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[Combined outpatient alcoholism therapy and occupational rehabilitation on welfare recipients--results of a pilot study].

This study tested the feasibility of outpatient abstinence treatment among alcohol dependent subjects on welfare. Patients had a long history of alcohol dependence and prolonged unemployment. Over a period of six months a total of 250 patients were approached by the social welfare office and asked to participate in the program. The program involved detoxification and a three month combined alcohol treatment and personal job training. Of the 250 persons approached 96 patients (about 40 %) appeared for the initial examination, 19 patients (13 %) finished detoxification and a total of 5 patients completed the program. The majority of a group of patients considered to be highly therapy resistant did not complete the program. Still it was important to demonstrate that a subgroup of patients did successfully complete this program. We consider this pilot project a successful starting point for further development of treatment approaches targeted more specifically at this group of patients.

Adult↗

A sports medicine clinic in the community.

We report the attempt to set up a mini sports medicine clinic in a health centre resourced by a Department of Community Medicine. The type of problems seen are similar to those reported by other clinics. On the results of this pilot project, we believe it would be possible to establish similar clinics in health centres elsewhere in the United Kingdom. The National Health Service resources required are minimal, but the benefits to local communities are considerable.

Adolescent↗

The role of telecare in the management of exacerbations of chronic obstructive pulmonary disease in the home.

We examined home care as an alternative to hospital admission in exacerbations of chronic obstructive pulmonary disease (COPD). We performed a pilot study to investigate the feasibility of using telecommunications technology to assist in the support of acutely ill patients with exacerbations of COPD at home. Realtime, interactive video, via an analogue video-phone, was used to allow patients in their own homes to obtain nursing support from a nurse located at a distant base station. Six individuals, four male and two female, had video-phones installed in their homes by members of the nursing intervention team. The age range was 52-72 years, mean 61.5. These patients used the system on 18 occasions. Experience in home telecare, via interactive video, has been limited to provision of ongoing support for relatively stable individuals with chronic illness. This pilot project represents the first attempt at providing home telecare in the UK to those experiencing an acute exacerbation of their chronic illness, who would otherwise have merited acute hospital admission.

Acute Disease↗

HEDIS (Health Employer Data and Information Set): are we finally comparing apples to apples?

The release of HEDIS 2.0 late last year was a milestone in the movement towards quality measurement of health plans. The pilot project to produce a credible report card that is comparable among health plans is already underway. Will HEDIS 2.0 finally give employers what they desperately need--a reliable measurement tool on which to base health plan decision making?

Community Participation↗

Nursing student information network: fostering collegial communications using a computer conference.

This article describes the development and implementation of a student-based computer information network in a university setting. A computer conference was established as a pilot project on two campuses in a large multipurpose, multicampus university school of nursing, and it was used to communicate information and facilitate collegial interaction among students, faculty, academic counselors, and administrators. The project demonstrates that computer conferences can be used to disseminate information effectively to diverse and geographically distant student populations. Such networks have the potential to enhance opportunities for collaborative learning experiences and student-faculty communication.

Communication↗

The pilot Stroke Data Bank: definition, design, and data.

Four university centers collaborated to contribute 1158 patients with acute episodes of cerebrovascular disease to the pilot Stroke Data Bank, initiated by NINCDS in 1978. During the pilot project a standard set of data collection forms were developed and used at each of the collaborating centers. Data on clinical course, laboratory findings, therapy and outcome were gathered prospectively throughout the patient's hospitalization and at specified follow-up intervals. Using operational definitions of stroke sub-types, consecutive cases were systematically allocated to specific categories of brain and vascular pathology. The definitions were based on clinical criteria as well as on laboratory data, including computerized tomography (CT), and angiography findings. This paper describes the pilot Stroke Data Bank and presents the distribution of cases by diagnostic and demographic categories. It represents one of the largest series of prospectively collected stroke cases studied by CT (90% of the cases) and angiography (42%). Based upon the methods and processes of this pilot study, a main phase of the Stroke Data Bank has been established to address a number of questions pertaining to stroke classification, evolution, diagnosis, and prognosis.

Adult↗

Accuracy of diagnostic information submitted to an insurance company.

Findings from two studies of the utilization of the mental health benefit under the Washington, D.C., area Blue Cross and Blue Shield Federal Employees Program suggest that diagnostic information submitted to insurance companies on claims forms is often inaccurate and therefore of little use for claims or peer review. The authors conclude that inaccurate information is submitted primarily because of legitimate concerns about patient confidentially. The urge that special claims and peer review procedures be developed to assure confidentiality of sensitive clinical information. A pilot project developed by the Washington Psychiatric Society and Blue Cross and Blue Shield is offered as an example of the kinds of systems that need to be devised.

Blue Cross Blue Shield Insurance Plans↗

The alternate program; an alternative for chronic care.

This paper describes a 2 1/2 year pilot project for long term schizophrenic patients. It describes the kind of patients involved, the program itself, the role of the staff, the results and finally the therapist's reflections working with chronic patients for long periods of time.

Chronic Disease↗

An academic-business partnership for advancing clinical informatics.

A jointly funded partnership between the school of nursing at a large midwestern university and a premier health care information technology supplier represents a pioneering event for education and for the health care information technology industry. The impetus for this partnership arose from Institute of Medicine reports published in late 1999 and early 2001 addressing the quality, error, and waste in the health care system in the United States. The Simulated E-hEalth Delivery System (SEEDS) provides opportunities based on best practices in education to learn and practice clinical skills in a state-of-the-art environment using a live-production, clinical information system designed for care delivery. A pilot project that began with a small cohort of baccalaureate nursing students has been implemented and extended. SEEDS will also be extended to other health professional programs.

Clinical Competence↗

Is telehealth the right tool for remote communities? Improving health status in rural Australia.

The health status of people in rural and remote areas, particularly of Indigenous Australians, has been widely reported to be poorer than their urban counterparts. Health care in rural and remote Australia has relied on the work of nurses, often in the absence of medical or allied health personnel other than via telecommunication. Over the last 5 years telehealth has been heavily promoted as an innovative and effective way of improving the health status of people in rural and remote areas by providing improved access to specialist care. Through national infrastructure development and funding for a vast array of pilot projects, telehealth provision has been promoted as progressive, effective, and modern. This Editorial reviews the literature and highlights a need for additional research around telehealth-mediated patient practitioner relationships.

Australia↗

Perceptions of quality of care in a minority population: a pilot study.

Mexican-American patients' perceptions of quality related to the care delivered by health care providers were explored. The review of literature demonstrated that a great volume of work has been done regarding patient satisfaction; however, very few reports of application of this type of research to the Mexican-American population exist. This pilot project attempted to relate the concepts of perception, satisfaction, and quality. Observations occurred in two hospitals with distinctly different patient populations, and results indicated a need to repeat this study with a much larger sample.

Adult↗

Coordinated care for the neuroscience patient: future directions.

A coordinated care model was developed on a neuroscience unit to achieve positive outcomes in a cost-effective environment. This included the development of a patient care coordinator (PCC) role, critical paths and a system for variance tracking. The PCC was responsible for coordinating care of patients and ensuring that patients progressed toward expected outcomes. Multidisciplinary critical paths were developed for four medical diagnoses. To evaluate the effectiveness of the program, an analysis of length of stay data, cost comparison, patient and staff satisfaction, and variance reports of one critical path, the microvascular decompression for trigeminal neuralgia were completed. Results from the pilot project were positive and provided valuable information for the use of coordinated care as a hospital-wide patient care delivery model.

Attitude of Health Personnel↗

Creating health-promoting schools in China with a focus on nutrition.

This pilot project in Zhejiang Province, China, aimed at improving the nutrition and health status of students, school personnel and parents, and developing a model project for nutrition interventions for the development of health-promoting schools (HPS) in China. Three primary and three secondary schools participated. Interventions included establishing school-based working groups, nutrition training for school staff, distribution of materials on nutrition, nutrition education for students, student competitions, school-wide health promotion efforts and outreach to families and communities. Results of a pre- and post-intervention survey one and a half years apart showed improvements in nutrition knowledge, attitudes and behavior among all target groups. Primary school students at the pilot schools made the greatest knowledge gains in the areas of Chinese dietary guidelines (increased from 49.2 to 78.0%, p < 0.01) and adequate dietary principles (increased from 42.9 to 68.0%, p < 0.01). Scores of secondary school students who reported liking school lunches rose at pilot schools from 17.9 to 45.2% (p < 0.01). School staff at control schools who reported taking breakfast declined from 81.4 to 66.6% (p < 0.01), while staff who reported taking lunch at school increased in pilot schools from 87.5% at baseline to 93.9% (p < 0.01). The largest increases in nutrition knowledge among all target groups occurred among parents and guardians. At the pilot schools parents increased their knowledge in the areas of nutritional deficiencies (from 35.0 to 66.2%, p < 0.01) and nutrient-rich foods (from 38.8 to 66.8%, p < 0.01). Talks with target groups confirmed changes in attitudes and behavior, and school visits revealed improvements to school facilities and school health services, establishing of school policies and a positive school climate. This study suggests that nutrition can effectively serve as an entry point to establish HPS in China and that the HPS concept is feasible to improve the dietary knowledge, attitudes and behavior of students, parents and school personnel.

Adolescent↗

Evaluation of a distance consulting service based on interactive video and integrated computerized technology.

Telemedicine equipment was installed at a rural site in Drumheller and at Calgary, 85 miles (136 km) away. It allowed consultation between health-care providers at Drumheller and specialists and subspecialists at the Faculty of Medicine in Calgary. The efficacy of the system in providing more equitable access to health care for persons living in geographically remote sites was evaluated during a 12-month pilot project. Seventy-five encounters were attempted during the study. A total of 55 encounters (42 clinical and 13 non-clinical) were completed. The completed clinical encounters were distributed across a wide spectrum of medical specialties. Users of the system reported favourably on the impact of the telemedicine system on access to health services for rural patients, on diagnostic, investigative and management decisions, on patient and physician travel times, on feelings of professional isolation and educational opportunities and on overall patient health status. The study provides new knowledge and demonstrates the success of the technology in this project. As expected, other problems were raised and addressed in a preliminary manner including: the potential for health-provider education; acquisition and retention of rural physicians; ethical, legal and patient confidentiality issues; minimum acceptable technology; and network management issues.

Canada↗

Family Life Theatre and youth health services.

The Family Life Theatre, integrated into the Youth Health Services of a medical institution in a large urban community, has achieved rather unusual success. After seven years of experience marked by a constant quest for improvements, what was started in 1973 as a very modest health education program, through the medium of improvisational theatre, has now become a pilot project, duplicated by many groups and institutions throughout the country. The experiences of the Family Life Theatre, and its multiple ramifications leading to a comprehensive approach to the adolescent health problems, are presented and analyzed in a public health perspective.

Adolescent↗

Living with mental illness: professional/family collaboration.

What started as a pilot project in the spring of 1990 has matured into a successful ongoing enterprise between professionals and families that continues to meet the needs of families experiencing the impact of mental illness. According to self-administered evaluations completed by those in attendance, and a subjective review by the planning committee, the program was an immediate success. It attained its overall education and mutual support objectives, and fostered successful collaboration between professionals and families. One hundred percent of family participants indicated that they would recommend the workshop to others in similar situations. In managing mental illness through collaborative partnerships, the family must be an integral part of each phase of project development. Family members are the "thermometer," measuring how closely the project is mirroring their needs. Since its inception, 370 people have participated in this dynamic project. This program demonstrates that through understanding, respect, and positive regard, families, friends, and professionals can work collaboratively to enhance the quality of life for all who are victimized by mental illness.

Adaptation, Psychological↗

Experiences from a collaborative project on the prevention of disability in leprosy patients in Shandong Province, the People's Republic of China.

Shandong Province (present population 89 million) in the People's Republic of China established a leprosy control programme in 1955. Between that year and the end of 1999, allowing for death and migration, the cumulative number of cases registered was 53,618, including 120 cases on multiple drug therapy (MDT) and 18,248 who had completed satisfactory courses of dapsone monotherapy and/or MDT. Of this latter group, 9500 cases (52%) suffered from visible disabilities (grade 2 of the WHO classification). Prevalence and incidence rates of leprosy have decreased dramatically since 1955 and, on average, only 50-70 new cases are now being detected annually in the entire province. Leprosy is thus no longer a public health problem, but the existence of such a large number of patients with grade 2 disabilities is clearly a matter of serious concern. This paper describes a pilot project to investigate the potential of health personnel in the leprosy programme and the dermatology and sexually transmitted diseases services to (a) prevent deterioration of existing disabilities in ex-patients through self-care and (b) prevent new neuritis in patients on MDT through early detection and the use of steroids.

Adult↗