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Hardie, Rae-Anne, Donna Moore, Derek Holzhauser, Michael Legg, Andrew Georgiou, and Tony Badrick. "Informatics External Quality Assurance (IEQA) Down Under: evaluation of a pilot implementation." LaboratoriumsMedizin 42, no. 6 (December 19, 2018): 297–304. http://dx.doi.org/10.1515/labmed-2018-0050.
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AbstractExternal quality assurance (EQA) provides ongoing evaluation to verify that laboratory medicine results conform to quality standards expected for patient care. While attention has focused predominantly on test accuracy, the diagnostic phases, consisting of pre- and post-laboratory phases of testing, have thus far lagged in the development of an appropriate diagnostic-phase EQA program. One of the challenges faced by Australian EQA has been a lack of standardisation or “harmonisation” resulting from variations in reporting between different laboratory medicine providers. This may introduce interpretation errors and misunderstanding of results by clinicians, resulting in a threat to patient safety. While initiatives such as the Australian Pathology Information, Terminology and Units Standardisation (PITUS) program have produced Standards for Pathology Informatics in Australia (SPIA), conformity to these requires regular monitoring to maintain integrity of data between sending (laboratory medicine providers) and receiving (physicians, MyHealth Record, registries) organisations’ systems. The PITUS 16 Informatics EQA (IEQA) Project together with the Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP) has created a system to perform quality assurance on the electronic laboratory message when the laboratory sends a result back to the EQA provider. The purpose of this study was to perform a small scale pilot implementation of an IEQA protocol, which was performed to test the suitability of the system to check compliance of existing Health Level-7 (HL7 v2.4) reporting standards localised and constrained by the RCPA SPIA. Here, we present key milestones from the implementation, including: (1) software development, (2) installation, and verification of the system and communication services, (3) implementation of the IEQA program and compliance testing of the received HL7 v2.4 report messages, (4) compilation of a draft Informatics Program Survey Report for each laboratory and (5) review consisting of presentation of a report showing the compliance checking tool to each participating laboratory.
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Kit, J. Ah, C. Prideau x, PW Harve y, J. Collin s, M. Battersb y, PD Mill s, and S. Dansi e. "Chronic disease self-management in Aboriginal Communities: Towards a sustainable program of care in rural communities." Australian Journal of Primary Health 9, no. 3 (2003): 168. http://dx.doi.org/10.1071/py03043.
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The Chronic Disease Self-Management (CDSM) strategy for Aboriginal patients on Eyre Peninsula, South Australia, was designed to develop and trial new program tools and processes for goal setting, behaviour change and self-management for Aboriginal people with diabetes. The project was established as a one-year demonstration project to test and trial a range of CDSM processes and procedures within Aboriginal communities and not as a formal research project. Over a one-year period, 60 Aboriginal people with type-2 diabetes in two remote regional centres participated in the pilot program. This represents around 25% of the known Aboriginal diabetic population in these sites. The project included training for four Aboriginal Health Workers in goal setting and self-management strategies in preparation for them to run the program. Patients completed a Diabetes Assessment Tool, a Quality of Life Questionnaire (SF12), the Work and Social Adjustment Scale (WASAS) at 0, 6 and 12 months. The evaluation tools were assessed and revised by consumers and health professionals during the trial to determine the most functional and acceptable processes for Aboriginal patients. Some limited biomedical data were also recorded although this was not the principal purpose of the project. Initial results from the COAG coordinated care trial in Eyre suggest that goal setting and monitoring processes, when modified to be culturally inclusive of Aboriginal people, can be effective strategies for improving self-management skills and health-related behaviours of patients with chronic illness. The CDSM pilot study in Aboriginal communities has led to further refinement of the tools and processes used in chronic illness self-management programs for Aboriginal people and to greater acceptance of these processes in the communities involved. Participation in a diabetes self-management program run by Aboriginal Health Workers assists patients to identify and understand their health problems and develop condition management goals and patient-centred solutions that can lead to improved health and wellbeing for participants. While the development of self-management tools and strategies led to some early indications of improvements in patient participation and resultant health outcomes, the pilot program and the refinement of new assessment tools used to assist this process has been the significant outcome of the project. The CDSM process described here is a valuable strategy for educating and supporting people with chronic conditions and in gaining their participation in programs designed to improve the way they manage their illness. Such work, and the subsequent health outcome research planned for rural regions, will contribute to the development of more comprehensive CDSM programs for Aboriginal communities generally.
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Johnston, Catherine L., Lyndal J. Maxwell, Graeme P. Maguire, and Jennifer A. Alison. "Does delivery of a training program for healthcare professionals increase access to pulmonary rehabilitation and improve outcomes for people with chronic lung disease in rural and remote Australia?" Australian Health Review 38, no. 4 (2014): 387. http://dx.doi.org/10.1071/ah14009.
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Objective Access to pulmonary rehabilitation (PR), an effective management strategy for people with chronic respiratory disease, is often limited particularly in rural and remote regions. Difficulties with establishment and maintenance of PR have been reported. Reasons may include a lack of adequately trained staff. There have been no published reports evaluating the impact of training programs on PR provision. The aim of this project was to evaluate the impact of an interactive training and support program for healthcare professionals (the Breathe Easy, Walk Easy (BEWE) program) on the delivery of PR in rural and remote regions. Methods The study was a quasi-experimental before–after design. Data were collected regarding the provision of PR services before and after delivery of the BEWE program and patient outcomes before and after PR. Results The BEWE program was delivered in one rural and one remote region. Neither region had active PR before the BEWE program delivery. At 12-month follow-up, three locally-run PR programs had been established. Audit and patient outcomes indicated that the PR programs established broadly met Australian practice recommendations and were being delivered effectively. In both regions PR was established with strong healthcare organisational support but without significant external funding, relying instead on the diversion of internal funding and/or in-kind support. Conclusions The BEWE program enabled the successful establishment of PR and improved patient outcomes in rural and remote regions. However, given the funding models used, the sustainability of these programs in the long term is unknown. Further research into the factors contributing to the ability of rural and remote sites to provide ongoing delivery of PR is required. What is known about the topic? PR including exercise training, education, and psychosocial support, is an effective and well evidenced management strategy for people with chronic obstructive pulmonary disease (COPD) that improves exercise capacity and quality of life, and reduces hospital admissions and length of stay. Despite the fact that participation in PR is seen as an essential component in the management of COPD, access remains limited, particularly in rural and remote regions. Difficulties with establishing and maintaining PR have been attributed to lack of physical and financial resources and adequately trained and skilled staff. There have been no published reports evaluating the impact of training programs for healthcare professionals in the provision of PR. What does this paper add? This paper is the first to demonstrate that the delivery of a well supported, interactive healthcare professional training program may facilitate the establishment of PR in rural and remote regions. Following delivery of the BEWE program, PR which broadly met the Australian recommendations for practice in terms of program content and structure, was established. Factors influencing the establishment of PR were related to the characteristics of the healthcare setting, such as remoteness, and to issues around staff retention. The settings where PR was not established were in less well-staffed, community-based, more remote settings. People with COPD who participated in these programs showed significant improvements in exercise capacity and quality of life. What are the implications for practitioners? One of the factors limiting the delivery of PR may be a lack of appropriately trained and skilled staff. Healthcare professionals’ participation in locally provided education and training programs targeted at developing skills for providing PR may enable effective PR programs to be established and maintained in rural and remote regions.
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Layton, M., E. Johnson, S. Hall, H. Cross, J. Bishop, G. McArthur, and K. Lacey. "The VCCC Research & Education Lead Program: Collective Leadership in Cancer Across Multiple Organisations." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 156s. http://dx.doi.org/10.1200/jgo.18.60100.
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Background and context: The Victorian Comprehensive Cancer Centre (VCCC) is Australia´s first formally constituted comprehensive cancer center, based on NCI principles. It is an alliance of 10 organizations: 7 hospitals, 2 medical research institutes and a university, based in Melbourne, Australia. A key goal for the VCCC is to create meaningful collaborations across partner organizations. Aim: The VCCC established the Research & Education Lead (R & E Lead) Program to build leadership capability who can harness the critical mass of talent across the VCCC alliance to work toward optimal integration of cancer research and education into routine patient care. Strategy/Tactics: This VCCC Research & Education Lead Program manifests the foundational principles of the VCCC by systematising and normalizing collaborative activities across the VCCC alliance. The program is a vehicle that allows the VCCC to address its strategic priorities to enable: - better integration of research, education and clinical care - sharing of ideas and knowledge to improve patient outcomes - shared education and training across member organizations Program/Policy process: Clinicians-scientists were appointed to each tumor stream as VCCC R & E Leads (approx. 0.2 EFT). Their role is to build networks of expertise and to drive change that is evidence-based, strategic and agreed across the VCCC alliance, with a focus on the end goal of better outcomes for cancer patients. The program provides the basis for a model of distributed leadership, wherein champions invested in the VCCC concept are embedded in partner organizations. Outcomes: Three R & E Leads were initially appointed as a pilot for 2 years, with a further three leads appointed during this period. Following the pilot, the program has been expanded to encompass 10 tumor streams as well as leads in primary care integration and cancer nursing. Achievements to date have included the development of a Massive Online Open Course in Cancer Survivorship, conduct of numerous symposia and events that upskill the cancer workforce in niche areas identified by the leads as needs, and consensus on the clinical challenges and research priorities to be tackled collectively within each tumor stream. Overarching program benefits included increased engagement and collaboration across partner organizations, more sharing of knowledge, and more participation in collaborative efforts including VCCC strategy development and advocacy. What was learned: A key finding of an interim program evaluation identified that the appointment of clinician-scientists as the leads was an important factor in their ability to cross the boundaries between research and clinical practice and between organizations, and to work closely and cohesively with clinical service leads for the tumor streams.
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Hui, Daphne, Bert Dolcine, and Hannah Loshak. "Approaches to Evaluations of Virtual Care in Primary Care." Canadian Journal of Health Technologies 2, no. 1 (January 12, 2022): es0358. http://dx.doi.org/10.51731/cjht.2022.238.
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A literature search informed this Environmental Scan and identified 11 evaluations of virtual care in primary care health settings and 7 publications alluding to methods, standards, and guidelines (referred to as evaluation guidance documents in this report) being used in various countries to evaluate virtual care in primary care health settings. The majority of included literature was from Australia, the US, and the UK, with 2 evaluation guidance documents published by the Heart and Stroke Foundation of Canada.
Evaluation guidance documents recommended using measurements that assess the effectiveness and quality of clinical care including safety outcomes, time and travel, financial and operational impact, participation, health care utilization, technology experience including feasibility, user satisfaction, and barriers and facilitators or measures of health equity.
Evaluation guidance documents specified that the following key decisions and considerations should be integrated into the planning of a virtual care evaluation: refining the scope of virtual care services; selecting an appropriate meaningful comparator; and identifying opportune timing and duration for the evaluation to ensure the evaluation is reflective of real-world practice, allows for adequate measurement of outcomes, and is comprehensive, timely, feasible, non-complex, and non–resource-intensive.
Evaluation guidance documents highlighted that evaluations should be systematic, performed regularly, and reflect the stage of virtual care implementation to encompass the specific considerations associated with each stage. Additionally, evaluations should assess individual virtual care sessions and the virtual care program as a whole.
Regarding economic components of virtual care evaluations, the evaluation guidance documents noted that costs or savings are not limited to monetary or financial measures but can also be represented with time. Cost analyses such as cost-benefit and cost-utility estimates should be performed with a specific emphasis on selecting an appropriate perspective (e.g., patient or provider), as that influences the benefits, effects, and how the outcome is interpreted.
Two identified evaluations assessed economic outcomes through cost analyses in the perspective of the patient and provider. Evidence suggests that, in some circumstances, virtual care may be more cost-effective and reduces the cost per episode and patient expenses (e.g., travel and parking costs) compared to in-person care. However, virtual care may increase the number of individuals treated, which would increase overall health care spending.
Four identified evaluations assessed health care utilization. The evidence suggests that virtual care reduces the duration of appointments and may be more time-efficient compared to in-person care. However, it is unclear if virtual care reduces the use of medical resources and the need for follow-up appointments, hospital admissions, and emergency department visits compared to in-person care.
Five identified evaluations assessed participation outcomes. Evidence was variable, with some evidence reporting that virtual care reduced attendance (e.g., reduced attendance rates) and other evidence noting improved attendance (e.g., increased completion rate and decreased cancellations and no-show rates) compared to in-person care.
Three identified evaluations assessed clinical outcomes in various health contexts. Some evidence suggested that virtual care improves clinical outcomes (e.g., in primary care with integrated mental health services, symptom severity decreased) or has a similar effect on clinical outcomes compared to in-person care (e.g., use of virtual care in depression elicited similar results with in-person care).
Three identified evaluations assessed the appropriateness of prescribing. Some studies suggested that virtual care improves appropriateness by increasing guideline-based or guideline-concordant antibiotic management, or elicits no difference with in-person care.
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Martyn, Julie-Anne, Jackie Scott, Jasper H. van der Westhuyzen, Dale Spanhake, Sally Zanella, April Martin, and Ruth Newby. "Combining participatory action research and appreciative inquiry to design, deliver and evaluate an interdisciplinary continuing education program for a regional health workforce." Australian Health Review 43, no. 3 (2019): 345. http://dx.doi.org/10.1071/ah17124.
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Objective Continuing education (CE) is essential for a healthcare workforce, but in regional areas of Australia there are challenges to providing and accessing relevant, reliable and low-cost opportunities. The aim of the present study was to collaborate with the local regional healthcare workforce to design, deliver and evaluate an interdisciplinary CE (ICE) program. Methods A participatory action research (PAR) model combined with an appreciative inquiry (AI) framework was used to design, deliver and evaluate an ICE program. A focus group of 11 health professionals developed an initial program. Evaluation data from 410 program participants were analysed using AI. Results The ICE program addressed the CE barriers for the regional healthcare workforce because the locally derived content was delivered at a reasonable cost and in a convenient location. Program participants identified that they most valued shared experiences and opportunities enabling them to acquire and confirm relevant knowledge. Conclusion ICE programs enhance interdisciplinary collaboration. However, attendance constraints for regional healthcare workforce include location, cost, workplace and personal factors. Through community engagement, resource sharing and cooperation, a local university and the interdisciplinary focus group members successfully designed and delivered the local education and research nexus program to address a CE problem for a regional healthcare workforce. What is known about the topic? Participation in CE is mandatory for most health professionals. However, various barriers exist for regional health workers to attending CE. Innovative programs, such as webinars and travelling workshops, address some of the issues but create others. Bringing various health workers together for the simultaneous education of multiple disciplines is beneficial. Collectively, this is called ICE. What does this paper add? Using PAR combined with AI to design an ICE program will focus attention on the enablers of the program and meet the diverse educational needs of the healthcare workforce in regional areas. Engaging regional health professionals with a local university to design and deliver CE is one way to increase access to quality, cost-effective education. What are the implications for practitioners? Regional healthcare workers’ CE needs are more likely to be met when education programs are designed by them and developed for them. ICE raises awareness of the roles of multiple healthcare disciplines. Learning together strengthens healthcare networks by bolstering relationships through a greater understanding of each other’s roles. Enriching communication between local health workers has the potential to enhance patient care.
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Delic, Sabit, Piers Blombery, María José Calasanz, Devon S. Chabot-Richards, Dolors Colomer, Matteo G. Della Porta, Paul A. S. Evans, et al. "Cdx Report Program: Heterogeneity Revealed in Current Reporting Practices for Hemato-Oncology Companion Diagnostic (CDx) Markers in Multiple Countries." Blood 134, Supplement_1 (November 13, 2019): 5837. http://dx.doi.org/10.1182/blood-2019-128652.
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Introduction: In the current era of precision medicine, CDx tests have become the basis for optimal patient care and targeted treatment. While technical aspects of a CDx assay's performance are audited regularly by participation in external quality assessment (EQA) programs, the reporting of these CDx markers is rarely scrutinized. The aim of this first of its kind CDx report program is to get a detailed picture of hemato-oncology CDx marker reporting across multiple countries. Therefore, we evaluated multiple laboratory parameters and reviewed actual content of clinical CDx reports. Methods: Thirty-four clinical labs from Germany, Italy, Spain, and the United Kingdom provided information for 7 biomarkers used for treatment decisions in hemato-oncology. An identical program is already running in Australia and the United States and will be initiated shortly in India and China. The CDx markers covered in this CDx report program were: BCR-ABL1 in chronic myeloid leukemia (CML), at diagnosis; BCR-ABL1 in CML, minimal residual disease (MRD); IDH1/2 in acute myeloid leukemia (AML); FLT3-ITD in AML; FLT3-TKD in AML; IGHV in chronic lymphocytic leukemia (CLL); and TP53 in CLL. The information requested from participating laboratories included two anonymized or blank reports: one with a positive/mutant result and one with a negative/wild-type result. The received anonymized reports were reviewed by experts within each country according to pre-agreed criteria. In addition, labs participated in a short online survey evaluating test volumes, turnaround times (TATs), positivity rates, participation in an EQA program, and status regarding accreditation and reimbursement. The results of the questionnaires were forwarded as anonymized and aggregated data to reviewing experts. Results: Overall, we received 184 survey datasets and 179 sets of anonymized reports. The review of the anonymized reports according to pre-defined criteria revealed differences in the way CDx results are represented and interpreted in clinical reports. Since not all markers covered in this program were tested by all participating labs, the number of survey datasets per CDx marker ranged from 16 to 34 (IGHV: 16; TP53: 19; IDH1/2: 24; FLT3-TKD: 28; FLT3-ITD: 30; BCR-ABL1 [MRD]: 33; and BCR-ABL1 [diagnosis]: 34). The 184 survey datasets represented more than 7000 tests per month (Figure). The stated average TAT across all covered markers was 6.9 days, ranging from 5.3 days to 8.6 days in the covered countries. The TATs for the individual markers ranged from 4.4 days to 9.4 days (FLT3-ITD: 4.4 days; FLT3-TKD: 4.6 days; BCR-ABL1 [diagnosis]: 5.3 days; BCR-ABL1 [MRD]: 6.9 days; IDH1/2: 8.4 days; IGHV: 9.3 days; and TP53: 9.4 days). In 103/179 (58%) datasets labs participated in EQA programs, and in 76/179 (42%) datasets labs did not participate in EQA programs. For 84/180 (47%) datasets, labs were ISO15189-accredited; for 12/180 (7%) datasets, labs were College of American Pathologists (CAP)-accredited; and for 84/180 (47%) datasets, labs were not accredited by either ISO15189 or CAP. Conclusion: CDx report program results reveal a broad range globally in CDx reporting practices. The identified differences in laboratory parameters, such as TAT and the actual content of clinical CDx reports, suggest a need for international harmonization of CDx reporting. The anonymized and aggregated data generated provide the basis for other initiatives and may support guideline updates and the international harmonization of CDx reporting. Figure. Estimated number of companion diagnostic tests per month covered in the CDx report program. Figure Disclosures Delic: Diaceutics: Employment, Equity Ownership. Blombery:Janssen: Honoraria; Novartis: Consultancy; Invivoscribe: Honoraria. Calasanz:Janssen: Honoraria; Diaceutics: Honoraria; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene: Honoraria. Colomer:Novartis: Honoraria; Incyte: Honoraria. Evans:Diaceutics: Honoraria; Novartis: Honoraria. Haferlach:MLL Munich Leukemia Laboratory: Employment, Equity Ownership. Mason:Novartis: Honoraria; Jazz Pharmaceuticals: Honoraria; AbbVie: Honoraria. Thiede:Daiichi Sankyo: Honoraria; Diaceutics: Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Honoraria, Research Funding, Speakers Bureau; AgenDix GmbH: Employment, Equity Ownership. Clark:Diaceutics: Employment, Equity Ownership.
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ACKERMAN, ILANA N., RACHELLE BUCHBINDER, and RICHARD H. OSBORNE. "Challenges in Evaluating an Arthritis Self-management Program for People with Hip and Knee Osteoarthritis in Real-world Clinical Settings." Journal of Rheumatology 39, no. 5 (March 1, 2012): 1047–55. http://dx.doi.org/10.3899/jrheum.111358.
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Objective.To evaluate the influence of a 6-week Arthritis Self-Management Program (ASMP) on health-related quality of life (HRQOL) and self-management skills in clinical settings.Methods.Individuals with hip or knee osteoarthritis referred to orthopedic surgeons or rheumatologists at 6 hospitals in Victoria, Australia, were recruited. In a randomized controlled trial, participants received the Stanford ASMP and self-help book (intervention) or book only (control). Assessments included the Assessment of Quality of Life instrument (AQoL; range −0.04 to 1.00) and Health Education Impact Questionnaire (heiQ; range 1–6) at baseline and up to 12 months. The primary outcome was HRQOL at 12 months (assessed using the AQoL).Results.Recruitment was concluded early due to persistent challenges including infrequent referrals and patient inability or disinterest in participating. Of 1125 individuals screened, only 120 were randomized (control, n = 62; intervention, n = 58). Seven ASMP were conducted while 18 scheduled ASMP were cancelled. Forty-four of 58 intervention group participants received the intervention as allocated (76%); all control group participants were sent the book (100%). Ninety-four participants (78%) completed 12-month assessments (control, 90%; intervention, 66%). There was no difference in HRQOL at 12 months (adjusted mean difference −0.02, 95% CI −0.09 to 0.05). At 6 weeks, the intervention group reported higher heiQ skill and technique acquisition scores (adjusted mean difference 0.29, 95% CI 0.04 to 0.55); however, this dissipated by 3 months.Conclusion.Significant challenges hampered this evaluation of the ASMP. The observed lack of enthusiasm from potential referrers and patients raises doubts about the practicality of this intervention in real-world settings. (ANZCTR Clinical Trials Registry no. ACTRN12606000174583)
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Lynch, Elizabeth, Kate Laver, Tamina Levy, and Timothy Schultz. "‘The way that we are collecting and using data has evolved’ evaluating the Australian National Stroke Audit programme to inform strategic direction." BMJ Open Quality 12, no. 1 (January 2023): e002136. http://dx.doi.org/10.1136/bmjoq-2022-002136.
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BackgroundThe National Stroke Audit has been used to audit and provide feedback to health professionals and stroke care services in Australia since 2007. The Australian Stroke Clinical Registry was piloted in 2009 and numbers of hospitals participating in the registry are increasing. Considering the changing data landscape in Australia, we designed this study to evaluate the stroke audit and to inform strategic direction.MethodsWe conducted a rapid review of published literature to map features of successful data programmes, followed by a mixed-methods study, comprising national surveys and interviews with clinicians and administrators about the stroke audit. We analysed quantitative data descriptively and analysed open-ended survey responses and interview data using qualitative content analysis. We integrated data from the two sources.ResultsWe identified 47 Australian data programs, successful programs were usually funded by government sources or professional associations and typically provided twice yearly or yearly reports.106 survey participants, 14 clinician and 5 health administrator interview participants were included in the evaluation. The Stroke Audit was consistently perceived as useful for benchmarking, but there were mixed views about its value for local quality improvement. Time to enter data was the most frequently reported barrier to participation (88% of survey participants), due to the large number of datapoints and features of the audit software.Opportunities to improve the Stroke Audit included refining Audit questions, developing ways to automatically export data from electronic medical records and capturing accurate data for patients who transferred between hospitals.ConclusionWhile the Stroke Audit was not perceived by all users to be beneficial for traditional quality improvement purposes, the ability to benchmark national stroke services and use these data in advocacy activities was a consistently reported benefit. Modifications were suggested to improve usability and usefulness for participating sites.
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Barton, C. J., J. L. Kemp, E. M. Roos, S. T. Skou, K. Dundules, M. Pazzinatto, F. Matthew, J. Wallis, and K. M. Crossley. "Program evaluation of glad Australia physiotherapist and patient outcomes." Osteoarthritis and Cartilage 29 (April 2021): S402—S403. http://dx.doi.org/10.1016/j.joca.2021.02.520.
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Radha Prabhu, V., Armita Hanley, and Sue Kearney. "Evaluation of a hospital volunteer program in rural Australia." Australian Health Review 32, no. 2 (2008): 265. http://dx.doi.org/10.1071/ah080265.
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A voluntary survey questionnaire that assessed experience with and perception of the volunteering program was mailed to 62 current and 9 former volunteers and 47 staff members of Latrobe Regional Hospital (LRH). Sixty-one completed questionnaires were returned. The nature of hospital work attracted volunteers (57%) and most volunteers felt oriented to the hospital, supervised and supported. The volunteers enjoyed working with patients and felt they contributed to better services and staff and patient support. There was a need felt that more training and development, recognition, orientation and supervision would be beneficial. Overall, most volunteers rated their experience as good (60%) to excellent (25%). Staff rated the contribution from volunteers as good (41%) to excellent (47%). Volunteers identified several areas of improvement, including opportunities for further training and supervision. Volunteers play a crucial role within the health care system. There is tremendous scope for further development of the volunteer role and increasing opportunities for training and development, recognition and encouragement.
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Lagerström, Monica, and Mats Hagberg. "Evaluation of a 3 Year Education and Training Program." AAOHN Journal 45, no. 2 (February 1997): 83–92. http://dx.doi.org/10.1177/216507999704500207.
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An education and training program comprising 1) patient transfer technique, 2) physical fitness exercise, and 3) stress management was conducted during 3 consecutive years at a Swedish hospital. The present study was based on data from four sets of questionnaires, distributed to 348 female nursing personnel who participated in the entire program. The aim of the study was to evaluate the program. It was evident from the questionnaires that 90% of the subjects were positive about participating in the program and 88% expected that participation would lead to decreased musculoskeletal disorders. However, no decrease in the prevalence of musculoskeletal symptoms during the study time period was observed. One year after the cessation of the program, 93% of all nurses reported they mostly or always used the new patient transfer technique and 99% considered it to be useful.
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Joubert, Jacques, Stephen M. Davis, Geoffrey A. Donnan, Christopher Levi, Graeme Gonzales, Lynette Joubert, and Graeme J. Hankey. "ICARUSS: An effective model for risk factor management in stroke survivors." International Journal of Stroke 15, no. 4 (February 20, 2019): 438–53. http://dx.doi.org/10.1177/1747493019830582.
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Background and purpose After an initial stroke, the risk of recurrent stroke is high. Models that implement best-practice recommendations for risk factor management in stroke survivors to prevent stroke recurrence remain elusive. We examined a model which focuses on vascular risk factor management to prevent stroke recurrence in survivors returning to their primary care physicians. This model is coordinated from the stroke unit, integrates specialist stroke services with primary care physicians, and directly involves patients and carers in risk factor management. It is underpinned by the shared care principle in which there is joint participation of specialists as well as primary care physicians in a planned, integrated delivery of care with ongoing involvement of patients and carers, a structure which encourages implementation of best-practice recommendations as well as transferability and sustainability. We hypothesized that an integrated, multimodal intervention based on a shared-care model which supports joint participation of stroke specialists and primary care physicians would improve the implementation of best-practice recommendations for risk factor management in stroke survivors returning to the community. Methods We undertook a double-blind randomized controlled trial, testing the model in three Australian cities using stroke survivors admitted to stroke units and discharged from hospital to return to their primary care physicians. The model was a shared care, multifaceted integrated program which included bidirectional feedback between general practitioner and specialist unit, education, and engagement of patient and carer in self-management with ongoing input from a multidisciplinary team. The primary endpoint was improvement or abolition of risk factors such as raised blood pressure, diabetes, hyperlipidemia, the modification of adverse life-style factors such as lack of exercise, smoking and alcohol abuse and adherence to preventive medication at one year. Intermediate measurement points were scheduled at three monthly intervals. Analysis was by intention to treat, evaluated by covariance or a linear model adjusting for confounding factors or variance of base-line risk factors. The study was registered as ACTRN = 1261100026498. Results The study population was as follows: intervention ( n = 112), control ( n = 137). At baseline, there was no statistical difference between the groups for any variable. At the 12-month evaluation, there was a significant decrease in systolic blood pressure from baseline in the intervention group of 5.2 mmHg ( p < 0.01). This change was not observed in the control group ( p = 0.29). Moreover, at 12 months the mean systolic blood pressure in the intervention group was 129.4 mmHg (SD 14.7), a result which was not obtained in controls. Fasting total cholesterol as well as triglycerides was reduced significantly in the intervention group (both p < 0.01) but this was not the case in the control group ( p = 0.11 and p = 0.27, respectively). At 12 months, there was no change in BMI in the intervention group but there was a significant increase in BMI ( p = 0.02) in the control group. At 12 months in the intervention group, the mean distance walked with ease compared to the baseline measurements was increased by a mean distance of 600 m while in the control group the distance walked with ease was reduced compared to that measured at baseline. At 12 months, the Barthel index in the intervention group demonstrated improved function ( p = 0.01), but no change was observed in controls. At 12 months in the intervention group, there was a significant decrease in number of standard alcoholic drinks consumed per week compared to the baseline ( p = 0.04). This was not observed in the control group ( p = 0.34). Conclusion In stroke survivors, the ICARUSS (Integrated Care for the Reduction of Secondary Stroke) model is superior to usual care with respect to best-practice recommendations for traditional risk factors as well as behavioral and functional outcomes.
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Walker, Katherine, Matthew Johnson, William Dunlop, Margaret Staples, Hamish Rodda, Ian Turner, and Michael Ben-Meir. "Feasibility evaluation of a pilot scribe-training program in an Australian emergency department." Australian Health Review 42, no. 2 (2018): 210. http://dx.doi.org/10.1071/ah16188.
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Objective Medical scribes have an emerging and expanding role in health, particularly in Emergency Medicine in the US. Scribes assist physicians with documentation and clerical tasks at the bedside while the physician consults with his or her patient. Scribes increase medical productivity. The aim of the present study was to examine the feasibility of a pilot hospital-administered scribe-training program in Australia and to evaluate the ability of an American training course (Medical Scribe Training Systems) to prepare trainee scribes for clinical training in an emergency department in Australia. Methods The present study was a pilot, prospective, observational cohort study from September 2015 to February 2016 at Cabrini Emergency Department, Melbourne. Scribe trainees were enrolled in the pre-work course and then trained clinically. Feasibility of training scribes and limited efficacy testing of the course was undertaken. Results The course was acceptable to users and demand for training exists. There were many implementation tasks and issues experienced and resources were required to prepare the site for scribe implementation. Ten trainees were enrolled for preclinical training. Six candidates undertook clinical training, five achieved competency (required seven to 16 clinical shifts after the preclinical course). The training course was helpful and provided a good introduction to the scribe role. The course required adaptation to a non-US setting and the specific hospital setting. In addition, it needed more detail in some common emergency department topics. Conclusion Training scribes at a hospital in Australia is feasible. The US training course used can assist with preclinical training. Course modification is required. What is known about the topic? Scribes increase emergency physician productivity in Australia. There is no previous work on how to train scribes in Australia. What does this paper add? We show that implementing a scribe-training program is feasible and that a training package can be purchased from the US to train scribes in Australia and that it is useful. We also show the adaptation that the course may require to meet Australian emergency department needs. What are the implications for practitioners? Scribes could become an additional member of the emergency department team in Australia and can be trained locally.
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O'Donnell, Jonathan David, Amy Pickar Abernethy, Greg Samsa, Tina Staley, Kristin MacDermott, and Sophia Smith. "Evaluation of an online, skill-building, group intervention for patients with cancer: Pillars4Life." Journal of Clinical Oncology 32, no. 31_suppl (November 1, 2014): 239. http://dx.doi.org/10.1200/jco.2014.32.31_suppl.239.
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239 Background: Psychosocial distress is common for those with cancer; new interventions are needed. Pillars4Life is an online educational program that teaches coping skills in a group format. What is the relationship between participation in the LiveStrong-funded Pillars4Life program and personal psychosocial outcomes? Methods: This was a longitudinal observational cohort study. Cancer patients participating in the Pillars4Life program were recruited from the 17 hospitals that received the LiveStrong Community Impact Award. Consenting participants participated in 10 weekly sessions and completed electronic surveys at baseline and 3 months. Patient reported measures included: distress [Distress Thermometer (DT), Patient Care Monitor (PCM)], depression [Patient Health Questionnaire 9 (PHQ9)], anxiety [Generalized Anxiety Disorder 7 (GAD7)], posttraumatic stress [PTSD Checklist-Civilian (PCLC)], despair (PCM), fatigue [Functional Assessment of Chronic Illness Therapy (FACIT)], and cancer-related wellbeing [Functional Assessment of Cancer Therapy-General (FACTG)] outcomes. Results: Patient participants (n=130) were: mean age 56±11 years; 87% female; 89% white; 61% married; 48% employed; 51% had breast cancer; and 63% were receiving treatment. Mean scores significantly improved from baseline to month 3 on all patient-reported outcome measures: DT (-0.9), PCM Distress (-3.0), PHQ9 (-2.3), GAD7 (-2.3), PCLC (-4.3), PCM Despair (-2.9), FACT-G (4.7), all p<.001; and FACIT-Fatigue (3.3, p=.001). Patients who reported distress at baseline (DT≥4; n=70) had clinically significant improvements (moderate to strong effect sizes ranged from 0.5 to 1.0 standard deviation units) in DT; PCM Distress, Quality of Life, and Despair; PHQ9; GAD7; PCLC; FACTG, among others. Conclusions: Participation in Pillars4Life was associated with statistically and clinically significant improvements on key psychosocial and quality of life patient-reported outcomes measures. Importantly, distressed patients experienced meaningful improvement.
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Harding, Catherine, Alexa Seal, and Narelle Mills. "Evaluation of a Lifestyle and Weight Management Program Within Rural General Practice." Journal of Primary Care & Community Health 13 (January 2022): 215013192210841. http://dx.doi.org/10.1177/21501319221084166.
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Introduction: Australia has one of the highest rates of obesity in the developed world. In response to increasing rates of overweight and obesity in rural Australia, one regional primary health network commissioned the development of a multi-faceted weight and lifestyle management program, addressing nutrition, physical activity, and psychological approaches to behavioral change. This study evaluated the success of the program that was implemented in multiple general practices within regional New South Wales. Methods: De-identified data were received from 16 general practices that participated in the Murrumbidgee Lifestyle and Weight Management Program (MLWMP). Patient weight outcome and functional status measures were determined using descriptive statistics (SPSS). Results: Mean body mass index (BMI) of the 1217 participants was 37.4 kg/m2 and 75% of participants were female. Almost 40% of participants who had a BMI ≥ 40 kg/m2 had been diagnosed with a mental health condition. Upon completion of the program at 6 months, participants had lost an average of 3.2 kg. Over 31% of participants had lost at least 5% of their initial weight and 40% had reduced their waist circumference by at least 5 cm. Overall health and functional status measures were significantly higher upon program completion. There were significant improvements in quality of life measures regardless of level of weight loss during the program. Conclusions: The MLWMP, implemented in general practices within rural and regional Australia, had positive effects on both practices and participants demonstrating the value of intervention programs in primary care. Participants achieved a modest reduction in BMI, waist circumference, and weight. Further work is needed to determine the longer-term success of the program.
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Vandenberg, Brooke E., Jenny Advocat, Craig Hassed, Jennifer Hester, Joanne Enticott, and Grant Russell. "Mindfulness-based lifestyle programs for the self-management of Parkinson’s disease in Australia." Health Promotion International 34, no. 4 (April 11, 2018): 668–76. http://dx.doi.org/10.1093/heapro/day021.
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Abstract Despite emerging evidence suggesting positive outcomes of mindfulness training for the self-management of other neurodegenerative diseases, limited research has explored its effect on the self-management of Parkinson’s disease (PD). We aimed to characterize the experiences of individuals participating in a facilitated, group mindfulness-based lifestyle program for community living adults with Stage 2 PD and explore how the program influenced beliefs about self-management of their disease. Our longitudinal qualitative study was embedded within a randomized controlled trial exploring the impact of a 6-week mindfulness-based lifestyle program on patient-reported function. The study was set in Melbourne, Australia in 2012–2013. We conducted semi-structured interviews with participants before, immediately after, and 6 months following participation in the program. Sixteen participants were interviewed prior to commencing the program. Of these, 12 were interviewed shortly after its conclusion, and 9 interviewed at 6 months. Prior to the program, participants felt a lack of control over their illness. A desire for control and a need for alternative tools for managing the progression of PD motivated many to engage with the program. Following the program, where participants experienced an increase in mindfulness, many became more accepting of disease progression and reported improved social relationships and self-confidence in managing their disease. Mindfulness-based lifestyle programs have the potential for increasing both participants’ sense of control over their reactions to disease symptoms as well as social connectedness. Community-based mindfulness training may provide participants with tools for self-managing a number of the consequences of Stage 2 PD.
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Isbanner, Sebastian, Julia Carins, and Sharyn Rundle-Thiele. "Healthy Eats—Evaluation of a Social Marketing Program Delivered in Primary School Settings in Queensland." International Journal of Environmental Research and Public Health 19, no. 21 (November 3, 2022): 14415. http://dx.doi.org/10.3390/ijerph192114415.
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One in four school children in Australia are overweight or obese. In response, the Healthy Eats program was developed, piloted, and delivered using a whole-of-school approach underpinned by the socio-ecological model to increase fruit and vegetable consumption among children aged 8–10 years in regional Queensland, Australia. This research presents an outcome evaluation of the Healthy Eats program using pre–post data collected throughout 2021 (cross-sectional for knowledge and longitudinal for behaviour) from 19 schools to assess whether changes occurred in students’ nutritional knowledge (n = 1868 (pre = 933, post = 935)) and fruit and vegetable consumption (n = 1042 (pre = 521, post = 521)). Knowledge data was collected via self-reports two weeks prior and immediately after the Nutrition Module. Behavioural data on daily fruit and vegetable consumption was gathered via student passports (i.e., surveys) one week before and for four consecutive weeks after the Nutrition Module. Chi-Square Difference tests and t-Tests were conducted with a significance level set at p < 0.05. Across all 19 schools, knowledge of the daily recommended serves of fruit and vegetables improved significantly following participation in the program, aligning knowledge closer to the Australian dietary guidelines. Behavioural results for fruit consumption were favourable, with clear improvements reported. Increases in vegetable consumption were demonstrated in two of the eight schools. A discussion on the knowledge–action gap is provided, including recommendations for future iterations of the Healthy Eats program.
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Tang, Diana, Rona Macniven, Nicholas Bender, Charlotte Jones, and Bamini Gopinath. "Development, implementation and evaluation of the online Movement, Interaction and Nutrition for Greater Lifestyles in the Elderly (MINGLE) program: The protocol for a pilot trial." PLOS ONE 17, no. 5 (May 12, 2022): e0267581. http://dx.doi.org/10.1371/journal.pone.0267581.
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Introduction People with age-related macular degeneration (AMD) are more likely to experience loneliness, have poorer diets and be less physically active than people without AMD. The online Movement, Interaction and Nutrition for Greater Lifestyles in the Elderly (MINGLE) program is a holistic evidence-based intervention aiming to support people with AMD by incorporating physical activity, social interaction and nutrition education components all delivered via a COVID-19-safe Zoom platform. This study will involve two phases: 1) a formative qualitative study with AMD patients to identify the barriers and facilitators to participating in the proposed MINGLE program; and 2) a 10-week pilot study to evaluate the feasibility, acceptability and preliminary efficacy of MINGLE. Methods and analysis Phase 1 involves AMD patients who will be recruited from an eye clinic in Western Sydney, Australia to participate in audio-recorded semi-structured interviews. Verbatim interview transcripts will be coded using the Capability, Opportunity, Motivation and Behaviour (COM-B) model and themes established. These themes will be used as a guide to specifically tailor the proposed MINGLE program to people with AMD. Phase 2 involves 52 AMD patients who will then be recruited from the same clinic to participate in the MINGLE program. Pre-post questionnaires will be administered to intervention participants to collect information on the following variables: demographics, socioeconomic status, vision function, loneliness, quality of life (including depression), falls risk, physical activity (level), and dietary intake. The acceptability and feasibility of the MINGLE program will also be evaluated using descriptive statistics. Trial registration number ACTRN12621000939897p.
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Jubelt, Lindsay E., Kevin G. Volpp, Dana E. Gatto, Joelle Y. Friedman, and Judy A. Shea. "A Qualitative Evaluation of Patient-Perceived Benefits and Barriers to Participation in a Telephone Care Management Program." American Journal of Health Promotion 30, no. 2 (November 2015): 117–19. http://dx.doi.org/10.4278/ajhp.131203-arb-610.
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Blatch, Chris, Kevin O'Sullivan, Jordan J. Delaney, Gerard van Doorn, and Tamara Sweller. "Evaluation of an Australian domestic abuse program for offending males." Journal of Aggression, Conflict and Peace Research 8, no. 1 (January 11, 2016): 4–20. http://dx.doi.org/10.1108/jacpr-10-2015-0194.
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Purpose – The purpose of this paper is to determine recidivism outcomes for 953 offending men with domestic violence histories, serving community-based sentences and enroled in the domestic abuse program (DAP), provided by Corrective Services New South Wales in Australia. Design/methodology/approach – An intention to treat definition of DAP participation and a quasi-experimental and pseudo-prospective research design compared recidivism outcomes of the treatment group to a propensity score matched control group. Cox and Poisson regression techniques determined survival time to first reconviction and rates of reconvictions adjusted for time at risk. Findings – DAP enrolment was associated with significant improvements in odds of time to first general reconviction (15 per cent) and first violent reconviction (by 27 per cent) compared to controls. Reconviction rates were significantly lower (by 15 per cent) for DAP enrolees. Programme completion was necessary for significant therapeutic effect; 62 per cent completed the programme. Practical implications – This evaluation suggests the 20 session DAP is an effective intervention which could be adopted by other jurisdictions to modify criminal behaviours of domestically abusive men; potentially lessening the physical, emotional and financial impacts on victims and providing savings to government and criminal justice systems. The methodology, with refinements, could be adopted by other service providers to evaluate similar community-based therapeutic interventions in forensic settings. Originality/value – First peer reviewed evaluation of the DAP. The programme contributes to evidence-based best practice interventions for domestically violent men.
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Brusco, Natasha, Andrea Voogt, Melissa Nott, Libby Callaway, Mae Mansoubi, and Natasha Layton. "Meeting Unmet Needs for Stroke Rehabilitation in Rural Public Health: Explorative Economic Evaluation of Upper Limb Robotics-Based Technologies through a Capabilities Lens." Societies 12, no. 5 (October 10, 2022): 143. http://dx.doi.org/10.3390/soc12050143.
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Rehabilitation technologies are rapidly evolving, presenting promising interventions for people with neurological impairments. Access to technology, however, is greater in metropolitan than rural areas. Applying a capabilities approach to this access issue foregrounds healthcare recipients’ rights and personhood within the discourse on resource allocation. Within this context, this study aimed to investigate the economic viability of robotics-based therapy (RBT) in rural Victoria, Australia. A regional health network developed a model of care to provide equitable access to RBT following stroke. This explorative economic evaluation examined both the clinical and economic impact of RBT program implementation across six program iterations compared to 1:1 out-patient rehabilitation. While clinical outcomes were equivalent, the per patient RBT cost ranged from AUD 2681 (Program 1) to AUD 1957 (Program 6), while the per patient cost of usual care 1:1 out-patient rehabilitation, was AUD 2584. Excluding Program 1, the health service cost of usual care 1:1 out-patient rehabilitation was consistently higher, indicating that an established RBT program may be cost-effective, specifically providing less cost for the same effect. This research demonstrates the economic feasibility of delivering RBT in a regional public health stroke service. More broadly, it provided a reduction in the capability gap between rural and metropolitan stroke survivors by tackling an access disadvantage.
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Culos-Reed, SN, M. Dew, J. Shank, DM Langelier, and M. McDonough. "Qualitative Evaluation of a Community-Based Physical Activity and Yoga Program for Men Living With Prostate Cancer: Survivor Perspectives." Global Advances in Health and Medicine 8 (January 2019): 216495611983748. http://dx.doi.org/10.1177/2164956119837487.
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Purpose Physical activity (PA) programs for prostate cancer survivors have positive effects on many aspects of health-related quality of life. Translating this research into sustainable community-based settings is necessary to ensure access to programs for survivors. This study examines patient perspectives in the community-based TrueNTH Lifestyle Management (TrueNTH LM) program in Calgary, Canada. Methods Eleven men from programs at civic wellness centers participated in 2 small semistructured focus groups (n = 5 and 6) at the University of Calgary. Motivation for program initiation and adherence, benefits and barriers to participation, and individual satisfaction and feedback on program improvement were discussed. Audio recordings were transcribed and analyzed using thematic methodology guided by a pragmatic philosophy on the patient experience in the program. Results Themes identified included perceived benefits of participating (physical, psychological, and social), facilitators for involvement in the PA program (program design, initial free access, tailored to prostate cancer specific needs, psychosocial environment), and opportunities for improvement and sustainability (exercise as a part of standard care, cost structure, home-based options). Conclusions These findings provide valuable insight into patient perspectives on effective characteristics of prostate cancer and exercise programs. TrueNTH LM has implemented findings, and ensuring needs (benefits and barriers) are addressed for prostate cancer survivors when entering community-based PA programs.
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Burgess, Naomi, and Deborah Chen. "OP160 Enhancing Innovation Through HTA: Experience From South Australia." International Journal of Technology Assessment in Health Care 34, S1 (2018): 58. http://dx.doi.org/10.1017/s0266462318001666.
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Introduction:A statewide health technology assessment (HTA) program was implemented to increase equity of access and support robust assessment of technologies, with a focus on those that are high-cost, high-risk, or have state-wide impact.Methods:Local hospital networks and clinicians refer technologies to the South Australia Policy Advisory Committee on Technology (SAPACT) for assessment. Independently produced, comprehensive HTA reports are developed using internationally recognized evidence and critical appraisal methodologies. Clinical and economic systematic analyses are utilized, with extensive clinical consultation, to develop recommendations for new technologies and their role in models of care. Feasibility of adoption and local implementation are considered, including existing service delivery and appropriate training and credentialing. For approved technologies, SAPACT may also develop audit criteria and seek implementation reports on clinical outcomes.Results:The HTA framework has been successfully adopted across South Australia Health, increasing the incorporation of evidence-based decision making in the use of high-cost and high-risk health technologies. Over 35 evidence evaluations for high-risk and high-cost health technologies have been conducted for a broad range of treatment interventions. SAPACT develops and utilizes HTA decision-making criteria for transparency of Committee considerations. The program recommends adoption or rejection of technologies, or it may request a re-submission due to safety concerns or a lack of proven effectiveness. SAPACT has also granted temporary approval through adoption under clinical evaluation to inform investment decisions. A key component is working with clinicians to define specific treatment criteria and patient selection. SAPACT continues to strengthen relationships with all stakeholders, increase patient input through the development of public summary documents for technologies, and improve monitoring and reporting of clinical outcomes.Conclusions:The HTA program has been very productive and positively received. The success of the program is underpinned by its engagement with clinicians, hospital networks, and consumers. The completion of SAPACT HTA reviews and the publication of the SAPACT decision-making criteria have increased the credibility of decisions, supporting enhancements in patient care and cost efficiency for the state government.
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Higgins, Niall, Samantha Keogh, and Claire Rickard. "Evaluation of a Pilot Educational Program on Safe and Effective Insertion and Management of Peripheral Intravenous Catheters." Journal of the Association for Vascular Access 20, no. 1 (March 1, 2015): 37–42. http://dx.doi.org/10.1016/j.java.2014.12.001.
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Abstract Peripheral intravenous catheter (PIVC) insertion and subsequent care have been highlighted as areas for improvement in the management of intravascular devices; however, only the fundamentals of PIVC care are routinely taught to registered nurses in Australia. In 2013, a vascular access-focused elective postgraduate course, Peripheral Intravenous Access and Care (8035NRS) was commenced for students enrolled in any of the Griffith University master's degree programs. It was developed with the intent to translate research knowledge into practice by providing access to the latest research findings and current best practices in peripheral intravenous access. Topics covered preinsertion, insertion, and postinsertion care and were developed for the online environment, which is known to be conducive to individual student learning styles. Learning activities included viewing short videos delivered by local and international clinical researchers. This course is the first known university-provided, postgraduate academic course on this subject in Australia, and possibly 1 of the few available internationally. The course succeeded in its aim of increasing knowledge and skills about safe, evidence-based PIVC insertion and care to registered nurses. Its development and implementation at the postgraduate level may be regarded as a strategy to provide a greater understanding regarding scope and relevance for nursing practice and for informed decision making on optimum integration at the undergraduate level. This ultimately will increase positive patient outcomes and the patient experience of vascular access.
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Peterson, David, Tracey Clark, Richard Sprod, Trudi Verrall, Louise English, and Amanda Thomson. "Bloody Good! The Impact of eLearning on Medical and Nursing Practice." International Journal of Advanced Corporate Learning (iJAC) 10, no. 2 (November 9, 2017): 75. http://dx.doi.org/10.3991/ijac.v10i2.7349.
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<p class="Abstract">Blood transfusion is a commonly-performed medical procedure that improves and saves the lives of patients. However, this procedure also has significant risks, is sometimes used inappropriately and has substantial costs associated with the collection, testing, processing and distribution of blood and blood products.</p><p class="Abstract">BloodSafe eLearning Australia (BEA) (<a href="/index.php/i-jac/author/saveSubmit/www.bloodsafelearning.org.au">www.bloodsafelearning.org.au</a>) is an education program for Australian doctors, nurses and midwives, designed to improve the safety and quality of clinical transfusion practice. Courses are interactive and include case studies, videos, and best-practice tips. Successful completion of a multiple-choice assessment provides learners with a certificate of completion. To date there are more than 400,000 registered learners, from more than 1500 organisations, who have completed more than 765,000 courses.</p><p class="Abstract">Stakeholder feedback shows that the program: provides credible, consistent education across Australia; is cost effective; reduces duplication; is ‘best-practice’ elearning that is readily accessible; allows institutions to focus on practical aspects of transfusion education; results in change to clinical practice; and supports the broader implementation of a blood management strategy in Australia.</p><p class="Abstract">User evaluation shows that the courses have a positive impact, with 89% of respondents stating they had gained additional knowledge of transfusion practice, processes and/or policy and more than 87% reporting they will make, or have made, changes to their work practices which will improve patient safety and outcomes.</p>The BloodSafe eLearning Australia program provides education to a large number of health professionals across Australia. Evaluation demonstrates that these courses provide users with a consistent and reliable knowledge base that translates into changes to practice and improved patient outcomes.
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Ravulo, Jioji. "An Integrated Case Management Model to Assist Pacific Youth Offenders and Their Families in Australia." Care Management Journals 17, no. 4 (December 2016): 170–79. http://dx.doi.org/10.1891/1521-0987.17.4.170.
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Pasifika Support Services (PSS) was a program managed by a nongovernment organization, Mission Australia, and funded by the New South Wales Premiers Office to meet the needs of young offenders from a Pacific background. PSS ran from June 2005 to June 2009 and implemented a cost-effective integrated case management model with the New South Wales Police Force adapted to address social risk factors specific to Pacific youth offenders and family support networks. Sixty young people were reviewed regarding the outcomes achieved through their participation, further supported by an evaluation carried out by an external evaluator who found that 65% of participants did not reoffend after 18 months of completing the program. An importance of developing a shared approach to employing a holistic and intensive model of case management that affects individual, community, and organizational change through culturally relevant processes and practices, paired with a cross institutional commitment underpins the various outcomes discussed.
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Jeon, Yun-Hee, Mirim Shin, Adam Smith, Elizabeth Beattie, Henry Brodaty, Dennis Frost, Anthony Hobbs, et al. "Early Implementation and Evaluation of StepUp for Dementia Research: An Australia-Wide Dementia Research Participation and Public Engagement Platform." International Journal of Environmental Research and Public Health 18, no. 21 (October 28, 2021): 11353. http://dx.doi.org/10.3390/ijerph182111353.
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Recruiting participants for dementia research takes time. For those who are interested, opportunities to participate can be ad hoc. Delays in finding the right participants can result in studies taking longer to deliver, often requiring funding extensions, and ultimately increasing the cost and limiting the effectiveness of research and evaluation. To address these issues, a digital platform, StepUp for Dementia Research, was developed in 2019 and evaluated through ongoing data analytics, researcher feedback and annual volunteer surveys in 2019 and 2021. Using innovative matching technology, StepUp provides volunteers with an opt-in, secure way of registering interest in dementia studies and allows researchers to access matched volunteers in Australia. As of June 2021, 1070 volunteers registered (78% female), and 25 organizations became ‘champions’ for StepUp promotion. Of 122 registered researchers, 90 completed training. Forty studies from 17 research/health institutions recruited participants using StepUp. The evaluation demonstrated program feasibility and recruitment efficiency with a high level of satisfaction from users. Evaluation outcomes highlighted disparities in public participation in dementia research (e.g., gender, education and race/ethnicity) and provided valuable insights for further enhancements of StepUp. A concerted and strategic effort is needed by leading registries such as StepUp to ensure narrowing volunteer participation gaps in dementia research.
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Christensen, Erin, Kara Webber, Janet L. Kelly, Stanley S. Weber, and Teresa A. O'Sullivan. "Evaluation of a Longitudinal Institutional Advanced Pharmacy Practice Model." INNOVATIONS in pharmacy 9, no. 3 (October 12, 2018): 2. http://dx.doi.org/10.24926/iip.v9i3.992.
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Objective: To evaluate a longitudinal experiential training model for advanced pharmacy practice experiences (APPEs).
Innovation: A six-month longitudinal pilot program named the Focused Institutional Longitudinal Experience (FILE) program was developed at two academic medical centers to maximize active participation of the student and minimize the time spent orienting and onboarding students to each APPE experience. A unique component of the FILE program is the longitudinal service project, which involved a medication use evaluation, including a review of published literature and drug policy recommendations to medical center quality committees.
Analysis: Student ratings regarding the quality and value of the FILE student experience was compared to the traditional APPE model. Nine quality measures were compared (e.g. amount of opportunity for direct patient care experience, learning, integration into healthcare team, and accountability for patient outcomes) between students from the FILE program to peers completing similar APPEs outside the FILE program. FILE students and APPE preceptors also completed surveys regarding the value of several program aspects.
Key Findings: There was no difference between FILE and non-FILE student self-rated measures of APPE quality, and thus the decision to participate in a longitudinal APPE program should be based on the personal preference of the student. Students in the FILE program agreed or strongly agreed (mean score 4.3) that they felt prepared for post-graduate training at the completion of the program. The potential value that students in a longitudinal program might bring to the site is reinforced by the general agreement by preceptors in the end of year survey that FILE students take less of their time to orient to their service and the trend toward perception that FILE students are more likely to independently participate in patient care activities.
Next Steps: To address feedback on preceptor-mentor role and the desire for more interaction with pharmacy residents, students are now paired with a pharmacy resident, and the student and resident work together on the service project with a clinical pharmacist as an advisor. Updated standards of practice clearly delineate the roles and responsibilities of students, residents, and the clinical pharmacist preceptor. Annual surveys of FILE students and preceptors provide necessary feedback to continuously improve the quality of the program.
Article Type: Note
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Foster, Michele, Elizabeth Kendall, Paul Dickson, Wendy Chaboyer, Beth Hunter, and Travis Gee. "Participation and chronic disease self-management: Are we risking inequitable resource allocation?" Australian Journal of Primary Health 9, no. 3 (2003): 132. http://dx.doi.org/10.1071/py03037.
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The Ottawa Charter for Health Promotion supported the empowerment of individuals to participate in their health care and have control over their health. For older adults with chronic conditions, the Chronic Disease Self-Management Program has been widely adopted as an adjunct to existing healthcare options. A growing body of literature has supported the positive impact of self-management programs on outcomes for people with a range of chronic conditions. However, evidence also suggests that participation in these programs is biased. This paper draws on pilot data to describe the profile of those people who inquire, enrol, attend, and complete CDSM courses in Queensland, Australia. As expected, there was evidence that males, Indigenous people, people of non-English speaking background, and those with multiple responsibilities were less likely to participate. Most importantly, participation was affected by a self-selection bias associated with health status. Those who were either unwell or well at the time of the course were unlikely to attend, minimising the preventative value of the CDSM program. Further, CDSM evaluation studies are likely to be inherently flawed and the distribution of health resources can become inequitable.
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Lopez, Rafael, Antonio Antón, Enrique Aranda, Alfredo Carrato, Manuel Constenla, Juan J. Cruz-Hernández, Eduardo Díaz-Rubio, et al. "Evaluation of Spanish hospitals participating in the Quality Oncology Practice Initiative program." Journal of Clinical Oncology 38, no. 29_suppl (October 10, 2020): 222. http://dx.doi.org/10.1200/jco.2020.38.29_suppl.222.
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222 Background: Measuring and tracking quality of care is highly relevant in today’s healthcare. The Quality Oncology Practice Initiative (QOPI) program is a referral for evaluating oncology practices worldwide. The ECO Foundation (Excellence and Quality in Oncology), a collaboration of oncology experts from the major Spanish hospitals involved in cancer treatment, reached an agreement with ASCO (American Society of Clinical Oncology) to include Spanish hospitals in its QOPI program. Methods: We analyzed the results of the QOPI core module measures from 19 Spanish hospitals submitting their data in nine rounds (from Fall 2015 to Fall 2019). Results: Of the 19 hospitals, 15 participated more than once; none participated in all 9 rounds (2 hospitals participated in 8 rounds). The highest scores were for pathology report confirming malignancy, documenting plan of care for moderate/severe pain and chemotherapy dose, and chemotherapy administered to patients with metastatic solid tumor with performance status undocumented. Measures regarding a summary of chemotherapy treatment, tobacco use cessation counseling, and assessment of patient emotional well-being were among the lowest scored measures. Six of the 15 practices who participated repeatedly achieved a better score in their last round compared to their first. Overall, scores of Spanish hospitals improved from 67.79% in Fall 2015 to 68.91% in Fall 2019. Conclusions: This is the first study to evaluate QOPI scores in Spain; it showed that repeated participation enhances quality of care, although there is room for improvement. The ECO Foundation will continue supporting and engaging with practices to increase their participation in order to improve oncology care and implement strategies that address the areas for improvement.
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Dartnell, Jonathan, Jane London, Jeffrey Elliott, Catherine Hill, and Rachelle Buchbinder. "OP84 Collaborative Program To Improve Early Management Rheumatoid Arthritis." International Journal of Technology Assessment in Health Care 35, S1 (2019): 21. http://dx.doi.org/10.1017/s0266462319001399.
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IntroductionOptimal rheumatoid arthritis (RA) management requires coordinated management and consistent communication by health practitioners with patients. Suboptimal methotrexate use is a factor leading to increased use of biological disease modifying antirheumatic drugs (bDMARDs), which account for significant government drug expenditure. A multidisciplinary co-design approach was used to develop and implement a program aiming to improve early management and quality use of medicines (QUM) for people with RA in Australia.MethodsLiterature review and key informant interviews identified broad potential QUM issues in RA management. An initial exploratory multidisciplinary meeting prioritized QUM issues, identified audiences and perspectives, and scoped focus areas to address with education. Iteratively through co-design meetings and activities, program objectives were agreed, barriers and enablers for change explored, characteristics of intervention activities considered and rated, and program products developed and reviewed. Program evaluation included participation and distribution data, surveys and interviews, and analyses of general practice and Pharmaceutical Benefits Scheme (PBS) data.ResultsQUM issues addressed include: (i) timely initiation of conventional synthetic (cs) DMARDs; (ii) appropriate use and persistence with csDMARD therapy, especially methotrexate; and (iii) clarity around professional roles and best practice for prescribing, dispensing, and monitoring DMARDs, and managing lifestyle factors and other risks associated with RA. The educational program (October 2017 to June 2018) included: an article promoting key messages (email to ~115,000 health practitioners), prescriber feedback report based on PBS data (to all Australian rheumatologists), an RA action plan (completed by health practitioners for consumers), an interactive case study (553 participants), visits to 1200 pharmacies promoting key messages, a multidisciplinary webinar (431 live and 366 on-demand), fact sheets for consumers available through MedicineWise app (medicine management app for consumers), and social media activity.ConclusionsA multidisciplinary co-design process has provided a model for developing a multifaceted QUM program incorporating and addressing multiple perspectives.
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Kelly, Christopher, Lyn Holley, and Stephen Fogle. "Evaluation of an early implementation of the revised Opening Minds Through Art Program." Innovation in Aging 4, Supplement_1 (December 1, 2020): 814. http://dx.doi.org/10.1093/geroni/igaa057.2963.
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Abstract The established international program Opening Minds through Art (OMA) has been revised; this presentation reports evaluation of an early implementation with Gerontology university students and Alzheimer’s nursing home patients. Ten patients were paired with student volunteers meeting once a week for eight weeks to co-create original artwork in structured one-hour sessions. Before and after art creation each volunteer recorded personal feelings and their partner’s mood and satisfaction. Findings indicate the revised program is satisfying for patients and improves their mood. Families seeing the art expressed surprise and appreciation regarding patient creative capacity. Analysis of data indicates positive outcomes for student volunteers and Alzheimer’s patients. Student volunteer reflections link program participation with expanded knowledge, insight, and especially empathy for Alzheimer’s patients and their families. The current study contributes to robust support in the literature for efficacy of arts programming for student learning and the morale of Alzheimer’s patients and their families.
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Lacey, Susan R., Caryl Goodyear-Bruch, Adrienne Olney, Dave Hanson, Marian S. Altman, Natasha S. Varn-Davis, Debbie Brinker, Ramón Lavandero, and Karen S. Cox. "Driving Organizational Change From the Bedside: The AACN Clinical Scene Investigator Academy." Critical Care Nurse 37, no. 4 (August 1, 2017): e12-e25. http://dx.doi.org/10.4037/ccn2017749.
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BACKGROUND Staff nurses are pivotal in leading change related to quality improvement efforts, although many lack skills to steer change from the bedside. The American Association of Critical-Care Nurses (AACN) staff nurse leadership program, Clinical Scene Investigator (CSI) Academy, teaches and empowers staff nurses in leadership skills and change concepts to translate evidence into practice affecting patient outcomes. OBJECTIVES To describe the curriculum of the AACN CSI Academy that provides staff nurses with the leadership skills required to create unit-based change projects that positively impact patient/family outcomes. METHODS The curriculum of the Academy included leadership topics, communication, change concepts, quality improvement methods, project management, and data management and analysis. Each team of participants collected project data to show improvements in patient care. The program evaluation used many data sources to assess the program effectiveness, relating to the professional growth of the participant nurses. The participants assessed project patient outcomes, sustainability, and spread. RESULTS The first cohort of CSI participants included 164 direct care nurses from 42 hospitals in 6 cities. They rated the Academy highly in the program evaluation, and they reported that the Academy contributed to their professional development. The individual hospital quality improvement projects resulted in positive patient and estimated fiscal outcomes that were generally sustained 1 year after the program. CONCLUSION With the skills, tools, and support obtained from participation in the CSI Academy, staff nurses can make substantial contributions to their organizations in clinical and possibly fiscal outcomes.
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Willman, Britta, Kjell Grankvist, and Karin Bölenius. "Evaluation of the clinical implementation of a large-scale online e-learning program on venous blood specimen collection guideline practices." Clinical Chemistry and Laboratory Medicine (CCLM) 56, no. 11 (October 25, 2018): 1870–77. http://dx.doi.org/10.1515/cclm-2018-0051.
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Abstract Background: When performed erroneously, the venous blood specimen collection (VBSC) practice steps patient identification, test request management and test tube labeling are at high risk to jeopardize patient safety. VBSC educational programs with the intention to minimize risk of harm to patients are therefore needed. In this study, we evaluate the efficiency of a large-scale online e-learning program on personnel’s adherence to VBSC practices and their experience of the e-learning program. Methods: An interprofessional team transformed an implemented traditional VBSC education program to an online e-learning program developed to stimulate reflection with focus on the high-risk practice steps. We used questionnaires to evaluate the effect of the e-learning program on personnel’s self-reported adherence to VBSC practices compared to questionnaire surveys before and after introduction of the traditional education program. We used content analysis to evaluate the participants free text experience of the VBSC e-learning program. Results: Adherence to the VBSC guideline high-risk practice steps generally increased following the implementation of a traditional educational program followed by an e-learning program. We however found a negative trend over years regarding participation rates and the practice to always send/sign the request form following the introduction of an electronic request system. The participants were in general content with the VBSC e-learning program. Conclusions: Properly designed e-learning programs on VBSC practices supersedes traditional educational programs in usefulness and functionality. Inclusion of questionnaires in the e-learning program is necessary for follow-up of VBSC participant’s practices and educational program efficiency.
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Hevey, David, Jennifer Wilson O’Raghallaigh, Veronica O’Doherty, and Katie Lonergan. "Pre-post effectiveness evaluation of Chronic Disease Self-Management Program (CDSMP) participation on health, well-being and health service utilization." Chronic Illness 16, no. 2 (August 8, 2018): 146–58. http://dx.doi.org/10.1177/1742395318792063.
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ObjectivesThe Chronic Disease Self-Management Program (CDSMP) is a standardized self-management intervention for patients with various chronic diseases. CDSMP provides self-management skills to enhance patient health, well-being, and coping skills. The present study evaluates the effectiveness of CDSMP delivered in routine clinical services on health, health behaviors and healthcare utilization in patients with various chronic illnesses.MethodsA pragmatic single group pre-post design evaluated the effectiveness of the CDSMP in an Irish cohort using self-report data collected by service providers in hospital, community health and patient organizations. Data on health, health behavior and healthcare utilization were collected at baseline ( n = 263), immediately post-program ( n = 102), and six months ( n = 81) after enrollment.ResultsCDSMP participants reported statistically significant increases in activity levels, self-efficacy, energy and quality of life, and a significant decrease in depression scores at six months follow-up. There was a significant decrease in self-reported visits to the GP and in total nights spent in hospital.DiscussionThis national pre–post study provides preliminary evidence for the potential effectiveness of CDSMP delivered during routine care in improving important health outcomes and reducing health care utilization among a heterogeneous sample of chronic disease patients.
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Foley, Bridget C., Katherine B. Owen, William Bellew, Luke Wolfenden, Kathryn Reilly, Adrian E. Bauman, and Lindsey J. Reece. "Physical Activity Behaviors of Children Who Register for the Universal, State-Wide Active Kids Voucher: Who Did the Voucher Program Reach?" International Journal of Environmental Research and Public Health 17, no. 16 (August 6, 2020): 5691. http://dx.doi.org/10.3390/ijerph17165691.
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Active Kids is a government-led, universal voucher program that aims to reduce the cost of participation in structured physical activity for all school-enrolled children in New South Wales (NSW), Australia. As part of the Active Kids program evaluation, this cross-sectional study examined the Active Kids’ program’s reach to children in NSW and their physical activity behaviors, before voucher use. Demographic registration data from all children (4.5–18 years old) who registered for an Active Kids voucher in 2018 (n = 671,375) were compared with Census data. Binary and multinomial regression models assessed which correlates were associated with meeting physical activity guidelines and participation in the sessions of structured physical activity. The Active Kids program attracted more than half (53%) of all eligible children in NSW. Children who spoke a primary language other than English at home, were aged 15–18 years old, lived in the most disadvantaged areas, and girls, were less likely to register. Of the registered children, 70% had attended structured physical activity sessions at least once a week during the previous 12 months, whilst 19% achieved physical activity guidelines. Active Kids achieved substantial population reach and has the potential to improve children’s physical activity behaviors.
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Hill, Anne, Railton Hill, and Susan Moore. "Product Evaluation in a Social Marketing and Community Development Context: A Case Study and Initial Report." Social Marketing Quarterly 15, no. 2 (May 22, 2009): 92–104. http://dx.doi.org/10.1080/15245000902957318.
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We provide an initial report and case study of product evaluation for social marketing undertaken specifically within a “community development” context. Starting Points is a highly differentiated not-for-profit development program targeting parents/caregivers of 0—4-year-olds. Parents/caregivers self select to participate in four highly interactive two-hour sessions, usually across a number of weeks, located within their own communities. The project was developed in Melbourne, Australia, and is being delivered in many communities across the nation. The service product evaluated is essentially the enhancement of parental confidence, achieved through parental/caregiver participation in the community-based programs which are initiated, marketed, and delivered by peer facilitators. The article locates such evaluation within the program evaluation and marketing audit literatures, describes the product evaluation component of the research design, and reports preliminary empirical results. These suggest that the Starting Points product is perceived both by participant parents and their partners as resulting in significant increases in parental confidence, sustained well past the immediate postparticipation period. These results provide one critical empirical element of a thorough service evaluation, itself a step toward a thorough-going social marketing auditing process.
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Parikh, Ravi B., Justin E. Bekelman, Qian Huang, Joseph R. Martinez, Ezekiel J. Emanuel, and Amol S. Navathe. "Characteristics of Physicians Participating in Medicare’s Oncology Care Model Bundled Payment Program." Journal of Oncology Practice 15, no. 10 (October 2019): e897-e905. http://dx.doi.org/10.1200/jop.19.00047.
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PURPOSE: The Oncology Care Model (OCM) is Medicare’s first bundled payment program for patients with cancer. We examined baseline characteristics of OCM physician participants and markets with high OCM physician participation to inform generalizability and complement the ongoing practice-level evaluation of the OCM. METHODS: In this cross-sectional study, we identified characteristics of US medical oncologists practicing in 2016, using a national telephone-verified physician database. We linked these data with Dartmouth Atlas and Medicare claims data from 2011 through 2016 to identify characteristics of markets with high OCM participation. We used logistic regression to examine relationships between market characteristics and OCM participation. RESULTS: Of 10,428 US medical oncologists, 2,605 (24.9%) were listed in an OCM practice. There were no differences in sex or medical training between OCM participants and nonparticipants, although OCM participants were slightly younger. OCM participants practiced in larger (median daily patient volume, 80 v 55 patients) and urban practices (95.2% v 90.7%) and were less likely to be part of a health system (41.0% v 60.4%) or solo practice (45.5% v 67.4%; all P < .001). Participation was higher in southern and mid-Atlantic markets. Markets with high OCM physician participation had higher specialist density, hospital care intensity, and acute care use at the end of life (all P < .001). Market-level penetration of Accountable Care Organizations (adjusted odds ratio, 4.65; 95% CI 3.31 to 6.56; P < .001) and Medicare Advantage (adjusted odds ratio 2.82; 95% CI, 1.97 to 4.06; P < .001) were associated with higher OCM participation. CONCLUSION: In the first description of oncologists participating in the OCM, we found differences in practice demographics, care intensity, and exposure to nontraditional payment models between OCM-participating and nonparticipating physicians. Such provider-level differences may not be captured in Medicare’s practice-level analysis.
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Sutantri, Sutantri. "Current status and future directions of cardiac rehabilitation program: a review of the literature." Journal of Health Technology Assessment in Midwifery 2, no. 2 (November 4, 2019): 59–68. http://dx.doi.org/10.31101/jhtam.971.
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One of the effective treatments for patients recovering from acute cardiac illness or surgery is cardiac rehabilitation (CR). CR has proven to be effective to reduce mortality, morbidity, and also to improve the quality of life. The purpose of this review is to present the current status of CR program worldwide as well as to identify a potential approach for further investigation. Literature searching of electronic databases was conducted in several databases including CINAHL, MEDLINE, PsycINFO, and EMBASE, and Google Scholar. CR aims to restore patients with CVD to a state of good health. Each country has different approach in the provision and organization of CR as well as the allocation of resources, which depends on their health policies and politics. The indications for CR also differ between countries, but traditionally CR has been used following acute myocardial infarction (MI). CR programs have been divided into three phases of progression. Hospital-based or supervised site-based programs have been known as the most common model of CR in most countries. The core components of CR include patient assessment, nutritional counselling, exercise training, physical activity counselling, weight management, tobacco cessation, aggressive coronary risk-factor management, and psychosocial management. Despite the apparent benefits of CR in patients with CVD, these programs remain largely underused. The participation rates in the USA, Australia, and Europe are low, estimated at 10-30%. New research areas that explore new ways of CR delivery to improve referral and participation rates are essential.
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Shah, Smita, Brett G. Toelle, Susan M. Sawyer, Jessica K. Roydhouse, Peter Edwards, Tim Usherwood, and Christine R. Jenkins. "Feasibility study of a communication and education asthma intervention for general practitioners in Australia." Australian Journal of Primary Health 16, no. 1 (2010): 75. http://dx.doi.org/10.1071/py09056.
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The Physician Asthma Care Education (PACE) program significantly improved asthma prescribing and communication behaviours of primary care paediatricians in the USA. We tested the feasibility and acceptability of a modified PACE program with Australian general practitioners (GP) and measured its impact on self-reported consulting behaviours in a pilot study. Recruitment took place through a local GP division. Twenty-five GP completed two PACE Australia workshops, which incorporated paediatric asthma management consistent with Australian asthma guidelines and focussed on effective communication strategies. Program feasibility, usefulness and perceived benefit were measured by questionnaires before the workshop and 1 month later, and an evaluation questionnaire after each workshop. GP were universally enthusiastic and supportive of the workshops. The most useful elements they reported were communication skills, case studies, device demonstrations and the toolkit provided. GP self reports of the perceived helpfulness of the key communication strategies and their confidence in their application and reported frequency of use increased significantly after the workshops. The PACE program shows promise in improving the way in which Australian GP manage asthma consultations, particularly with regard to doctor–patient communication. The impact of the modified PACE Australia program on the processes and outcomes of GP care of children with asthma is now being measured in a randomised controlled trial.
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Talati, Zenobia, Carly Grapes, Emily Davey, Trevor Shilton, and Simone Pettigrew. "Implementation Outcomes Following Participation in a Large-Scale Healthy Workplace Program Conducted Across Multiple Worksites." American Journal of Health Promotion 34, no. 5 (April 3, 2020): 512–19. http://dx.doi.org/10.1177/0890117120911504.
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Purpose: To measure implementation outcomes of a freely available workplace health promotion program (Healthier Workplace Western Australia [HWWA]) that provides employees with services and supports to make changes in their workplaces. Setting: Western Australian workplaces. Subjects: Employees accessing HWWA services. Intervention: A range of services (training sessions, tailored advice, grant schemes, online resources) were offered relating to nutrition, physical activity, smoking, alcohol consumption, and mental health. Design/Measures: Of the 1627 individuals e-mailed 6 months after participation in HWWA, 345 (21%) individuals who recalled accessing one or more services completed a survey assessing the number and type of changes they had implemented and the perceived barriers to doing so. Analysis: Negative binomial regressions and one-way analysis of variances assessed whether respondent characteristics or number of services used was associated with the number and types of changes made. A qualitative analysis of the perceived barriers was also conducted. Results: The majority of respondents (86%) reported implementing one or more changes. Greater perceived responsibility/authority to make change (β = .56, P < .01), perceived support from coworkers (β = .23, P < .05), and number of HWWA services used (β = .04, P < .05) were positive predictors of the number of changes made. Frequently reported barriers included cost/budget restrictions, lack of management support, and resistance from staff. Conclusion: The HWWA program facilitated implementation of various healthy workplace initiatives across the organizations represented in the evaluation.
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Grimmer-Somers, Karen, Wendy Dolesj, and Joanne Atkinson. "Enhanced Primary Care pilot program benefits Type II diabetes patients." Australian Health Review 34, no. 1 (2010): 18. http://dx.doi.org/10.1071/ah09619.
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Background.The Australian Government Medicare Enhanced Primary Care (EPC) initiative for chronic disease management (CDM) supports integrated allied health (AH) and general medical practitioner (GP) care. There are limited examples of how to operationalise this initiative in private practice, and minimal evidence of expected service utilisation or acceptability to patients. This paper reports on a 2007 Australian integrated GP/private sector AH pilot program, based on Medicare EPC guidelines for Type II diabetes. Objectives.Describe how the pilot program was put in place (operationalised). Report on service utilisation and patient perspectives of the pilot program. Methods.Pilot program: patients with Type II diabetes were referred to credentialed diabetes educators (CDEs), dietitians or podiatrists by their GP, via a Medicare-approved team care arrangement (TCA). Dietitians and CDEs operated on a sessional basis from GPs’ rooms, and podiatrists operated from their own clinics. All AH providers accepted the Medicare Plus rebate only, and provided guidelines-based care (focussed on patient education, disease ownership and self-management). Service utilisation was measured by the number and type of AH attendances per patient. Patient perspectives of the pilot program, and what they perceived they had gained from participation in it, were measured by semi-structured telephone interviews. Results.An average of 2.3 AH consultations were consumed by 588 patients, of whom 59 were interviewed. Interviewed patients appreciated the ready and timely access to AH services at no additional cost, the integration of GP/AH care, and being actively involved in managing their disease. Approximately 60% of patients had never previously consulted an AH provider regarding diabetes. Interviewees perceived that collocated, integrated GP–AH care heightened their disease awareness, improved their knowledge of their disease and encouraged them to better self-manage. Most interviewees indicated that they did not require further AH assistance in the short term (having gained what assistance they needed), and ~60% interviewees indicated they would pay a gap fee for similar AH services in the future. Conclusion.Integrated AH/GP guidelines-based care provided in GP clinics appears to be cost efficient. It has the potential to improve patient access to AH care, promote the role of integrated care in the management of Type II diabetes, and improve patient education and self-management. What is known about the topic?There is a growing body of research on the effectiveness of multidisciplinary teams in the management of patients with chronic disease, in terms of promoting better health and self-management education. However little is known in Australia about the operationalisation of the Enhanced Primary Care (EPC) program by general medical practitioners (GPs) and private allied health (AH) providers, to manage any chronic disease. Service utilisation and patient perspectives of integrated GP/AH care under the EPC program are also largely unreported. What does this paper add?This paper describes how the pilot program was put in place (operationalised) within the Australian context using the Medicare EPC initiative, for the management of Type II diabetes. It describes service utilisation, and patient perspectives of integrated private AH and GP care in terms of the process, and what they gained from participating in it. What are the implications for practitioners?Integrating private AH and GP care in GPs’ rooms in Australia, under the EPC program, appears to be cost effective and readily accessible, and provides advantages for patients with Type II diabetes.
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Mathern, Nathalie, Johanna Sandmann, Thorsten Sichtermann, Hani Ridwan, Alexander Riabikin, Andrea Stockero, Omid Nikoubashman, and Martin Wiesmann. "Can training on ex-vivo models increase neurointerventionalists’ subjective self-confidence in the operating room?" PLOS ONE 17, no. 2 (February 22, 2022): e0264180. http://dx.doi.org/10.1371/journal.pone.0264180.
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In a changing learning environment where young neurointerventionalists spend less time in the operating room, computer simulators have been established as a new training model. Our aim was the comparison of silicone models and computer simulators, and the evaluation of their influence on subjective self-confidence of operators. Pre- and postquestionnaires of 27 participants and 9 tutors were evaluated after the participation in a three-days interventional stroke course using silicone models and computer simulators. Training on computer simulators was considered as more realistic and important before patient contact than training on silicone models. Participants rated their own abilities as significantly better after participation in the course and felt significantly better prepared for patient care. Training on computer simulators can increase the subjective self-confidence of trainees. We suggest a stepwise training program, comprising both ex-vivo and the porcine in-vivo model, finished by conventional operating room teaching, to prepare neuroradiologists for optimal patient care when performing interventions.
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Cherney, Adrian. "Evaluating Programs to Counter Violent Extremism: The Example of Case-Managed Interventions." Proceedings 77, no. 1 (April 28, 2021): 20. http://dx.doi.org/10.3390/proceedings2021077020.
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In recent years, there has been a proliferation of programs aimed at preventing radicalization and disengaging known violent extremists. Some programs have targeted individuals through the use of case management approaches and the development of individual intervention plans (e.g., the Desistance and Disengagement Program and the Channel program in the UK; the Australian New South Wales Corrections Proactive Integrated Support Model—PRISM—and state-based division initiatives in Australia). There is a broad consensus in the literature that the evaluation of such initiatives has been neglected. However, the evaluation of case-managed interventions to counter violent extremism (CVE) is challenging. They can have small caseloads which makes it difficult to have any comparison or control group. Client participation can vary over time, with no single intervention plan being alike. This can make it hard to untangle the relative influence of different components of the intervention on indicators of radicalization and disengagement. In this presentation, results from primary research that set out to evaluate case-managed CVE interventions in Australia and develop evaluation metrics are presented. This research involves the examination of interventions implemented by New South Wales corrections and state police. The effectiveness of these interventions was assessed against a five-point metric of client change. Client change overtime was analyzed using case note information collected by the various interventions on client participation. Results show that client change is not a linear process and that the longer an individual is engaged in a case-managed intervention, the more likely they are to demonstrate change relating to disengagement. Specific case studies are used to illustrate trajectories and turning points related to radicalization and to highlight the role of case-managed interventions in facilitating disengagement. Key elements of effective interventions include the provision of ongoing informal support. Investment in capturing case note information should be a priority of intervention providers. Different challenges confronted by case-managed CVE interventions are highlighted.
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Rogers, Alison, Madeleine Bower, Cathy Malla, Sharon Manhire, and Deborah Rhodes. "Developing a Cultural Protocol for Evaluation." Evaluation Journal of Australasia 17, no. 2 (June 2017): 11–19. http://dx.doi.org/10.1177/1035719x1701700203.
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Evaluation is understood to be important for ensuring programs and organisations are effective and relevant. Evaluation findings, however, can be potentially inappropriate or not useful if those who have an in-depth understanding of the context are not involved in guidance, direction or implementation. The Fred Hollows Foundation's Indigenous Australia Program (IAP), with more than half of its employees identifying as Aboriginal and/or Torres Strait Islander, has developed a cultural protocol for evaluation to strengthen the quality of its program evaluations, whether they are carried out by internal staff or external evaluators. The development of the protocol was initiated after an evaluation capacity building appraisal identified the potential benefits of increased external support to undertake evaluation activities, and the requirement for this external support to be undertaken in a culturally appropriate manner. The protocol was developed by combining IAP's experience and knowledge with contemporary evaluation and research approaches, particularly those developed for use in cross-cultural settings, with the aim of producing a meaningful and locally relevant resource. The protocol aims to assist staff and external evaluators to ensure that evaluation activities are undertaken with the appropriate respect for, and participation of, Aboriginal and Torres Strait Islander individuals and communities. Consistent with IAP principles, those involved in the process of developing the protocols sought to ensure that engagement between staff, evaluators and evaluation participants occurs in culturally-appropriate ways. IAP believes that the protocol will contribute to stronger evaluation practices, deeper understanding and thus, more useful outcomes. This article describes the process of engaging IAP staff with contextual evidence and the literature around cultural protocols to create a meaningful tool that is useful in our particular context. The process of development described will be useful for: organisations undertaking initiatives that source external evaluators; internal evaluators engaging with external expertise; or evaluators linking with organisations working in a cross-cultural setting.
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Nguy, Jodie, Melissa Petrakis, and Michael Wilson. "Evaluation of a four-week Rehabilitation Assessment program introduced at an Australian Community Care Units setting: mental health consumers and clinicians perspectives." European Journal for Person Centered Healthcare 2, no. 3 (July 15, 2014): 359. http://dx.doi.org/10.5750/ejpch.v2i3.743.
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Background: Community Care Units (CCUs) are purpose built residential accommodation for adults with severe and enduring mental illness. The CCUs are staffed by clinical mental health staff 24 hours per day and there are consistent guidelines as to the process these programs utilise to prioritise who would most benefit from them. A CCU based in the Inner East of Melbourne, Australia, has utilised one bed as a ‘review program’ to assess patients’ functional livings skills and potential for engagement with the long-term rehabilitation program as part of a general more person-centered healthcare approach. Aims: The purpose was to evaluate: (1) patient perception of the program and if this benefits their rehabilitation, (2) the perception of clinicians who refer to the program and (3) the perception of clinicians of the CCU multidisciplinary team (MDT). Method: A purposive sample of patients and clinicians was employed. Semi-structured interviews were conducted with 7 patients who had participated in the review program between January 2010 - April 2012 and an online survey was conducted with responses from 5 case managers who had referred patients and 9 clinicians in the CCU MDT team who had participated in conducting the review. Results: Our results indicated that patients found the process somewhat overwhelming and an adjustment to their daily routine; they were generally unclear as to the rationale for referral to the program. Clinicians found the program to be a useful process in assisting a more in-depth understanding of their patients’ needs. Conclusion: Results suggest that review and modification to program delivery could enhance patient benefits and enhance more person-centered approaches to care.
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Trehan, Ram Swarup, Winston Wong, Daniel Winn, Joseph Cooper, Tim Olson, Jeffrey A. Scott, and Bruce A. Feinberg. "Financial impact of an oncology medical home on participating providers." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): e17581-e17581. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e17581.
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e17581 Background: CareFirst BlueCross BlueShield (CFBCBS) partnered with Cardinal Health Specialty Solutions (CHSS) to launch the first cancer care clinical pathway in the United States in August 2008. Due to early success of the program with regard to savings and physician participation and compliance, CFBCBS and CHSS piloted an oncology medical home program in January 2011 with the hope of further decreasing cancer care costs while continuing consistency and quality of patient care. The medical home program offered a new physician reimbursement model that shifted the source of revenue from margin on drug sales to cognitive services. This would allow physicians to focus on optimal patient care without the financial incentive to prescribe chemotherapy. We analyzed the financial impact of the medical home program on participating physicians 1 year after implementation. Methods: Intravenous drug codes plus the evaluation and management codes for patient visits and chemotherapy administration were used in the analysis. We analyzed amounts paid to participating practices for chemotherapy, supportive care treatments, and nondrug services for year +1 to the amounts paid for the same services for year -1. We also analyzed the medical home fee schedule for year +1 when compared to the first-generation fee schedule applied to program year +1 utilization. This was calculated by repricing year +1 claims to the first-generation fee schedule and comparing that cost to what was actually paid under the medical home fee schedule. Results: Fourteen practices (31 physicians, 478 patients) joined the medical home program. Average amounts paid to physicians were 4.7% higher for year +1 compared to the prior year. The average cost difference for year +1 based on the medical home fee schedule versus the first-generation fee schedule was -5.7%. If physicians had chosen not to join the medical home program their revenues would have increased by 11%. Conclusions: Drug cost inflation was a significant contribution to savings in this model and directly impacts the observed lower average reimbursement to medical home participants versus their pathway program peers. Providers are likely to seek remedies for continued participation.
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Jefferson, Theresa, Gloria Phillips-Wren, and Phoebe D. Sharkey. "Assessing Individual Health Insurance Coverage and Utilization Before and After the Patient Protection and Affordable Care Act." International Journal of Strategic Decision Sciences 7, no. 4 (October 2016): 55–70. http://dx.doi.org/10.4018/ijsds.2016100105.
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The adoption of the Patient Protection and Affordable Care Act (PPACA) in 2010 with the intent to improve the U.S. health care delivery system by expanding health insurance coverage and controlling health care costs has generated intense debate regarding its implementation. Marketplaces known as insurance exchanges have been established to provide coverage for Americans who otherwise could not get affordable health care benefits. These exchanges have been plagued with financial losses and other challenges leading to several large insurance providers discontinuing participation in the program. There are many possible remedies under consideration to make the program work better. This research seeks to support program evaluation as well as potential modifications to the law by providing baseline data to compare access and costs in states with state-based exchanges compared to states with federal exchanges. The authors perform an analysis by state for the years 2012 and 2013 (pre-PPACA implementation) using data from the Current Population Survey (U.S. Census) as well as de-identified claims data from Inovalon, Inc.
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Musial, Jane, Andrea Cawte, Robert Mullins, Mary Hannan-Jones, and Susan de Jersey. "Implementation and evaluation of a university–hospital partnership program for Type 2 diabetes." Australian Health Review 46, no. 1 (November 16, 2021): 78–84. http://dx.doi.org/10.1071/ah21173.
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Objective The aims of this study were to determine whether a university–hospital partnership program for Type 2 diabetes (T2D) would: be well attended; reduce the number of patients on the diabetes out-patient waiting list who have been waiting longer than the recommended; increase discharge from the hospital clinic; increase university health clinic (UHC) occasions of service; be sustainable; and be acceptable to participants. Method A prospective observational study was conducted between 2016 and 2019. Participants with T2D were referred to a UHC, initially from a hospital diabetes wait list. The final program consisted of 10 weeks: before and after individual assessments, as well as 8 weeks of exercise and education facilitated by health professionals and students. Participant demographic characteristics and data on attendance, discharge and follow-up requirements, the percentage of patients waiting longer than the recommended for a new hospital out-patient appointment, university activity and patient satisfaction were collected. Results In all, 130 participants commenced the program, 80% completed at least six of eight group sessions and 80% attended the final assessment. The percentage of people waiting longer than recommended decreased from 63% to 16%. The hospital discharged 87% and 59% of participants from the dietitian and endocrinologist respectively. The UHC recorded 2056 occasions of service and 2056 student experiences including dietetics, exercise physiology, psychology, nursing, optometry, social work and podiatry students relating to the program. Satisfaction was high, as measured by the Short Assessment of Patient Satisfaction, with a mean score of 23.9 from a possible score of 28.0 (n = 93). Conclusion The partnership resulted in a new model of care for patients with T2D and increased learning experiences for students. What is known about the topic? Diabetes is the fastest growing disease in Australia, placing unsustainable demands on the health system. Access to patient-centred care and self-management education is essential to optimise glycaemic control, prevent or delay complications and maintain quality of life. The increasing demand of diabetes on the health system affects access to timely care, with unacceptably long wait times reported, resulting in an increase in morbidity and mortality and poor patient satisfaction. A potential solution is the use of clinical students to contribute to service delivery. Student-assisted and student-led health clinics have increased access to care across the globe for many years. What does the paper add? Although group education has the potential to reduce the burden on clinical service delivery, it was unclear whether a partnership program using students and university and hospital resources would be acceptable to people with T2D and whether this model delivered at a UHC would be sustainable and of benefit to both the health service and university. The results of the evaluation suggest that a university–hospital partnership program is well accepted by participants, well attended, reduces the number of patients waiting for a hospital appointment longer than the acceptable waiting times, increases UHC activity and provides interdisciplinary student experiences. As such, this paper provides evidence that this model of care offers a potential solution to increasing demands for health services for diabetes and student clinical experience. What are the implications for practitioners? Partnerships between UHCs and hospitals offer a sustainable solution to increasing demand for diabetes services and student training requirements. The description of the development, implementation and evaluation processes can be used by practitioners and educators as a framework for the translation of similar models of care to meet demands in other areas where demand for health services exceeds capacity.