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Results for “Program Sustainability”

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At least 19 recordsLinked to original sources
PubMedDate not supplied

Organizational characteristics of successful innovative health care programs sustained over time.

Sustaining a successful program over times is critical in today's rapidly changing health care environment. This study sought to identify the characteristics of organizations that implemented innovative health programs for older adults and sustained those programs over time. The Gerontological Health Section of the American Public Health Association created an award in 1998, endowed by the Archstone Foundation, to recognize innovative programs providing health and related social support services to older adults. The 20 award winners were interviewed in Fall 2002, using a structured questionnaire based on the conceptual model for sustainability articulated by Shediac-Rizkallah and Bone. The findings provided insights into the importance of leadership, financing, organizational structure, governance, marketing, and evaluation/research.

Aged↗
PubMed1998

Medicare program; sustainable growth rate for fiscal year 1999--HCFA. Notice with comment period.

This notice announces the fiscal year 1999 sustainable growth rate (SGR) for expenditures for physicians' services under the Medicare Supplementary Medical Insurance (Part B) program as required by section 1848(f) of the Social Security Act. The SGR for fiscal year 1999 is -0.3 percent. The negative fiscal year 1999 SGR is driven by the projected drop in Medicare fee-for-service enrollment.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1994

Effect of a sustained program of resistance training on the acute growth hormone response to resistance exercise in older adults.

We have previously shown that an episode of resistance exercise provokes an acute rise in circulating growth hormone (GH), and that this rise is severely blunted in older men and women. To determine whether this impairment simply reflects the decreased physical fitness of older people, we studied the effects of long-term resistance training on circulating levels of GH and insulin-like growth factor I (IGF-I) and on the acute GH response to exercise in 5 men and 9 women, aged 69.6 +/- 1.1 yrs (SEM). Subjects were randomly assigned to either an exercise program, consisting of 12 weight-lifting exercises (3 sets of 8 repetitions, 3 times each week) or to a control group. After testing maximum baseline strength by the 1 RM method, subjects returned to the laboratory for assessment of basal GH and IGF-I levels and the GH response to exercise. Venous blood was drawn at baseline, after each of 12 exercises (3 sets of 8 repetitions at 85% 1 RM), and every 2 minutes into the first 10 minutes of recovery. The exercise circuit with blood sampling was repeated at 15, 30 and 52 weeks for both groups. Basal GH and IGF-I values did not change in either group throughout the training period nor did the GH secretory response to exercise. Three exercisers had a peak GH concentration greater than 8 micrograms/l after 30 weeks of training, although only one of these showed a significant increase (29 micrograms/l) after 52 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

A school reentry program for burned children. Part I: Development and implementation of a school reentry program.

Sustaining a burn injury is a devastating and painful experience. After acute concerns have been dealt with, continued support of the child and family is important in achieving a smooth return to normal activities. Reports from burned patients for whom physical therapy was a concern identified a need for physical therapy involvement in school reentry to facilitate a resumption of normal school routine. Physical therapy involvement in school reentry has been successful and rewarding with a reasonable commitment of manpower. Utilization of personnel in the administrative structure of state and local school systems promoted the acceptance of the program by local school personnel. Although this program is designed to meet the needs of burned children, the goals of the school reentry program may meet similar needs of children with other chronic illnesses.

Adolescent↗
PubMed1999

[Implementation of an individualized program of sustained development in neonatal intensive care: why, how?].

The Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) is based upon a behavioral observation of the premature newborn. The information is used for suggesting individualized caregiving and environmental changes. The role of the parents in supporting the development is reinforced. This program appears to reduce ventilation, artificial feeding and hospitalization stay length, and is also found to improve neurobehavioral maturation. Its setting in a neonatal intensive care unit implies a collective reflective process and staff education.

Child Development↗
PubMed2003

A framework for understanding "evidence" in prevention research and programs.

This report provides a multidimensional framework for understanding the meaning of evidence in prevention science. Six themes comprise the framework, each with impact on the meaning of evidence. (1) There are rigorous prevention scientific strategies now in use; each has shared but also unique requirements for the meaning of evidence. Some are directed at individuals, others at small social contexts, others at larger societal structures. (2) The phases of prevention research have shared but also unique requirements for evidence. These include efficacy, effectiveness, sustainability, going-to-scale, and sustaining programs systemwide. (3) Prevention programs address different segments of the population defined by levels of risk: the total population; a smaller subpopulation at increased risk; or a still smaller subpopulation at very high risk. The levels influence the meaning of evidence. (4) Economic analysis and economic evidence must become a central part of prevention research. These are needed for appropriate policy decision making and for assessing long-term benefits. (5) Collaboration is required for rigor in prevention research: including researchers, but also policy makers, program advocates and leaders, and community and institutional leaders. Broad ownership is critical for implementing rigorous research and for sustaining program fidelity. (6) Acceptance of a multidimensional framework for understanding "evidence" is essential across those agencies and institutions that carry out and/or use prevention science. The more widely the vision of the prevention field is shared, and the more the various qualities and rules of evidence are accepted and implemented, the better the quality will be of prevention research and programs.

Evidence-Based Medicine↗
PubMed1998

Alberta's Rural Physician Action Plan: an integrated approach to education, recruitment and retention.

This paper describes the development and characteristics of a comprehensive, integrated and sustained program for the education, recruitment and retention of physicians for rural practice in Alberta--the Rural Physician Action Plan. The participation of key stakeholders (including government, the provincial medical association, the licensing authority, faculties of medicine, practising rural physicians and regional health authorities) and a sustained program budget have been key organizational issues for success. Critical to the effectiveness of this program has been the focus on professional and lifestyle issues targeting 3 distinct groups: physicians in training, physicians in practice, and rural communities and health authorities. Substantial program funding since 1991-92 of up to $3 million per year has increased rural-based activities significantly. For example, 87% of medical students and 91% of residents in family medicine in Alberta now experience 4 weeks or more of rural practice. The authors believe that the historic issues and recent trends militating against recruitment and retention of rural physicians will continue unchecked without comprehensive and sustained approaches such as Alberta's Rural Physician Action Plan.

Alberta↗
PubMed2026

Delphi study robot consenso: Strategies for the implementation of robotic surgery in general surgery in the Spanish hospital network.

INTRODUCTION: The implementation of robotic surgery in public hospitals presents multiple logistical, educational, and organizational challenges. In the absence of unified guidelines, a national consensus is required to optimize its safe and efficient adoption. This study aimed to establish a set of consensus-based and measurable recommendations for the implementation of robotic surgery programs in hospitals within the Spanish National Health System, based on the experience of centres with established robotic programs and intended to serve as guidance for hospitals that are initiating or planning their implementation. METHODS: A national Delphi study was conducted with the participation of robotic surgery experts from 26 public hospitals. The expert panel was composed exclusively of digestive surgeons with experience in robotic surgery. Three iterative rounds of expert panel evaluation were conducted between March 2024 and March 2025. The questions were grouped into five thematic blocks. Consensus was defined as an agreement level of ≥66.7%. Kendall's W coefficient was used to assess concordance. RESULTS: High levels of consensus were achieved on key aspects related to infrastructure, structured training, cost evaluation, and quality assurance mechanisms. Areas of disagreement were also identified, such as the need for a dedicated anaesthesiologist, purchase of accessory instruments during the initial phase, and official accreditation pathways. CONCLUSIONS: This study provides a guideline for developing a national robotic surgery strategy focused on patient safety, program sustainability, and standardized training of surgical teams. These recommendations can guide hospitals at different stages of robotic technology adoption. Given that the consensus was reached from an exclusively surgical perspective, the recommendations focus on patient safety, program sustainability, and standardized training of the surgical team, and should be interpreted in an adaptable manner according to each centre's context, case volume, and available resources.

Cirugía Asistida por Robot↗
PubMed1999

[Optimized programming of sustained rate duration in patients with implantable cardioverter-defibrillators and diagnosed atrial fibrillation].

The discrimination of supraventricular versus ventricular tachycardias by an implantable cardioverter-defibrillator (ICD) is still a remaining clinical problem. The false positive detection of supraventricular as ventricular tachycardias causes inadequate electrical therapies of the ICD. To improve the increase of specificity criterias like "Onset" or "Stability" are offered. If these criterias during tachycardia are not fulfilled, the "sustained rate duration" (SRD) is offered as a security criterion. The SRD reasons the delivery of the therapy during tachycardia after a programmable time. Aim of the study was to evaluate, if SRD in patients with known arrhythmia absoluta (AA) in atrial fibrillation and programmed "Onset"/"Stability" increases the sensitivity without loss of specificity in the treatment of hemodynamically tolerated ventricular tachycardias and which programming should be chosen. Our patient collective included 274 patients (pts) with new implanted ICD of the third generation. In 39 (14%) pts AA was known in the medical history. From these 39 (100%) pts, 18 (46%) pts had known tachyarrhythmic episodes (group I) in the area of the ventricular tachycardia-zone > or = 160 beats per minute, whereas in 21 (54%) pts a tachyarrhythmia absoluta (TAA) was unknown (group II). During follow-up of 12 +/- 8 (2-26) months, 151 tachycardias occurred and could be classified as supraventricular tachycardias by stored electrograms. In 9/18 pts of group I, a TAA occurred during follow-up. The initial programmed SRD during first TAA was 62 +/- 39 (35-90) s and was prolonged to 135 +/- 64 (90-180) s. After this prolongation, no inadequate therapy was delivered. In group II, 19/21 (90%) were inadequately treated during TAA. The initial SRD-programming was 45 +/- 28 (0-90) s and was prolonged to 201 +/- 150 (60-480) s during follow-up. After prolongation of the SRD, no more inadequate therapies due to AA were delivered. In pts with new implanted ICD and known TAA, which is hemodynamically tolerated, the SRD should be programmed beside all other available detection parameters for improving the increase of specificity at least 135 s to avoid inadequate therapies of the ICD. In pts with unknown TAA, SRD should be prolonged to 135 s at least the second tachyarrhythmic episode, which is hemodynamically well tolerated.

Adolescent↗
PubMedDate not supplied

Effects of a health promotion program on sustaining health behaviors in older adults.

BACKGROUND: Controversy exists regarding the optimal way to provide health promotion education to the elderly. This prospective randomized study evaluated the effectiveness of individualized assessment and counseling coupled with the receipt of a written health plan on client adherence to health behavior recommendations. METHODS: Two hundred thirty-seven ethnically diverse and predominantly low-income adults 60 and older, participating for the first time in an established statewide public health prevention program delivered in both rural and urban clinics, were recruited and randomly assigned to treatment and control groups. All participants received a standardized assessment that included a health history, nutrition assessment, and limited physical exam from a public health nurse. The treatment group additionally received a written personal health plan and individualized counseling to support implementation of the plan. Both groups were interviewed after one year to determine their adherence to the original recommendations. RESULTS: Seventeen preventive services and health behaviors were evaluated. There were no statistically significant differences between the groups on health care use and previous health behaviors at baseline. Using logistic regression and controlling for socioeconomic and demographic variables, we found that the treatment group that received a personal health plan and counseling completed significantly more preventive referrals and health behavior changes (P < .001). CONCLUSIONS: A client-centered planning process with supportive counseling by public health nurses, combined with health plans provided to clients, can significantly increase the prevention measures taken by older adults.

Aged↗
PubMed2003

New Moves: a school-based obesity prevention program for adolescent girls.

BACKGROUND: This study tests the feasibility of an innovative school-based program for obesity prevention among adolescent girls. New Moves was implemented as a multicomponent, girls-only, high-school physical education class. METHODS: Six schools were equally randomized into intervention and control conditions. Data were collected at baseline, postintervention, and 8-month follow-up to assess program impact on physical activity, eating patterns, self-perceptions, and body mass index (BMI) among 89 girls in the intervention and 112 girls in the control conditions. Program evaluation also included interviews with school staff, parent surveys, and participant interviews and process evaluation surveys. RESULTS: The feasibility of implementing New Moves was high, as indicated by strong satisfaction among participants, parents, and school staff, and by program sustainability. Participants perceived a positive program impact on their physical activity, eating patterns, and self-image. Girls in the intervention significantly progressed in their stage of behavioral change for physical activity from baseline to follow-up. However, for the majority of outcome variables, differences between intervention and control schools at postintervention and follow-up were not statistically significant. CONCLUSIONS: New Moves was well received and fills a needed niche within school physical education programs. An expanded intervention and evaluation is needed to enhance and assess long-term program effectiveness.

Adolescent↗
PubMed1997

Pesticide use, exposure, and risk: A joint Israeli-Palestinian perspective.

The major predictors of health risk from pesticide exposure are quantity and toxicity of pesticides reaching end-users, field workers, and persons (including children) with casual and indirect exposures to field and food residues, drift, and contaminated groundwater. Past work in Israel and the Palestinian National Authority has documented risks for acute poisoning, daily illness, transient neurotoxic effects, and potential cancer hazards in workers, populations exposed to pesticide drift, and the general population. Risk assessment predicts that reduction in use of agents with high toxicity and pesticide substitution are desired strategies for achieving the largest reductions in risk, but successful implementation and program sustainability depend on maintaining crop yield and increasing farmer earnings. A joint pilot Israeli-Palestinian-NGO program aims to determine whether crop yields and profits can be sustained while reducing pesticide use, promoting integrated pest management, and restricting ecosystem damage. The project involves six components: (1) assessments of health risk and crop yield in relation to pesticide use and exposure; (2) training health-agricultural teams to introduce and evaluate crop growth and managements with reduced pesticide use; (3) tracing and stopping import and trade in banned or restricted pesticides; (4) restricting child labor; (5) promoting information delivery and worker and community right-to-know and right-to-act; and (6) establishing a uniform regional standard for protection of workers and the general public. Preliminary evidence (organochlorines and breast cancer, organophosphates and illness in field workers) indicates that (1) a reduction of use is the foremost determinant of a reduction in health risk; (2) cotton yield can be increased despite a reduction in pesticide use (organophosphates); and (3) a reduction in pesticide use (organophosphates and organochlorines) has to be part of a crop rotation program for food crops timed to seasonal fluctuations in supply, demand, and crop price.

Agricultural Workers' Diseases↗
PubMed2000

Future prospects of voluntary health insurance in Thailand.

Voluntary health insurance schemes in Thailand are still under development and have yet to seriously address the questions of equity and efficiency, while private health insurance is limited to people who can afford the premium. One form of insurance, commonly known as the health insurance card scheme, was first introduced as the Health Card Program in 1983. This program is based on risk sharing of health expenditures, with no cost sharing, in a voluntary health insurance prepayment scheme. With the uncertain performance of the Thai economy, program sustainability and the efficient use of resources are major concerns. The Health Card Program needs enough enrollees to ensure a sufficient pool of risks. This study looks at health card purchase and utilization patterns, using data from Khon Kaen Province, and finds that employment, education levels and the presence of illness are significant factors influencing card purchase. The last factor is related to the problem of adverse selection of the program; families with symptoms of sickness are more likely to buy cards, resulting in greater use of health services. The results also show an improvement in accessibility to health care and a high level of satisfaction among card holders, both key objectives of the program. It is suggested that changes in the health card system could enable it to evolve into a community-based compulsory health insurance scheme for rural areas.

Adolescent↗