be eligible for buy-in under program rules for 2000. Adjusting that number to account for increases in the Medicare population between 1995 and 1999 yields an estimated eligible population of 7.8 million in 1999. Compared with other elderly Medicare recipients, eligible elderly QMBs and SLMBs have poorer health, more functional limitations, and higher rates of health care use. Thus, not only are their income resources relatively limited, but their need for potentially expensive medical care is also greater. Similar differences were not found in health, functional limitations, and health care use among disabled participants in the QMB and SLMB programs. Our estimates imply that about 2.5 million noninstitutionalized individuals were eligible for but not enrolled in the QMB and SLMB programs in 1999. That finding suggests that fewer eligibles may be available for targeting by outreach efforts than was previously believed. Outreach may be more difficult than it would be with a larger eligible population. (ABSTRACT TRUNCATED)

Adolescent↗

PubMed2004

Current practices in evaluating radiology residents, faculty, and programs: results of a survey of radiology residency program directors.

RATIONALE AND OBJECTIVES: We surveyed program directors to determine current radiology program practices in evaluating their residents, faculty, and program. MATERIALS AND METHODS: In January 2003, a 52-item Web-based survey was made available to program directors of accredited core radiology programs. Responses to the items were tabulated to determine relative frequency distribution. Two-tailed Pearson chi-square tests were used to compare proportions and assess the association between variables. RESULTS: A total of 99 (52%) of 192 program directors responded. Programs were largely in compliance with Accreditation Council for Graduate Medical Education (ACGME) requirements. Noncompliance was related to the requirements to evaluate residents at least four times per year in at least 22 (22.2%) of 99 programs and annually evaluate the program in 20 (20.2%) of 99 programs. New program directors (<1-year tenure) were less likely than those with >/=1-year tenure to be using the Association of Program Directors in Radiology Education Committee global rating form (41.2% versus 68.8%, P =.03). Programs that used this form, compared with those that didn't, were more likely to evaluate resident competence in systems-based practice (88.5% versus 44.0%, P =.001). Being a program director for 1 or more years versus less than 1 year was associated with using a computerized evaluation system (35.8% versus 11.8%, P =.05). CONCLUSION: In general, there is a high degree of compliance among radiology programs in meeting ACGME evaluation requirements. However, some programs do not comply with requirements for frequency of resident evaluation or annual program evaluation. The percentage of new program directors is high and related to not using or knowing about useful evaluation resources. Use of computerized evaluation systems, which have the potential to decrease the work associated with evaluations and provide more dependable and reliable data, is minimal.

Data Collection↗

PubMed2003

Geriatric medicine fellowship programs: a national study from the Association of Directors of Geriatric Academic Programs' Longitudinal Study of Training and Practice in Geriatric Medicine.

This report documents the development and growth of geriatric medicine fellowship training in the United States through 2002. A cross-sectional survey of geriatric medicine fellowship programs was conducted in the fall 2001. All allopathic (119) and osteopathic (7) accredited geriatric medicine fellowship-training programs in the United States were involved. Data were collected using self-administered mailed and Web-based survey instruments. Longitudinal data from the American Medical Association (AMA) and the Association of American Medical Colleges' (AAMC) National Graduate Medical Education (GME) Census, the Accreditation Council for Graduate Medical Education (ACGME), and the American Osteopathic Association (AOA) were also analyzed. The survey instrument was designed to gather data about faculty, fellows, program curricula, and program directors (PDs). In addition, annual AMA/AAMC data from 1991 to the present was compiled to examine trends in the number of fellowship programs and the number of fellows. The overall survey response rate was 76% (96 of 126 PDs). Most (54%) of the PDs had been in their current position 4 or more years (range: <1-20 years), and 59% of PDs reported that they had completed formal geriatric medicine fellowship training. The number of fellowship programs and the number of fellows entering programs has slowly increased over the past decade. During 2001-02, 338 fellows were training in allopathic programs and seven in osteopathic programs (all years of training). Forty-six percent (n = 44) of responding programs offered only 1-year fellowship-training experiences. PDs reported that application rates for fellowship positions were stable during the academic years (AYs) 1999-2002, with the median number of applications per first year position available in AY 2000-01 being 10 (range: 1-77). In 2001-02, data from the AMA/AAMC National GME Census indicated a fill rate for first-year geriatric medicine fellowship positions of 69% (259 first-year fellows for 373 positions). During 2001-02, more than half of programs (53%) reported having two or fewer first-year fellows, whereas 31% had three or four first-year fellows. Thirty-three programs (36%) reported having no U.S. medical school graduate first-year fellows, and another 25 (28%) reported having only one. Of the 51 programs offering second-year fellowship training, PDs reported 61 post-first-year fellows (median 1, range: 0-7). During the past 10 years, 27 new allopathic geriatric medicine fellowship programs opened; there are now 119 programs. There are also seven osteopathic programs. The recruitment of high-quality U.S. medical school graduates into these programs remains a challenge for the discipline. Furthermore, the retention of first-year fellows for additional years of academic training has been difficult. Incentives will be needed to attract the best graduates of U.S. family practice and internal medicine training programs into academic careers in geriatric medicine.

Career Choice↗

PubMed1999

Program closure and change among VA substance abuse treatment programs.

OBJECTIVE: The population of Veterans Affairs (VA) substance abuse treatment programs in 1990 and 1994 was examined to determine which factors-program legitimacy or cost-accounted for program closure and change. Legitimacy is a concept in institutional theory that organizations tend to take on a form appropriate to the environment. METHODS: The study had two competing hypotheses. The first was that if external pressures push programs to produce high-quality and efficient treatment, then those that are initially closer to the legitimate form should be less likely to close later, and among surviving programs they should be less likely to experience change. The second hypothesis was that cost is the primary factor in program closure and change. The study used data from administrative surveys of all VA programs (273 in 1990 and 389 in 1994). Program legitimacy variables measured whether programs offered the prevalent type of treatment, such as 12-step groups or behavioral treatment, and had the prevalent type of staff. RESULTS: Program costs did not explain closure or change. For inpatient programs, the risk of closure increased in facilities with more than one substance abuse treatment program. The risk of closure increased for outpatient programs offering the prevalent type of treatment, contrary to what was predicted by the legitimacy hypothesis. Inpatient programs that offered the prevalent treatment were less likely to change the type of treatment offered. CONCLUSIONS: Patterns of change differed over time for inpatient and outpatient programs. Legitimacy factors, rather than cost, seem to play a role in program closure and change, although the picture is clearer for inpatient programs than for outpatient programs.

Health Facility Closure↗

PubMed1999

Changing trends in program assessment in physical therapy education: perceptions of program directors.

Rather than focusing on student outcomes, educational programs are starting to assess activities that support the achievement of a program's specific mission and goals. Directors, faculty, students, and other stakeholders are encouraged to participate in the assessment activities. The accreditation agency for physical therapy education has recently implemented new criteria for program assessment that contain 11 components related to program content, management, and resources, with recommendations that various stakeholders participate in the process. The purposes of this study were 1) to identify the extents to which specific stakeholders participated in the assessment of three program components, and 2) to learn how program directors rated the importance of the new criteria. A survey was used to collect information from the program director of each accredited physical therapy program in the United States. The response rate was 50%. Results indicated that 76-100% of program chairs and faculty almost always participated in assessment activities related to institutional and program policies and procedures, and resources. In comparison, 20-57% of students, graduates, and support staff participated. Program chairs and faculty participated significantly more (p = 0.0000) compared with students, graduates, and support staff. Approximately 90% of the program directors believed the new criteria were important to the effectiveness of their programs. The results were used to critique program assessment in physical therapy education against recommendations cited in the literature and to share the perceptions that program directors have regarding assessment components that address broad areas of program activities and resources.

Accreditation↗

PubMed2001

Transition programs in cystic fibrosis centers: perceptions of pediatric and adult program directors.

There is a growing population of adults with cystic fibrosis (CF) and a need for development of adult CF programs. Recommendations for transfer of patients to an adult program include a transition program. Our goal was to assess the current status of transition programs in US CF centers. In addition, we sought to determine the problems related to the transfer of patients to adult programs as perceived by CF center program directors. A survey was sent in 1998 to 110 pediatric and 44 adult program directors at CF centers approved by the Cystic Fibrosis Foundation (CFF), with a response rate of 65.5% and 72.7%, respectively: 22.2% of pediatric centers reported having a non-CFF-approved adult program, and 38.9% had no specific adult program. About one fifth of pediatric centers cited lack of an adult CF physician as an impediment to establishing an adult program. Age (82% of programs; mean, 18.5 years), but not marriage (17.1%) or pregnancy (24.8%), was used as a criterion for transfer. Criteria precluding transfer included patient/family resistance (51.4%), disease severity (50.5%), and developmental delay (46.7%). The concept of transfer is introduced to the patient and family at the time of diagnosis in a minority (14%) of programs. Over one half of the patients did not meet the adult team until the time of transfer. Pediatricians reported higher perceived parent, patient, pediatric staff, and adult staff concerns about transition issues than did adult program directors. We conclude that there is a lack of standardized programs for transfer of CF patients from a pediatric to an adult care setting, and that there are differences between pediatric and adult program directors' perceptions of concerns that CF patients, their families, and the medical teams have about transfer. These differences may impede the successful transition of patients into an adult program.

Adolescent↗

PubMed2005

Resident duty hours reform: results of a national survey of the program directors and residents in neurosurgery training programs.

OBJECTIVE: The new Accreditation Council for Graduate Medical Education (ACGME) requirements regarding resident work hours have been implemented since July 2003. Neurological surgery training programs have been especially affected because of the limited number of residency positions and the residents' long duty hours. The perceptions of program directors and residents may provide important insight into the evolution of new guidelines for improvement of resident training. METHODS: We conducted a nationwide survey of 93 program directors and 617 residents to characterize their perceptions regarding the changes in their training programs related to compliance with the ACGME requirements. The survey was conducted from July through September 2003 using electronic mail. RESULTS: The response rates were 45% and 23% among the program directors and residents, respectively. Most programs offered one (37%) or two (38%) resident training positions per year. Although 92% of programs had implemented the ACGME work hours requirements before or since July 2003, 8% had not yet implemented these guidelines. Sixty-eight percent of program directors indicated employment of ancillary health care professionals to fulfill the ACGME duty hours reform; 84% (95% confidence interval [CI], 64-94%) thought that this practice has not limited the residents' clinical experience. Eleven percent of respondents (18 of 164 respondents) who provided Level I trauma coverage were unable to maintain compliance with the ACGME guidelines. Ninety-three percent (95% CI, 89-96%) of all respondents thought that the work hour reform has had a negative impact on the continuity of patient care. Fifty-five percent (95% CI, 46-63%) of the residents and only 33% (95% CI, 20-50%) of the program directors thought that the ACGME requirements are likely to result in improved American Board of Neurological Surgery written test scores. Twenty-nine percent (95% CI, 22-37%) of the residents and 17% (95% CI, 8-32%) of the program directors thought that resident attendance at national conferences would increase. Similarly, although 46% (95% CI, 37-54%) of residents perceived that these work hour limitations would facilitate residents' research/publication-related activities, only 21% (95% CI, 11-37%) of program directors agreed. Forty-one percent (95% CI, 33-49%) of the residents and 74% (95% CI, 58-86%) of the program directors perceived that the chief residents operate on fewer complex cases since the institution of the ACGME duty hour guidelines. Seventy-five percent of residents think they are less familiar with their patients. Overall, 61% (95% CI, 53-69%) of the residents and 79% (95% CI, 63-89%) of the program directors noted that the ACGME guidelines have had a negative effect on their training programs. CONCLUSION: On the basis of their early experience, the majority of the residents and program directors think that the ACGME duty hour guidelines have had an adverse effect on continuity of patient care and resident training. The effects of these guidelines on neurosurgery programs should be carefully monitored, because more sophisticated solutions may be needed to address house staff fatigue. Strategies to enhance the educational content of the residents' work hours and to preserve continuity of patient care are necessary.

Data Collection↗

PubMed2005

Medicare program; health care infrastructure improvement program; selection criteria of loan program for qualifying hospitals engaged in cancer-related health care. Interim final rule with comment period.

This interim final rule with comment period sets forth the criteria for implementing a loan program for qualifying hospitals engaged in research in the causes, prevention, and treatment of cancer as specified in section 1016 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) (Pub. L. 108-173). Specifically, this rule establishes a loan application process by which qualifying hospitals including specified entities may apply for a loan for the capital costs of health care infrastructure improvement

Economics, Hospital↗

PubMed2003

Constructing the program impact theory for an evidence-based work rehabilitation program for workers with low back pain.

PURPOSE: Several low back pain work rehabilitation programs have been developed and evaluated for their outcomes. Unfortunately, the program impact theory for these programs is not described, and consequently, the exact mechanisms of action by which these programs intend to increase the probability of return to work remain unknown. This lack of knowledge jeopardizes the implementation of effective programs by health professionals and managers. The objective of this paper is to present the results of an exploratory study aimed at building the program impact theory for the PREVICAP work rehabilitation program. METHODS: The program impact theory was develop by conducting: unpublished documents and scientific literature analyses, individual and group discussions with multiple stakeholders and observation of program reality by reviewing the files of workers who completed the program. RESULTS: The PREVICAP program's impact theory was elaborated based on an ecological approach to work rehabilitation. Program goals and objectives were defined for the three dimensions of the model: the worker, the work environment and the interaction between the worker and his work environment. Two program action mechanisms were defined and describe how the program was intended to achieve its expected outcomes. CONCLUSIONS: This study made explicit the PREVICAP program impact theory and can help rehabilitation practitioners to address work disability according to an ecological model.

Canada↗

PubMed1992

Resident research in obstetrics and gynecology: development of a program with comparison to a national survey of residency programs.

OBJECTIVE: The objective of this report is to describe our recently established resident research program and to compare this program with those of other obstetrics and gynecology residency training programs in the United States. STUDY DESIGN: The components of our program are described. Data for comparison from other programs were obtained from questionnaires, phone follow-up and the Directory of Obstetrics and Gynecology Residency Programs of the Council on Resident Education in Obstetrics and Gynecology. RESULTS: We initiated a residency research program in 1987 with acceptable projects defined, a time for completion of manuscripts established, and a Resident Research Day organized with presentation of articles, critique by a guest speaker, and an awards banquet. Nationally, less than 60% of residency programs have research requirements. Of the 208 programs responding to the written questionnaire 86% of programs associated with a university required research compared with 10% of community-based residency programs. CONCLUSION: While more than a third of residency programs in obstetrics and gynecology do not have resident research programs, the trend is for programs to establish research as a required portion of training. An outline of a recently established program is provided.

Data Collection↗

PubMed2006

Educational development program for residency program directors and coordinators.

BACKGROUND: Residency program directors and program coordinators have increasing demands placed on them by accrediting agencies and require educational development specifically tailored to their needs. DESCRIPTION: We created, piloted, and evaluated an educational development program consisting of 10 sessions spanning 1 year for program directors and a parallel set of sessions for program coordinators. EVALUATION: On average, more than half the residency programs participated in the sessions. Programs improved in residency activities related to their program's handbook, interviewing, evaluations, rotation descriptions, and program evaluation. They did not improve in educational scholarly activities. Program directors and coordinators indicated that the program improved their skills, and they would recommend the program for others. CONCLUSIONS: This 10-session program improved important elements of residency education and was favorably received.

Administrative Personnel↗

PubMed2006

Substance use disorder treatment programs in Switzerland and the USA: Program characteristics and 1-year outcomes.

AIM: This study compared matched samples of substance use disorder (SUD) patients in Swiss and United States (US) residential treatment programs and examined the relationship of program characteristics to patients' substance use and psychosocial functioning at a 1-year follow-up. DESIGN AND SETTING: The study used a prospective, naturalistic design and a sample of 10 public programs in the German-speaking part of Switzerland and 15 US public treatment programs. PARTICIPANTS: A total of 358 male patients in Swiss programs were matched on age, marital status and education with 358 male patients in US programs. A total of 160 Swiss and 329 US patient care staff members also participated. MEASUREMENT: Patients completed comparable inventories at admission, discharge and 1-year follow-up to assess their substance use and psychological functioning and receipt of continuing care. Staff members reported on program characteristics and their beliefs about substance use. FINDINGS: Compared to Swiss patients, US patients had more severe substance use and psychological problems at intake and although they did not differ on abstinence and remission at follow-up, had somewhat poorer outcomes in other areas of functioning. Swiss programs were longer and included more individual treatment sessions; US programs included more group sessions and were more oriented toward a disease model of treatment. Overall, length of program, treatment intensity and 12-step orientation were associated with better 1-year outcomes for patients in both Swiss and US programs. CONCLUSIONS: The sample of Swiss and US programs studied here differed in patient and treatment characteristics; however, in general, there were comparable associations between program characteristics and patients' 1-year outcomes. These findings suggest that associations between treatment processes and patients' outcomes may generalize from one cultural context to another.

Adult↗

PubMed1999

The dissemination of a smoking cessation program to 23 antenatal clinics: the predictors of initial program adoption by managers.

OBJECTIVE: To investigate whether the method of dissemination, antenatal clinic practice norms for smoking intervention and subjective evaluation of the attributes of a new smoking cessation program are associated with a nurse unit manager's initial decision to adopt the new program. METHOD: Twenty-three hospital clinics were randomly allocated to two groups which received the program either by simple or intensive dissemination methods. Simple dissemination involved a mailout of the 'Fresh Start' program and intensive dissemination involved a mailout which was enhanced by personal contact with midwifery facilitators who provided support and training for the program. It was hypothesised that intensive dissemination would improve program adoption compared to simple dissemination. It was also hypothesised that managers' perceptions of the program and clinic smoking intervention practice norms would predict program adoption. A hierarchical regression analysis was used to examine the association between these variables and the adoption of program components. RESULTS: The results indicated that the method of dissemination and the managers' perceptions of the program are significant predictors of program adoption. CONCLUSIONS: Although clinic practice norm for smoking cessation education is not a significant predictor of program adoption, it appears to mediate managers' perceptions of the program.

Female↗

PubMed2005

Barriers to diabetes self-management education programs in underserved rural Arkansas: implications for program evaluation.

BACKGROUND: Diabetes prevalence has reached epidemic proportions. Diabetes self-management education (DSME) has been shown to improve preventive care practices and clinical outcomes. In this study, we discuss the barriers faced during the implementation of DSME programs in medically underserved rural areas of Arkansas. CONTEXT: Arkansas is a rural state, with most southeastern counties experiencing a shortage of health care professionals. The Arkansas Diabetes Prevention and Control Program and its partners established 12 DSME programs in underserved counties with a high prevalence of diabetes. METHODS: DSME programs were delivered by a registered nurse and a dietitian who provided 10 to 13 hours of education to each program participant. Baseline, 6-month, and year-end data were collected on preventive care practices, such as daily blood glucose monitoring, foot examination, systolic and diastolic blood pressure, and glycosylated hemoglobin level, among the participants in newly established DSME programs. CONSEQUENCES: Of the 12 DSME programs established, 11 received American Diabetes Association recognition. The number of participants in the DSME programs increased 138% in 1 year, from 308 in February 2003 to 734 in March 2004. Preventive care practices improved: daily blood glucose monitoring increased from 56% to 67% of participants, and daily foot examinations increased from 63% to 84% of participants. Glycosylated hemoglobin decreased by an average of 0.5 units per participant who completed the program. However, many anticipated and a few unanticipated barriers during the implementation of the program could not be overcome because of the lack of an evaluation plan. INTERPRETATION: Although results point to potential benefits of preventive care practices among DSME participants, interpretation of findings was limited by sample size. Sample size limitations are traced to barriers to assessing program outcome. Program evaluation should be integrated into the planning phase to ensure adequate measures of program effectiveness.

Adult↗

PubMed2005

Developing and evaluating a smoking cessation program combined with an Internet-assisted instruction program for adolescents with smoking.

OBJECTIVE: The purpose of this study was to develop a smoking cessation program combined with an Internet-assisted instruction (IAI) program to help youth smokers quit smoking, and to evaluate the effectiveness of the program in changing youth's attitudes toward smoking, smoking behavior, and self-efficacy for smoking cessation. METHODS: To achieve this goal, a comparative study of 77 senior high students divided into two groups was conducted. One group, designated as the experimental group, accepted a 6-week smoking cessation program plus an IAI program and the other group did not receive any intervention as the comparison group. All participants completed questionnaires before and after the program. RESULTS: The results showed that the strategy of combining the smoking cessation program and an IAI program was highly effective in terms of effects upon the youth's attitude towards smoking, smoking behavior, and self-efficacy. There was a highly positive correlation between the participants' attitude toward smoking and self-efficacy. In contrast, cigarette consumption was in a strongly negative correlation with self-efficacy. CONCLUSION: Most of all participants in the experimental group recognized the effectiveness of the program, and thought the smoking cessation program with an IAI program was helpful and welcomed by youth. This study can serve as reference for future design and implementation of IAI programs for youth smoking cessation.

Adolescent↗