共查询到20条相似文献,搜索用时 15 毫秒
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The purpose of this article is to introduce a new outcome-oriented, utilization-focused, and practical approach to program evaluation: Charting the Outcomes of Educational and Clinical Approaches (COECA) model. It provides a framework that encourages stakeholders to consider academic dissemination, product development, and implementation as three primary outcomes when evaluating educational and clinical approaches. The model then identifies measurements of the impact of each of these primary outcomes. Finally, it outlines three secondary outcomes that focus on education, clinical service, and administration. As an example, this article discusses the application of the model to an educational intervention in residency training. This intervention has been implemented at two sites. Secondary outcomes include increased competency of residents and a change in responsibilities among health care team members. The COECA model provides an easy-to-apply and efficient method for documenting actual progress and determining potential for further development. 相似文献
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Changing health behaviour outcomes in asthmatic patients: a pilot intervention study 总被引:2,自引:0,他引:2
Starting from a prior study, in which cognitive and coping variables proved to be related to well-being, the use of medical resources and the absence from work in asthmatic patients, the authors constructed a cognitive-educational (a combination of health education and rational emotive behaviour modification) intervention programme aiming at altering coping behaviour in asthmatic patients in order to influence emotional distress and use of medical resources. The effects of the programme were assessed by means of a pre-test-post-test control group design. The programme was offered to ten patients and their partners. Both before and after the intervention cognitive attitudes (optimism, locus of control, and shame or stigma), coping behaviour in attack situations (minimizing the seriousness of the attack, rational action and reacting emotionally), coping in daily life (maintaining a restrictive life-style, focussing on asthma and hiding asthma), emotional distress (anxiety, anger, and depression), and the use of medication were measured in the experimental and control group. It was found that patients who received the programme became less preoccupied with their asthma and reported significantly less emotional distress (anxiety and anger) in daily life. In addition, they used less maintenance medication (corticosteroids). The authors wish to stress the importance of using medical variables such as the number of attacks as covariates in this type of research. 相似文献
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C D Jenkins 《Social science & medicine (1982)》1992,35(4):367-375
This paper proposes that the most comprehensive current approach to the assessment of health interventions is exemplified in the expanding field of research into health-related quality of life. The paper initiates discussion of 11 conceptual and methodological issues which should be dealt with explicitly rather than by default in any such research study. Decisions about these 11 issues will shape the future directions of the field of health outcomes research. Health policy decisions will increasingly be based on outcome studies of health-related quality of life. 相似文献
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Myocardial infarction is a significant problem for Americans and individuals in developed countries. According to the American Heart Association, coronary heart disease is the single largest killer of Americans. Variation in practice is recognized as a key barrier to promoting positive outcomes in patients with cardiac illness. Implementation of clinical practice guidelines has been identified as one way to promote evidence-based practice, reduce practice variation, and ultimately improve the quality of care and outcomes of cardiac patients. Improving patient knowledge and understanding of guideline recommendations and the ways in which evidence-based recommendations are linked to recovery is recognized as one means of facilitating guideline adherence. Automated patient pathways are proposed as a means to improve patient access to guideline-based information at the point of care. Within this context, the prototype development of a Patient Education And Recovery Learning System, or PEARLS, is discussed along with the potential benefits of the use of automated patient pathways as one means for overcoming challenges associated with acute care patient education and facilitating patient adherence to clinical practice guideline recommendations. 相似文献
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Reasoning and judgement in health care entail complex responses to problems whose demands typically derive from several areas
of specialism at once. We argue that current evidence- or value-based models of health care reasoning, despite their virtues,
are insufficient to account for responses to such problems exhaustively. At the same time, we offer reasons for contending
that health professionals in fact engage in forms of reasoning of a kind described for millennia under the concept of wisdom.
Wisdom traditions refer to forms of deliberation which combine knowledge, reflection and life experience with social, emotional
and ethical capacities. Wisdom is key in dealing with problems which are vital to human affairs but lack prescribed solutions.
Uncertainty and fluidity must be tolerated in seeking to resolve them. We illustrate the application of wisdom using cases
in psychiatry, where non-technical aspects of problems are often prominent and require more systematic analysis than conventional
approaches offer, but we argue that our thesis applies throughout the health care field. We argue for the relevance of a threefold
model of reasoning to modern health care situations in which multifaceted teamwork and complex settings demand wise judgement.
A model based on practical wisdom highlights a triadic process with features activating capacities of the self (professional),
other (patient and/or carers and/or colleagues) and aspects of the problem itself. Such a framework could be used to develop
current approaches to health care based on case review and experiential learning. 相似文献
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S L Lusk M J Kerr D L Ronis B L Eakin 《American journal of health promotion : AJHP》1999,13(4):219-227
INTRODUCTION: Consistent use of hearing protection devices (HPDs) decreases noise-induced hearing loss, however, many workers do not use them consistently. Past research has supported the need to use a conceptual framework to understand behaviors and guide intervention programs; however, few reports have specified a process to translate a conceptual model into an intervention. PURPOSE: The strongest predictors from the Health Promotion Model were used to design a training program to increase HPD use among construction workers. SUBJECTS/SETTING: Carpenters (n = 118), operating engineers (n = 109), and plumber/pipefitters (n = 129) in the Midwest were recruited to participate in the study. DESIGN: Written questionnaires including scales measuring the components of the Health Promotion Model were completed in classroom settings at worker trade group meetings. MEASURES: All items from scales predicting HPD use were reviewed to determine the basis for the content of a program to promote the use of HPDs. Three selection criteria were developed: (1) correlation with use of hearing protection (at least .20), (2) amenability to change, and (3) room for improvement (mean score not at ceiling). RESULTS: Linear regression and Pearson's correlation were used to assess the components of the model as predictors of HPD use. Five predictors had statistically significant regression coefficients: perceived noise exposure, self-efficacy, value of use, barriers to use, and modeling of use of hearing protection. Using items meeting the selection criteria, a 20-minute videotape with written handouts was developed as the core of an intervention. A clearly defined practice session was also incorporated in the training intervention. CONCLUSION: Determining salient factors for worker populations and specific protective equipment prior to designing an intervention is essential. These predictors provided the basis for a training program that addressed the specific needs of construction workers. Results of tests of the effectiveness of the program will be available in the near future. 相似文献
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随着物质生活水平的提高,人们对精神健康的要求日益增长.因此,积极有效的精神卫生服务就显得尤为重要.要提高人们的精神健康水平,减少精神疾病的发生,促进精神疾病的早日康复,就必须培养新时期的精神卫生工作者. 相似文献
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In this article we discuss basic assumptions of health interventions with regard to their underlying concepts and selected strategies. Particularly, the lifestyle model of health promotion is presented and its consequences for health promotion and health interventions are discussed. Reference is made to two fields of interventions: prevention of cardiovascular diseases and worksite health promotion. It is concluded that health interventions have to clarify their concepts and strategies in detail before an evaluation of their outcomes can be carried out reasonably. 相似文献
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Charlson ME Allegrante JP McKinley PS Peterson JC Boutin-Foster C Ogedegbe G Young CR 《Health education research》2002,17(5):606-618
Patients who have been relieved of cardiac symptoms following angioplasty may not be sufficiently motivated to initiate behavior changes that can reduce risk of subsequent cardiac events. Finding an effective means to help patients modify their behavior thus presents a unique challenge. This paper describes an innovative behavioral intervention whose theoretical underpinning is net-present value economic theory. This intervention is being evaluated in a randomized controlled trial in which all patients complete a computerized baseline health assessment of 14 cardiovascular risk factors. Each patient is presented with an individualized risk-factor profile and asked to choose risk factors for modification. In the experimental group, each risk factor is presented with a corresponding numerical biologic age value that represents the relative potential to benefit from modifying each risk factor. Risk reduction for these patients is framed as the opportunity to reduce present biologic age (the net-present value), and improve current health status and quality of life. In the control group, risk reduction is framed in the standard risk-factor approach as the value of preventing future health problems. We hope to demonstrate that economic theory is a plausible perspective from which to design interventions aimed at communicating risk and facilitating change in health behaviors. 相似文献
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J.V. Appleton 《Public health》1997,111(2):107-113
One of health visitors' main roles is that of case finding and actively searching for health needs. This paper describes part of the findings of a study evaluating the clinical practice guidelines issued to health visitors to assist them in identifying families requiring increased health visitor support. A postal questionnaire was distributed to all Community Trust Chief Nurses in England (179), employing health visiting staff. The aim of the questionnaire was to assess the extent to which clinical guidelines are used throughout the country to identify families requiring extra health visiting support and to examine their validity and reliability. The survey results confirm the widespread existence of clinical guidelines in England to assist health visitors in identifying vulnerable families requiring extra support. The study provides evidence that the guidelines are largely subjective and invalid in nature. Questions are raised about the relationship between clinical guidelines and professional judgements. 相似文献