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Background: Care coordination is a key strategy used to improve health outcomes and efficiency, yet there are limited examples in dentistry. A large dental accountable care organization piloted care coordination by retraining existing administrative staff to coordinate the care of high-risk patients. Following the pilot's success, a formal "dental care advocate" (DCA) role was integrated system-wide. The goal of this new role is to improve care, patient engagement, and health outcomes while integrating staff into the clinical care team. We aim to describe the process of DCA role implementation and assess staff and clinician perceptions about the role pre- and post-implementation.Methods: Guided by the Consolidated Framework for Implementation Research, semi-structured interviews with clinical and operational administrative staff and observation at the company-wide training session were combined with pre- and post-implementation electronic surveys. Descriptive statistics and mean scores were tested for significance between each survey sample (t-tests), and qualitative data were thematically analyzed.Results: With preliminary evidence from the pilot and strong executive support, a dedicated leadership team executed a stepwise rollout of the DCA role over 6 months. Success was facilitated by an organizational culture of frequent interventions deployed rapidly through a centralized system, along with supportive buy-in from managerial teams and high staff acceptance and enthusiasm for the DCA role before implementation. Following implementation, significant changes in attitudes and beliefs about the role were measured, though managers held stronger positive impressions than DCAs. DCAs reported high confidence in new skills and dental knowledge post-implementation, including motivational interviewing and the ability to confidently answer patients' questions about their oral health. Overall, the fast-paced implementation of this new role was well received, although consistent and significant differences in mean attitudes between managers and DCAs indicate more work to fine-tune the role is needed.Conclusions: Successful implementation of the new DCA role was facilitated by a strong organizational commitment to team-based dentistry and positive impressions of care coordination among staff and managers. Upskilling existing administrative staff with the necessary training to manage some high-risk patient needs is one method that can be used to implement care coordination efforts in dentistry. [ABSTRACT FROM AUTHOR]

In the past decade, there has been a dramatic shift in US federal policies toward the use of experiments and high-quality quasi-experiments to evaluate the effectiveness of educational programs, practices, and policies. From a funding perspective, the effects of the policy shifts are clear given the dramatic increase in the number of experiments launched in the field. In this study, we examined the effects of the policy shifts on published literature, which is critical given the goal of building a body of knowledge on which to base educational policies and practices. We found little evidence of change in the frequency of published experiments among a sample of top journals in the field from the pre- to post-policy eras. However, there were a large number of experiments published in the newly established Journal of Research on Educational Effectiveness during the post-policy era. [ABSTRACT FROM AUTHOR]

Abstract: Background: We conducted a 3year intervention to increase awareness and adoption of eight more profitable nursery crop production practices that reduced certain traumatic and musculoskeletal injury hazards. Methods: We disseminated information to nursery managers across seven states using information channels they were known to rely on (e.g. trade publications, public events, university Extension, other managers). We evaluated rolling, independent, probability samples (n =1200) with mail questionnaires before the intervention and after each of 3 intervention years. We also evaluated samples (n =250) from a comparison group of New Zealand nursery managers. Results: The intervention was associated with increased awareness of four of the eight practices among US managers after year 3 compared to their baseline: zippers (20 vs. 32%, p ≤0.000), stools (11 vs. 22%, p ≤0.001), pruners (29 vs. 40%, p ≤0.014), and tarps (24 vs. 33%, p ≤0.009). There were no changes in adoption. New Zealand manager awareness was increased for hoes after year 2 compared to their baseline (35 vs. 52%, p ≤0.010). Conclusions: A modest, regionwide information dissemination intervention was associated with increased awareness, but not adoption. [Copyright &y& Elsevier]

Background: Patient-reported outcomes (PROs) are the consequences of disease and/or its treatment as reported by the patient. The importance of PRO measures in clinical trials for new drugs, biological agents, and devices was underscored by the release of the US Food and Drug Administration's draft guidance for industry titled “Patient-Reported Outcome Measures: Use in Medical Product Development to Support Labeling Claims.” The intent of the guidance was to describe how the FDA will evaluate the appropriateness and adequacy of PRO measures used as effectiveness end points in clinical trials... [ABSTRACT FROM AUTHOR]

The restructuring of the U.S. electric power industry has been described as “one of the largest single industrial reorganizations in the history of the world.” As with deregulation and reform of other industries, electricity restructuring was intended to produce cost efficiencies and price benefits to consumers. Whether it has achieved its stated objective is the focus of a number of recent studies that are examined in this review. The studies differ in numerous important ways – most importantly, in their methodologies and their conclusions. The focus of this review is on the strengths and limitations of their specific methodologies and, hence, on the confidence one might place in their conclusions. The article begins by setting out the basic methodological approaches employed in public policy evaluation. It then illustrates these points with examples from methodologies employed in several studies of electricity restructuring, concluding that several methodological deficiencies call into question the study results. In particular, despite much advocacy, there is little reliable and convincing evidence that consumers are better off as a result of the restructuring of the U.S. electric power industry. [ABSTRACT FROM AUTHOR]

This article examines the patients' self-report questions of diseases in the Medical Health Outcomes Survey, utilizing linked survey and medical data from the Veteran Health Administration for patients who are eligible for both Medicare and Veterans Affairs care to estimate their ability as measures of illness burden.

Abstract: Health information exchange (HIE) initiatives are in various stages of development across the United States. They aim to bring previously unavailable clinical data from patients’ disparate health records, which may be spread over multiple provider and payer networks, to the point of care where clinicians and their patients need it most. The implications of these initiatives on public health are numerous. This article provides general evaluation methods for measuring the impact of HIE on public health in six use cases: (1) mandated reporting of laboratory diagnoses, (2) mandated reporting of physician-based diagnoses, (3) public health investigation, (4) disease-based non-reportable laboratory data, (5) antibiotic-resistant organism surveillance, and (6) population-level quality monitoring. [Copyright &y& Elsevier]

This article describes the importance and role of 4 stages of formative evaluation in our growing understanding of how to implement research findings into practice in order to improve the quality of clinical care. It reviews limitations of traditional approaches to implementation research and presents a rationale for new thinking and use of new methods. Developmental, implementation-focused, progress-focused, and interpretive evaluations are then defined and illustrated with examples from Veterans Health Administration Quality Enhancement Research Initiative projects. This article also provides methodologic details and highlights challenges encountered in actualizing formative evaluation within implementation research. [ABSTRACT FROM AUTHOR]

Purpose. To examine the validity of using scores from a clinical evaluation form as an assessment of clinical competence. Method. Investigators collected a longitudinal clinical skills assessment database that included scores reflecting performance on standardized patient interactions, case-based learning performance, scores on multiple-choice clinical examinations, and preceptors' ratings of students during their clerkships. Pearson correlation coefficients and coefficients corrected for attenuation were calculated between the mean preceptor rating CEF score and the other measures collected during years one and two. Results. Estimates from an earlier across-clerkship generalizability study of the CEF demonstrated that a mean rating computed across 28 forms and four clerkships (the average measurement frequencies observed in this study), yielded an estimated G-coefficient of 0.62 (Kreiter and Ferguson, 2001). Reliabilities for the other measures ranged from 0.23 to 0.56. Nine of the twelve clinical skill measures correlated with the CEF. For those significantly correlated measures where reliabilities could be calculated, correlations corrected for attenuation ranged from 0.46 to 0.58. Conclusion. This study indicates that the skills measured by the CEF are related to other clinical performance measures and, conversely, that pre-clinical measures of skills that are believed to be important during clinical years are in fact predictors of preceptors' ratings of clinical performance later in medical school. In addition, the magnitude of the disattenuated coefficients suggests that ratings on the CEF are dependent on important aspects such as clinical knowledge. This study suggests that when averaged over a large number of observations, mean CEF scores demonstrate validity coefficients large enough to support their use as part of an evaluation of students' clinical performance. [ABSTRACT FROM AUTHOR]

Small, inexpensive, often poorly made handguns known as “Saturday night specials” are disproportionately involved in crime. Maryland banned the sale of Saturday night specials effective January 1, 1990. During the 2 years between the law's passage in 1988 and its effective date, legal handgun sales in Maryland were 34% higher than expected (p = 0.09). Interrupted time-series analysis of age-adjusted homicide rates for 1975–1998 with statistical controls for trends in two neighboring states, social and economic variables, and temporal patterns in Maryland's homicide rates was used to assess the effect of the law. Estimates of the Saturday night special ban effects depended on the assumption made about the timing of the law's effects. Models that assumed a delayed or gradual effect of the Saturday night special ban produced estimates indicating that firearm homicide rates were 6.8–11.5% lower than would have been expected without the Saturday night special ban (p ≤ 0.05). The model that assumed an immediate, constant change in response to the law showed no law effect, unless an outlier was excluded from the analysis. Excluding this outlier, the model estimated a 15% increase in firearm homicides associated with the Saturday night special ban. None of the models revealed significant law effects on nonfirearm homicides. [ABSTRACT FROM PUBLISHER]

ABSTRACTPurpose: To document changes in management of diabetic retinopathy by Australian ophthalmologists after release of the National Health and Medical Research Council (NHMRC) clinical guidelines. Methods: Self-administered questionnaires were mailed to Australian ophthalmologists prior to release of the NHMRC guidelines for the management of diabetic retinopathy, and at one and 2.5 years after release of the guidelines. The questionnaires elicited information about current management practices in relation to diabetic retinopathy. Results: The response rate for the baseline and two follow-up surveys was 82%, 81%, and 80%, respectively. More than 85% of the ophthalmologists responded that the guidelines were useful in improving management, were easy to understand, and were already part of their routine clinical practice. A relatively small percentage (12%) felt that the guidelines made recommendations that were not practical or feasible. Contrary to the NHMRC guidelines, at the second follow-up survey, only 50% of the ophthalmologists said that they would almost never perform fluorescein angiography in eyes with mild non-proliferative diabetic retinopathy. The change from baseline to the second follow-up in the percentage of ophthalmologists who would perform cataract surgery after treating clinically significant macular oedema (as advised by the NHMRC guidelines) was statistically significant (baseline = 83.7%, 95% confidence limit = 80.4, 87.0; second follow up = 90.4, 95% confidence limit = 87.3, 93.5). Conclusions: Distribution of the printed NHMRC Clinical Practice Guidelines: Management of Diabetic Retinopathy and full colour Retinopathy Chart resulted in a significant change in the recommended order of treatment of clinically significant macular oedema. However, no significant change in the use of fluorescein angiography was documented. [ABSTRACT FROM AUTHOR]

The validity of self-report of drug use has been found to vary widely. Moreover, previous research has focused on samples of adults. In 1996–1998, human immunodeficiency virus (HIV)-infected adolescents and high-risk, noninfected adolescents (n = 182) were recruited at 16 locations in 13 US cities into the Reaching for Excellence in Adolescent Care and Health (REACH) project, to the authors' knowledge, the first national study of disease progression among HIV-positive adolescents who were infected through sexual behavior or injection drug use. Self-report of marijuana use was assessed through audio computer-assisted self-administered interviewing (ACASI). Urines were tested for marijuana at a certified laboratory by using the enzyme-multiplied immunoassay technique. Conditional kappas for 2-, 5-, and 7-day self-reports were 0.57, 0.71, and 0.69, respectively. Maximum sensitivity was obtained from a combination of ACASI and urine drug testing. Contrary to previous studies, the data suggest that if a single evaluative instrument is to be used for prevalence, ACASI is more sensitive than urine drug testing for marijuana overall, but particularly for HIV-infected adolescents. Am J Epidemiol 2000;152:805–13. [ABSTRACT FROM PUBLISHER]

Objectives Curriculum innovations to improve clinical skills have been implemented at many American medical schools. A current curricular change at the University of Connecticut School of Medicine involves teaching wellness to students in the first year rather than the more traditional focus on disease processes. It is unknown, however, if focusing on wellness detracts from students’ future ability to perform the history of present illness (HPI) which requires students to focus on disease processes. Design The current study examined this issue by comparing two cohorts’ clinical skills (n=156), with one class participating in a traditional curriculum during their first year and the other in a revised curriculum teaching wellness during the first year. Each class was evaluated at the beginning of their second year to determine their level of clinical competence. Setting University of Connecticut School of Medicine Subjects Second-year medical students. Results Analyses suggested that teaching wellness did not detract from future ability to perform an HPI, and in fact students taught wellness had significantly higher history-taking scores. Conclusions Curricular innovations which stress wellness and prevention early in medical education do not detract from and may enhance students’ ability to perform the history of present illness later during medical training. [ABSTRACT FROM AUTHOR]

Objective: To determine whether raters using the American Board of Internal Medicine (ABIM) Resident Evaluation Form can detect differences among residents in clinical competence.Design: Cross-sectional study.Setting: Inpatient general medicine service in a university-affiliated public hospital.Participants: University-based internal medicine (UCIM) residents (ABIM certifying examination pass rate, 91%; mean score, 95th percentile), community hospital-based internal medicine (CHIM) residents (ABIM examination pass rate, 68%; mean score, 42nd percentile), and residents from three university-based non-internal medicine (UC non-IM) programs all assigned to the same inpatient general medicine service over a three-year period. Four hundred eighty-nine evaluations of 110 postgraduate-year-one residents were analyzed.Measurements and Main Results: Mean ratings for the UCIM residents were significantly higher than those for the CHIM or UC non-IM residents (analysis of variance [ANOVA], p < 0.05). Variance was smallest for the UCIM residents (F test, p < 0.01), and only the UCIM residents' mean scores were in the "superior" range (7-9) in all evaluated categories. The mean ratings for the CHIM residents while at the university-affiliated hospital were not significantly different from the ratings of the same residents at their home hospital. The ratings for the CHIM residents at either site were significantly lower than those for the UCIM residents in all categories (ANOVA, p < 0.05). Factor analysis revealed a single factor accounting for 76% of the variance among the ratings with all dimensions loading high on that factor (0.75-0.95), providing evidence for a "halo" effect. Mean interrater agreement over all variables was 0.87, indicating good consistency among raters.Conclusions: Ratings on the ABIM Resident Evaluation Form detect global differences among residents in clinical competence in the expected direction based on type of training program and performance on the ABIM certification examination, but fail to differentiate among the nine evaluated dimensions of clinical care. This rating method may be valid for assessing overall clinical performance, but is less useful for providing feedback in specific areas to individual residents. [ABSTRACT FROM AUTHOR]

Purpose: This study reports REACH (the extent to which an intervention or program was delivered to the identified target population) of interventions integrating primary care and behavioral health implemented by real-world practices., Methods: Eleven practices implementing integrated care interventions provided data to calculate REACH as follows: 1) Screening REACH defined as proportion of target patients assessed for integrated care, and 2) Integrated care services REACH-defined as proportion of patients receiving integrated services of those who met specific criteria. Difference in mean REACH between practices was evaluated using t test., Results: Overall, 26.2% of target patients (n = 24,906) were assessed for integrated care and 41% (n = 836) of eligible patients received integration services. Practices that implemented systematic protocols to identify patients needing integrated care had a significantly higher screening REACH (mean, 70%; 95% CI [confidence interval], 46.6-93.4%) compared with practices that used clinicians' discretion (mean, 7.9%; 95% CI, 0.6-15.1; P = .0014). Integrated care services REACH was higher among practices that used clinicians' discretion compared with those that assessed patients systematically (mean, 95.8 vs 53.8%; P = .03)., Conclusion: REACH of integrated care interventions differed by practices' method of assessing patients. Measuring REACH is important to evaluate the extent to which integration efforts affect patient care and can help demonstrate the impact of integrated care to payers and policy makers., (© Copyright 2015 by the American Board of Family Medicine.)

Background: The Advanced Nurse Practitioner in Critical Care role was developed to support the critical care team by undertaking specific roles traditionally associated with medical staff in the intensive care unit and high dependency unit. The rationale for the evaluation was to establish the specific tasks undertaken and scope of workload of these newly created posts., Aims: To report on an evaluation of the specific activities, workload and patterns of prescribing of advanced nursing practice posts within a critical care settings, Methods: A data collection form was designed to capture clinically and patient-related activities of these post-holders. Data from 1 week were recorded on one post-holder and subsequently analysed. During the evaluation the nurse practitioners worked with the consultant anaesthetist. Data were entered into Microsoft Excel and analysed using descriptive statistics., Results: The intensive care and high dependency unit ward round attributed to 46% of the nurse practitioners weekly activity and mainly consisted of patient assessments and prescribing. The rest of the time was mainly split between documentation and unsupervised patient assessments., Discussion: The nurse practitioners contributed to the majority of interventions traditionally performed by anaesthetic trainees. Independent patient assessment was highlighted as a significant part of that workload (12%). The evaluation also highlighted the broad nature required of nurse practitioner prescribing and thus reinforced the strategic decision not to introduce a restricted formulary., Conclusion: Advanced nurse practitioners in critical care effectively carried out the traditional medical tasks in which they were trained. As already experienced nurses with new enhanced skills they successfully contributed to and enhanced the delivery of care to the critically ill., (© 2014 British Association of Critical Care Nurses.)