Search

By developing a number of measures distinguishing amount, type of content, and when and how that content is used, the current study revealed effective patterns of use that are associated with quality of life benefits during an eHealth intervention. Results generally suggest that the benefits depend on how a patient uses the system, far more than on sheer amount of exposure or even what type of content is chosen. The next generation of eHealth system should focus on providing new and varying content over time, but even more on encouraging intensity of use and long-term commitment to the system., The use of the Internet for health education has reached what many might consider a critical mass. According to the National Cancer Institute's Health Information National Trends Survey (Nelson et [...]

Legendary Ohio State University football coach Woody Hayes once quoted the great Michigan State University coach Duffy Daugherty as saying, 'There are three things that can happen when you pass [...]

Objective. To test the effectiveness of a Bayesian model employing subjective probability estimates for predicting success and failure of health care improvement projects. Data Sources. Experts' subjective assessment data for model development and independent retrospective data on 221 healthcare improvement projects in the United States, Canada, and the Netherlands collected between 1996 and 2000 for validation. Methods. A panel of theoretical and practical experts and literature in organizational change were used to identify factors predicting the outcome of improvement efforts. A Bayesian model was developed to estimate probability of successful change using subjective estimates of likelihood ratios and prior odds elicited from the panel of experts. A subsequent retrospective empirical analysis of change efforts in 198 health care organizations was performed to validate the model. Logistic regression and ROC analysis were used to evaluate the model's performance using three alternative definitions of success. Data Collection. For the model development, experts' subjective assessments were elicited using an integrative group process. For the validation study, a staff person intimately involved in each improvement project responded to a written survey asking questions about model factors and project outcomes. Results. Logistic regression chi-square statistics and areas under the ROC curve demonstrated a high level of model performance in predicting success. Chi-square statistics were significant at the 0.001 level and areas under the ROC curve were greater than 0.84. Conclusions. A subjective Bayesian model was effective in predicting the outcome of actual improvement projects. Additional prospective evaluations as well as testing the impact of this model as an intervention are warranted. Key Words. Organizational change, Bayesian model, improvement, empirical evaluation, This paper describes the development of a short survey instrument and the creation of a companion Bayesian model that uses the survey data to predict the potential for successful implementation [...]

Health care practitioners were asked to identify and rank the obstacles that they are likely to encounter when trying to implement the total quality management (TQM) concept in their respective organizations. Health care professionals believed that the lack of proof that TQM could bring success was the greatest barrier to a successful TQM implementation. The study considered several factors that differentiated success from failure in innovation and improvement. Results of research work on innovations showed support for customer and quality mindedness. Future research work is recommended.

Systems thinking is a fundamental element of quality management and should be a fundamental element of health care reform. An implication of systems thinking is that one aim of health care should be to minimize the total costs of illness, not simply the direct medical expenditures. If we are to continue to improve health care over time, we should measure its impact on the total costs of illness to the patient, family, employer, and society. Thus a system of measurement is needed that quantifies total costs of illness and also suggests how these constituencies can collaborate to improve processes and reduce total costs. This article introduces the total costs of illness concept, contrasts it with societal costs of illness, describes a measurement system we developed to quantify it, and describes a case study examining the total costs of back injury illness to employers. We found that medical expenditures accounted for less than half of the total costs of illness, the average total costs of illness varied by over 350 percent among employers, and a simple metric (days off work) explained 62.5 percent of the variance in total costs of illness., Direct medical costs of an illness or injury comprise less than half of the total costs of that condition. The application of systems thinking to healthcare reform requires that other cost components be measured as well, including indirect costs to employers, patients, families and society. An industry/education research group developed a cost metric that analysed employer medical payouts, nonmedical payouts and lost opportunity costs to come up with total costs associated with back injury. The healthcare industry is encouraged to work with employers to ensure that improvement in the delivery of healthcare also reduces the total costs., 'Systems thinking' (Senge 1990) is one of the most important elements of quality management (QM). In fact, Deming (1989) identified systems thinking as one of the four sources of 'profound [...]

A study was done to evaluate the quality of psychiatric care using a Bayesian index. The Bayesian statistical methodology was patterned to predict a second panel's judgement quality and quality-related patient outcome, give an accurate measurement procedure and identify changes in patterns of emergency department practices. It was shown that the Bayesian quality index is valid and reliable in the determination of the quality of emergency psychiatric care., A primary purpose of emergency medical service systems is to ensure that the needs of the emergency victim are matched with the appropriate form of care, and to do so [...]

This study investigated the role of breast cancer survivors in a computer-mediated social support (CMSS) group for women with breast cancer. Applying a computer-aided content analytic method, the present study examined the differences in support provision between survivors and newly diagnosed patients. This study further investigated the impacts of survivor-provided social support on psychosocial adjustment of newly diagnosed patients. The results revealed that, compared with newly diagnosed patients, breast cancer survivors provided more emotional and informational support. Receiving emotional support from survivors contributed to an improvement in the quality of life and the depression of patients. The effects of survivor-provided informational support were not significant.

Understanding influence networks among substance abuse treatment clinics may speed the diffusion of innovations. The purpose of this study was to describe influence networks in Massachusetts, Michigan, New York, Oregon, and Washington and test two expectations, using social network analysis: (1) Social network measures can identify influential clinics; and (2) Within a network, some weakly connected clinics access out-of-network sources of innovative evidence-based practices and can spread these innovations through the network. A survey of 201 clinics in a parent study on quality improvement provided the data. Network measures and sociograms were obtained from adjacency matrixes created by UCINet. We used regression analysis to determine whether network status relates to clinics' adopting innovations. Findings suggest that influential clinics can be identified and that loosely linked clinics were likely to join the study sooner than more influential clinics but were not more likely to have improved outcomes than other organizations. Findings identify the structure of influence networks for SUD treatment organizations and have mixed results on how those structures impacted diffusion of the intervention under study. Further study is necessary to test whether use of knowledge of the network structure will have an effect on the pace and breadth of dissemination of innovations.

People who grow up with a family member who has a substance use disorder (SUD) are at risk for serious problems, and yet support for family members focuses mainly on the individual with the SUD. Technology may offer a way to make support widely available to family members of those with SUDs. This small randomized trial examined an online system of resources called CHESS (Comprehensive Health Enhancement Support System) for adult children of alcoholics (ACOAs), a population at greater risk for SUDs, depression, and other difficulties than adults whose parents were not alcoholics.

Little is known about the effective elements of Interactive Cancer Communication Systems (ICCSs). A randomized trial explored which types of services of a multifaceted ICCS benefited patients and the nature of the benefit. Women with breast cancer (N=450) were randomized to different types of ICCS services or to a control condition that provided internet access. The Comprehensive Health Enhancement Support System (CHESS), served as the ICCS. ICCS services providing information and support, but not coaching such as cognitive behavior therapy, produced significant benefits in health information competence and emotional processing. Provision of Information and Support ICCS services significantly benefited women with breast cancer. More complex and interactive services designed to train the user had negligible effects.

Interactive computerised support systems (CSS) providing confidential, convenient and logical aids might be useful for crisis people (e.g. AIDS/HIV+) who are isolated from services for geographic, economic, emotional or social reasons. Such interactive systems are usually designed for voluntary and repeated use, and the individual's cognitive styles may be crucial to the success of the system design. This paper first introduces a theoretical framework of cognitive styles and repeated CSS use, then a medical CSS for HIV+/AIDS, and finally an empirical study on the relationships between individual cognitive styles and voluntary computer use over time is discussed.

Severity indices are a key element in evaluation of health programs. But the methodologies used in development of such indices are rarely clearly defined. Moreover, there have been no tests of transportability of the index development methodologies that do exist, so there is no guarantee that panels of physicians convened by different facilitators would produce indices with similar performance characteristics. This paper describes a replicable index development strategy, a heart disease severity index developed by using that methodology, and a test of that methodology's transportability. Key words:severity; utility theory; emer gency medical services; evaluation; multi-attribute utility models. (Med Decis Making 6:27- 35, 1986)

Wepresent a method of constructing quantitative indices, which is based on the subjective opinions of a panel of experts, and discuss how a Bayesian probability model and panel opinions can be used together to produce an index. Among the advantages of the method are its face validity and ease of construction. Research shows that when expert opinions are solicited according to certain guidelines, subjective methods may be as accurate as the more objective ones. Guidelines along with a brief report of a recent application are also discussed.

Under existing federal regulations, it is mandated that the care of all nursing home residents be reviewed annually. A fouryear demonstration project in Wisconsin tested a sampling approach to nursing home resident review. The rationalefor the sampling approach is that one can more effectively identifypervasiveproblems with resident care by an in-depth examination of a sample of residents than by a cursory assessment of all residents. Ifproblems are identified in the sample, all residents can then be reviewed. However, reimbursement for nursing home care is also influenced by level of care and given that nursing home inspectors review the appropriateness of level of care, the issue arises as to what impact a sampling approach would have on reimbursement. This evaluation compares the changes in reimbursement owing to resident review under the sampling and federally mandated, 100% review methods. The results indicate that reviewinga sample of nursing home residents may offer similar reductions in nursing home reimbursement as a 100% resident review-but at a lower cost.

Evaluation of the effectiveness of emergency trauma care systems is complicated by the need to adjust for the widely variable case mix found in trauma patient populations. Several strategies have been advanced to construct the severity indices that can control for these population differences. This article describes a validity and reliability comparison of trauma severity indices developed under three different approaches 1) use of a multi-attribute utility (MAU) model; 2) an actuarial approach relying on empirical data bases; and 3) an “ad hoc” approach. Seven criteria were identified to serve as standards of comparison for four different indices. The study's findings indicate that the index developed using the MAU theory approach associates most closely with physician judgments of trauma severity. When correlated with a morbidity outcome measure, the MAU-based index shows higher levels of agreement than the other indices. The index development approach based on the principles of MAU theory has several advantages and it appears to be a powerful tool in the creation of effective severity indices.

This article describes a general model for setting priorities on proposed R & D projects. It reports on research that evaluates methods for implementing the model. Specifically investigated were techniques for establishing criteria weights, assigning quantitative scales to qualitative criteria and modifying the model to improve its performance. Methods for solving the problem of criteria independence and for estimating probability of project success are proposed, but not tested.

Part I. Describes how redesigning the organizational processes can offer an immediate and controllable path to improving quality of and acess to addiction treatment services.

Reports on the death of U.S. senator and addiction and mental health treatment advocate Paul Wellstone.

The article focuses on the importance of technological development in curing alcohol and drug addiction treatment in the U.S. The Robert Wood Johnson Foundation has envisioned of creating a new system that will reduce the need of human health care providers. The social psychology, robotics industry and other expert have thought of creating a public health booth with the virtual substance abuse counselors. This intends to replace the human counselor.

Background Emotional support has traditionally been conceived as something a breast cancer patient receives. However, this framework may obscure a more complex process, facilitated by the emerging social media environment, which includes the effects of composing and sending messages to others. Accordingly, this study explores the effects of expression and reception of emotional support messages in online groups and the importance of bonding as a mediator influencing the coping strategies of breast cancer patients. Methods Data were collected as part of two National Cancer Institute–funded randomized clinical trials. Eligible subjects were within 2 months of diagnosis of primary breast cancer or recurrence. Expression and reception of emotionally supportive messages were tracked and coded for 237 breast cancer patients. Analysis resulted from merging 1) computer-aided content analysis of discussion posts, 2) action log analysis of system use, and 3) longitudinal survey data. Results As expected, perceived bonding was positively related to all four coping strategies (active coping: β = 0.251, P = .000; positive reframing: β = 0.288, P = .000; planning: β = 0.213, P = .006; humor: β = 0.159, P = .009). More importantly, expression (γ = 0.138, P = .027), but not reception (γ = −0.018, P = .741), of emotional support increases perceived bonding, which in turn mediates the effects on patients’ positive coping strategies. Conclusions There is increasing importance for scholars to distinguish the effects of expression from reception to understand the processes involved in producing psychosocial benefits. This study shows that emotional support is more than something cancer patients receive; it is part of an active, complex process that can be facilitated by social media.