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PubMed2002

A Domestic Violence Screening Program in a public health department.

Domestic Violence (DV) is a public health problem with far-reaching effects for society. Local public health departments typically serve high-risk populations and have a unique opportunity to provide routine DV screening to all clients receiving services. This project piloted a DV screening program in the family planning clinic of a local public health department. Two interventions were required; the first was a 2-hr inservice program for family planning clinic staff. The second intervention consisted of development and implementation of the screening program. A comprehensive DV curriculum was developed and carried out at an inservice prior to the implementation of the screening program. Screening was evaluated over a 4-week period in the health department. Of the 182 women who were screened for DV, 21 (11.5%) screened positive for DV.

Ambulatory Care Facilities↗
PubMed2002

Primary care reform. Physicians' participation in Hamilton-Wentworth.

OBJECTIVE: To determine physicians' reasons for and against participating in a primary care reform (PCR) pilot project, to identify demographic and practice characteristics associated with participation, to gauge physicians' satisfaction with implementation of the project, and to seek suggestions for change. DESIGN: Cross-sectional mailed survey using a self-administered questionnaire. SETTING: Family practices in Hamilton-Wentworth, Ont. PARTICIPANTS: Eighty-two of 107 (76.6%) physicians who participated in the pilot project and 101 of 150 (67.3% of a 60% random sample of the area's remaining generalist physicians) who chose not to participate. MAIN OUTCOME MEASURES: Physicians' primary and secondary motives for participating or not; comments on the pilot project; and subjects' demographic, professional, and practice characteristics. RESULTS: Despite their experience with capitation practice, after controlling for other factors, physicians from health service organizations were no more likely than their fee-for-service colleagues to join the pilot project. Those in large group practices were more likely to participate. Both participants and non-participants were concerned about disrupting call groups, burdening office staff, not having enough time, and whether the project's objectives were achievable. Other key findings were how few patients declined enrolment and how many physicians had unrealistic ideas about the demands of participation and the capabilities of currently available information technology. CONCLUSION: While many Hamilton-area physicians were eligible and willing to participate in a PCR pilot project, many were not. Our findings suggest that physicians and government should clarify their expectations for PCR and that we need to look for better ways to register patients and select information technology for PCR.

Adult↗
PubMedDate not supplied

Evaluation of California's statewide implementation of enhanced perinatal services as Medicaid benefits.

The authors evaluated enhanced perinatal services developed by public health specialists that were implemented statewide through specially certified Medicaid providers to find out whether they were as effective as those services originally tested in the public health agency's pilot project, and more effective than services from regular Medicaid providers. Multivariate logistic regression analyses yielded adjusted odds ratios of use of care and health outcome measures for the statewide services compared with both the pilot project and routine Medicaid care. Although women receiving the enhanced services implemented statewide did not return for prenatal visits as well as those in the pilot project, they did better than women with routine Medicaid providers. Women who kept at least the eight prenatal visits recommended by the Public Health Service in 1989 had risks of low weight births no different from those in the pilot project and significantly better than those for women with at least eight visits with routine Medicaid providers (adjusted odds ratio 0.70 with a 95 percent confidence interval from 0.54 to 0.91). Thus, there is evidence for the efficacy of the services, but additional improvement could be realized through improving the use of care.

California↗
PubMed2003

The map to LOINC project.

We describe a pilot project to standardize local laboratory test names to Logical Observation Identifier Names and Codes (LOINC) at five Indian Health Service (IHS) medical facilities. An automated mapping tool was developed to assign LOINC codes. The laboratory test names not mapped to LOINC by the mapping tool were assigned LOINC codes manually. The results achieved matched current benchmarks.

Clinical Laboratory Techniques↗
PubMed2005

A proteomic study of the HUPO Plasma Proteome Project's pilot samples using an accurate mass and time tag strategy.

Characterization of the human blood plasma proteome is critical to the discovery of routinely useful clinical biomarkers. We used an accurate mass and time (AMT) tag strategy with high-resolution mass accuracy cLC-FT-ICR MS to perform a global proteomic analysis of pilot study samples as part of the HUPO Plasma Proteome Project. HUPO reference serum and citrated plasma samples from African Americans, Asian Americans, and Caucasian Americans were analyzed, in addition to a Pacific Northwest National Laboratory reference serum and plasma. The AMT tag strategy allowed us to leverage two previously published "shotgun" proteomics experiments to perform global analyses on these samples in triplicate in less than 4 days total analysis time. A total of 722 (22% with multiple peptide identifications) International Protein Index redundant proteins, or 377 protein families by ProteinProphet, were identified over the six individual HUPO serum and plasma samples. The samples yielded a similar number of identified redundant proteins in the plasma samples (average 446 +/- 23) as found in the serum samples (average 440 +/- 20). These proteins were identified by an average of 956 +/- 35 unique peptides in plasma and 930 +/- 11 unique peptides in serum. In addition to this high-throughput analysis, the AMT tag approach was used with a Z-score normalization to compare relative protein abundances. This analysis highlighted both known differences in serum and citrated plasma such as fibrinogens, and reproducible differences in peptide abundances from proteins such as soluble activin receptor-like kinase 7b and glycoprotein m6b. The AMT tag strategy not only improved our sample throughput but also provided a basis for estimated quantitation.

Blood Proteins↗
PubMed1997

Primary care. Failure to achieve take-off.

The Primary Care Act, passed in April, allowed for experimentation with new forms of service delivery and enabled health authorities to commission GP services directly, suspending the national contract. It encouraged HAs, general practices and trusts to submit proposals for pilot projects to improve primary care. More than 500 proposals have been drawn up and the pilot projects are meant to go live on 1 April 1988. But progress has been sluggish. Many HAs are struggling to sustain enthusiasm for pilot projects, and GPs are divided.

Contract Services↗
PubMed1999

Scaling the quality of clinical audit projects: a pilot study.

OBJECTIVE: To pilot the development of a scale measuring the quality of audit projects through audit project reports. DESIGN: Statements about clinical audit projects were selected from existing instruments, assessing the quality of clinical audit projects, to form a Likert scale. SETTING: The audit facilitators were based in Scottish health boards and trusts. STUDY PARTICIPANTS: The participants were audit facilitators known to have over 2 years experience of supporting clinical audit. The response at first test was 11 out of 14 and at the second test it was 27 out of 46. INTERVENTIONS: The draft scale was tested by 27 audit facilitators who expressed their strength of agreement or disagreement with each statement for three reports. MAIN OUTCOME MEASURES: Validity was assessed by test-re-test, item-total, and total-global indicator correlations. RESULTS: Of the 20 statements, 15 had satisfactory correlations with scale totals. Scale totals had good correlations with global indicators. Test-re-test correlation was modest. CONCLUSIONS: The wide range of responses means further research is needed to measure the consistency of audit facilitators' interpretations, perhaps comparing a trained group with an untrained group. There may be a need for a separate scale for reaudits. Educational impact is distinct from project impact generally. It may be more meaningful to treat the selection of projects and aims, methodology and impact separately as subscales and take a project profiling approach rather than attempting to produce a global quality index.

Female↗
PubMed2005

Reducing waste and errors: piloting lean principles at Intermountain Healthcare.

BACKGROUND: The Toyota Production System (TPS), based on industrial engineering principles and operational innovations, is used to achieve waste reduction and efficiency while increasing product quality. Several key tools and principles, adapted to health care, have proved effective in improving hospital operations. TOOLS: Value Stream Maps (VSMs), which represent the key people, material, and information flows required to deliver a product or service, distinguish between value-adding and non-value-adding steps. The one-page Problem-Solving A3 Report guides staff through a rigorous and systematic problem-solving process. PILOT PROJECT at INTERMOUNTAIN HEALTHCARE: In a pilot project, participants made many improvements, ranging from simple changes implemented immediately (for example, heart monitor paper not available when a patient presented with a dysrythmia) to larger projects involving patient or information flow issues across multiple departments. Most of the improvements required little or no investment and reduced significant amounts of wasted time for front-line workers. In one unit, turnaround time for pathologist reports from an anatomical pathology lab was reduced from five to two days. CONCLUSIONS: TPS principles and tools are applicable to an endless variety of processes and work settings in health care and can be used to address critical challenges such as medical errors, escalating costs, and staffing shortages.

Cost Control↗
PubMed1994

Pilot study of the use of the ECFMG clinical competence assessment to provide profiles of clinical competencies of graduates of foreign medical schools for residency directors. Educational Commission for Foreign Medical Graduates.

PURPOSE: To conduct the first of a series of pilot projects of the clinical competence assessment (CCA) of the Educational Commission for Foreign Medical Graduates (ECFMG) in order to provide profiles of clinical competencies of graduates of foreign medical schools for residency directors in the United States and for governments and institutions in other countries. METHOD AND RESULTS: In September 1992 the first pilot project of the ECFMG CCA was conducted for a program director who wanted to evaluate ten first-year residents in a midwestern U.S. program. The CCA consists of integrated clinical encounters with ten standardized patients, 60 laser videodisc pictorials, and analysis of test items of previously completed ECFMG certification examinations. Profiles of the following clinical competencies were provided to the program director: data gathering (history and physical examination), interviewing and interpersonal skills, diagnosis and management skills, interpretation of diagnostic and laboratory procedures, written communication of information to the health care team, and spoken-English proficiency. The profiles were provided as individual scores compared with mean scores of a reference group of 525 first-year residents who took the CCA at four U.S. assessment centers, and as percentile scores with a range of one standard error of measurement. CONCLUSION: The individual performance data in this first pilot project were valuable to the program director, who used them to supplement scores on a written examination during the first residency year. The pilot project has shown the ECFMG CCA to be a useful tool for program directors to evaluate applicants and residents who are graduates of foreign medical schools.

Clinical Competence↗
PubMed2003

The cost of slowing the spread of the gypsy moth (Lepidoptera: Lymantriidae).

Beginning in 1992, the Slow The Spread (STS) pilot project was initiated to target gypsy moth (Lymantria dispar L.) spread rate reduction by controlling populations in the transition zone. The project uses intensive monitoring techniques, with pheromone-baited sticky moth traps, to detect low-level populations and target them for eradication. The primary objective of the pilot project was to evaluate the feasibility of using integrated pest management techniques to slow the spread of gypsy moths over a large geographical area. In this study, the cost of STS pilot project activities in 1993-1995 was investigated. A cost accounting system was developed and used as a framework to collect the cost data and to investigate cost patterns and characteristics. Total expenditures of STS activities for 1993-1995 were 7,685.2 million dollars. Per unit cost was 49.67 dollars per trap with the direct cost component being 35.03 dollars per trap. Trapper labor and vehicle expense accounted for approximately 90% of this direct cost. Per unit cost for treatment activities was found to average 27.86 dollars per treated acre. In general, the STS pilot project is labor intensive, specifically the trapping component. From 1993-1995, 59% of total project expenditures were spent on trapping activities, 28% on pesticide treatments, and 13% on data management. A trapper productivity rate regression model is described.

Animals↗
PubMed1994

Expanding M NET: lessons from the development of a referring physician computer network.

M NET, the University of Michigan Medical Center's statewide referring physician computer network, was implemented as a pilot project in 1990. After three years of design, development and implementation, M NET has progressed from its pilot project status to a production system within the institution's strategic plan for hospital networking. This paper describes the evolution of M NET from a small pilot project to its current production status encompassing all clinical departments and hundreds of physicians across the state. The lessons learned from the pilot, the requirements of both the referring physicians and the Medical Center, and the development of a flexible and robust network architecture to allow network expansion are addressed.

Academic Medical Centers↗
PubMed1999

Can Flemish women in semi-rural areas be motivated to attend organized breast cancer screening?

BACKGROUND: The implementation of organized breast cancer screening in Flanders was prepared by means of pilot projects within a multicenter study. In the semi-rural district of Kontich (Province of Antwerp, Flanders) a pilot project was performed using a mobile screening unit. Compared to international standards, the attendance rate for this pilot project (i.e. 34%) was low. Non-organized screening, which already exists in Flanders, at least partly explains this low attendance rate for the organized screening. The main purpose of our study was to investigate the experience of the pilot target group with respect to the organized breast cancer screening in the district of Kontich, in order to maximize the conditions for a high attendance rate in the organized breast cancer screening programme throughout Flanders. METHODS: With a random numbers procedure, performed by the computer, 500 women were selected among those who were invited to the first screening round of the breast cancer screening programme in the district of Kontich (n = 6,897). These 500 randomly selected women were asked to cooperate with a face-to-face interview. The questionnaire used dealt with the different aspects of the organized mammographic screening which were expected to influence the decision to attend. RESULTS: There were 348 women who responded to the questionnaire (69.6%): 138 of them were attenders and 210 were non-attenders at the organized breast cancer screening. Attenders and non-attenders at the organized breast cancer screening in the district of Kontich had different views about various aspects of the screening programme. The percentages of those who thought that an item was important or very important to them, were for the 138 attenders and the 210 non-attenders respectively: "to receive a personal invitation letter": 90.6 vs. 48.1% (p < 0.05); "a preliminary visit to the GP": 9.4 vs. 34.3% (p < 0.05); "possibility of examination outside business hours": 15.9 vs. 30.0% (p < 0.05). CONCLUSIONS: Although the putting into action of a mobile unit in the semi-rural area of the district of Kontich was productive, the attendance rate was still too low compared to international standards. To increase the attendance rate, the following interventions should be considered: devising the personal invitation letter in a more attractive way, activating and stimulating the important motivational role of the GP in persuading women to attend the organized screening programme and offering the invited population the possibility to have a mammographic examination performed outside business hours. Appropriate measures are being explored.

Aged↗
PubMed1988

Design of a pilot study of glaucoma in Barbados.

In Barbados, West Indies, open-angle glaucoma is a major cause of blindness, presenting early and with advanced visual loss. This report describes the design of a pilot project that evaluated the feasibility of an epidemiologic study to measure glaucoma prevalence and ascertain risk factors in this population. A major goal of the pilot project was to test the proposed sampling and recruitment methods for the larger study. The pilot project identified a random national sample of 300 persons ≥ 35 years, 100 from each of three geographic strata, who were invited to participate in a comprehensive interview and ophthalmologic examination. Because the pilot study was still ongoing at the time of this report, data are available only on the first 172 persons in the sample; 88 percent of those contacted were eligible for the study and 97 percent agreed to participate without any differential participation by geographic area. Preliminary data on the first 170 persons examined show that 20 to 25 percent of participants had best corrected visual acuity of 20/40 or worse; about 10 percent had intraocular pressure >21 mmHg; over 20 percent had cup-disc ratios of ≥0.5; and ten persons had open-angle glaucoma.

Adult↗
PubMed2000

A meta-analytic approach to growth curve analysis.

A meta-analytic approach to growth curve analysis is described and illustrated by applying it to the evaluation of the Arizona Pilot Project, an experimental project for financing the treatment of the severely mentally ill. In this approach to longitudinal data analysis, each individual subject for which repeated measures are obtained is initially treated as a separate case study for analysis. This approach has at least two distinct advantages. First, it does not assume a balanced design (equal numbers of repeated observations) across all subjects; to accommodate a variable number of observations for each subject, individual growth curve parameters are differentially weighted by the number of repeated measures on which they are based. Second, it does not assume homogeneity of treatment effects (equal slopes) across all subjects. Individual differences in growth curve parameters representing potentially unequal developmental rates through time are explicitly modeled. A meta-analytic approach to growth curve analysis may be the optimal analytical strategy for longitudinal studies where either (1) a balanced design is not feasible or (2) an assumption of homogeneity of treatment effects across all individuals is theoretically indefensible. In our evaluation of the Arizona Pilot Project, individual growth curve parameters were obtained for each of the 13 rationally derived subscales of the New York Functional Assessment Survey, over time, by linear regression analysis. The slopes, intercepts, and residuals obtained for each individual were then subjected to meta-analytic causal modeling. Using factor analytic models and then general linear models for the latent constructs, the growth curve parameters of all individuals were systematically related to each other via common factors and predicted based on hypothesized exogenous causal factors. The same two highly correlated common factors were found for all three growth curve parameters analyzed, a general psychological factor and a general functional factor. The factor patterns were found to be nearly identical across the separate analyses of individual intercepts, slopes, and residuals. Direct effects on the unique factors of each subscale of the New York Functional Assessment Survey were tested for each growth curve parameter by including the common factors as hierarchically prior predictors in the structural model for each of the indicator variables, thus statistically controlling for any indirect effect produced on the indicator through the common factors. The exogenous predictors modeled were theoretically specified orthogonal contrasts for Method of Payment (comparing Arizona Pilot Project treatment or "capitation" to traditional or "fee-for-service" care as a control), Treatment Administration Site (comparing various locations within treatment or control groups), Pretreatment Assessment (comparing general functional level at intake as assigned by an Outside Assessment Team), and various interactions among these main effects. The intercepts, representing the initial status of individual subjects on both the two common factors and the 13 unique factors of the subscales of the New York Functional Assessment Survey, were found to vary significantly across many of the various different treatment conditions, treatment administration sites, and pretreatment functional levels. This indicated a severe threat to the validity of the originally intended design of the Arizona Pilot Project as a randomized experiment. When the systematic variations were statistically controlled by including intercepts as hierarchically prior predictors in the structural models for slopes, recasting the experiment as a nonequivalent groups design, the effects of the intercepts on the slopes were found to be both statistically significant and substantial in magnitude. (ABSTRACT TRUNCATED)

Capitation Fee↗
PubMedDate not supplied

The Brazelton Neonatal Behavioral Assessment Scale and maternal identity.

PURPOSE: To determine the effect of demonstrating the Brazelton Neonatal Behavioral Assessment Scale (NBAS) on the development of a maternal identity. DESIGN: Quasiexperimental design with matched groups. METHODS: As part of a larger longitudinal study examining maternal identity, pregnant women were recruited during prenatal classes or routine obstetrical visits; they then completed questionnaires assessing demographic, psychosocial, and maternal identity variables. All women were visited in the hospital after delivery. Three weeks after delivery, the women completed a questionnaire packet assessing demographic, psychosocial, maternal identity, and infant variables. Demonstration of the NBAS in the hospital after delivery was included as a pilot project within the larger study. For the pilot project, 22 women who received a demonstration of the NBAS were matched on age, parity, and socioeconomic status with 22 women from the larger study who did not receive the demonstration. RESULTS: No significant differences between groups were noted on any prenatal or postnatal psychosocial or maternal identity variables. However, women who received a demonstration of the NBAS found their infants to be significantly more predictable than infants of women in the control group. CLINICAL IMPLICATIONS: Demonstration of the NBAS had little effect on the development of a maternal identity in the women studied. However, the NBAS was a useful teaching tool for helping mothers anticipate their infants' responses to environmental stimuli. Further research is needed in this area.

Adult↗
PubMed1998

Telemedicine and developing countries. A report of study group 2 of the ITU Development Sector.

While there are significant potential advantages and benefits from telemedicine, the evidence of its cost-effectiveness and sustainability is meagre. This is because much of the telemedicine activity so far has been in the form of pilot projects of demonstrations in universities and hospitals with subsidized funding from government or other sources. The number of self-sustaining, commercial applications of telemedicine is still very small. Telemedicine undoubtedly yields cost savings in certain circumstances, but often the savings and benefits accrue to those who do not have to pay for the service. Thus, few service providers have found a way to recover their costs (and make a profit) from those to whom they provide their service. Even fewer countries have actually budgeted for the provision of telemedicine as a service widely available to their citizens. Nevertheless, with the rapidly declining cost in hardware and telecommunications, the level of interest and the corresponding activity in telemedicine is rising rapidly. Most of the telemedicine experience to date has been in the industrialized world. It is apparent that the first requirement of developing countries is for more information about telemedicine, what it is, and how it might be able to help solve some of the shortages in medical and health care. Given the potential of telemedicine to facilitate the provision of medical information and health care in rural areas, it seems useful for developing countries to undertake pilot projects in order to evaluate its potential and cost-benefits. The results of such pilot projects could be part of the development of a national health for all policy which takes telemedicine into account. In view of the other priorities of developing countries, especially those of the least developed countries, financing telemedicine activity is likely to remain a challenge for some time to come. Funding from external donor agencies may well be necessary, but local commitment and participation in pilot projects is essential if the project is to have a chance of success. As telemedicine requires a multidisciplinary approach, the active participation of telecommunication operators must be assured. Despite some false starts in the deployment of telemedicine as a continuing service to the general population--as opposed to a few well-to-do clients--telemedicine has great potential to improve access to health care and to contain costs in developing countries.

Computer Communication Networks↗