Transitioning from a pen-and-paper health risk appraisal to an online health risk appraisal at a petroleum company

Chevron Texaco's Health and Medical Services Department made the decision to use existing technology and transition from a paper health risk appraisal (HRA) to an online questionnaire. A cross-functional team was formed and a year was spent researching online tools to find a vendor who could supply a product best suited to Chevron Texaco's employee workforce. The purpose of this article is to describe the evolution of a paper-based HRA to an online tool as well as describe the project scope and strategy that a team of employees used in selecting the vendor. The article also describes implementation successes, challenges, and lessons learned in using the online tool with an industrial workforce. The strategy that was followed in deploying the Web site along with initial participation rates for this group of industrial employees are described.     

Health behavior changes associated with health hazard appraisal counseling in an occupational setting

A Health Hazard Appraisal (HHA) and counseling session for 292 employees was performed initially and repeated 1 year later. The following changes in medical risk factors over the year period were observed: reduction in blood pressure—especially in those with mild hypertension, decrease in cholesterol level in middle-aged men, some cessation of cigarette smoking, increase in reported exercise in women and men who initially were more sedentary, increase in the performance of breast self-examination by women, decrease in alcohol consumption in men, and increase in seat belt use by men. These changes resulted in a significant reduction in risk age for men. The program was subjectively judged to be very successful by both employees and the employer.     

From risk-based health surveillance to health promotion: an evidence-based experience in a health care setting

In the European countries the health surveillance may be provided as a part of the national health system intervention. In Italy, the legislative Decree (626/94) makes the health surveillance compulsory for all those workers who are exposed to occupational risks. The aim of this study was to describe the introduction of preventive and protective measures, according to the new regulations, in the teaching hospital of the University of Modena. The population examined in 2000 included 1523 workers. Specific health surveillance protocols were prepared on the grounds of the risk characteristics based on the scientific evidence and on the risk perception. The intervention was oriented towards health promotion. The subjects were classified into 10 groups according to the risk characteristics. The percentage of workers ranged from 4% to 42%, depending on the exposure-related health changes. Moreover, the study explored some of the health surveillance benefits: an improvement in worker's satisfaction, an improvement in relationship between stakeholders, an early detection of health changes and a sickness absence reduction after the influenza vaccination program.     

Development of an online tool for public health: the European Public Health Law Network

Background

The European Public Health Law Network was established in 2007 as part of the European Union (EU) co-funded Public Health Law Flu project. The aims of the website consisted of designing an interactive network of specialist information and encouraging an exchange of expertise amongst members. The website sought to appeal to academics, public health professionals and lawyers.

Methods

The Public Health Law Flu project team designed and managed the website. Registered network members were recruited through publicity, advertising and word of mouth. Details of the network were sent to health organizations and universities throughout Europe. Corresponding website links attracted many new visitors. Publications, news, events and a pandemic glossary became popular features on the site. Although the website initially focused only on pandemic diseases it has grown into a multidisciplinary website covering a range of public health law topics.

Results

The network contains over 700 publications divided into 28 public health law categories. News, events, front page content, legislation and the francophone section are updated on a regular basis. Since 2007 the website has received over 15,000 views from 156 countries. Newsletter subscribers have risen to 304. There are now 723 followers on the associated Twitter site.

Conclusion

The European Public Health Law Network has been a successful and innovative site in the area of public health law. Interest in the site continues to grow. Future funding can contribute to a bigger site with interactive features and pages in a wider variety of languages to attract a wider global audience.     

DISCERN: an instrument for judging the quality of written consumer health information on treatment choices

OBJECTIVE: To develop a short instrument, called DISCERN, which will enable patients and information providers to judge the quality of written information about treatment choices. DISCERN will also facilitate the production of new, high quality, evidence-based consumer health information. DESIGN: An expert panel, representing a range of expertise in consumer health information, generated criteria from a random sample of information for three medical conditions with varying degrees of evidence: myocardial infarction, endometriosis, and chronic fatigue syndrome. A graft instrument, based on this analysis, was tested by the panel on a random sample of new material for the same three conditions. The panel re-drafted the instrument to take account of the results of the test. The DISCERN instrument was finally tested by a national sample of 15 information providers and 13 self help group members on a random sample of leaflets from 19 major national self help organisations. Participants also completed an 8 item questionnaire concerning the face and content validity of the instrument. RESULTS: Chance corrected agreement (weighted kappa) for the overall quality rating was kappa = 0.53 (95% CI kappa = 0.48 to kappa = 0.59) among the expert panel, kappa = 0.40 (95% CI kappa = 0.36 to kappa = 0.43) among information providers, and kappa = 0.23 (95% CI kappa = 0.19 to kappa = 0.27) among self help group members. Higher agreement levels were associated with experience of using the instrument and with professional knowledge of consumer health information. Levels of agreement varied across individual items on the instrument, reflecting the need for subjectivity in rating certain criteria. The trends in levels of agreement were similar among all groups. The final instrument consisted of 15 questions plus an overall quality rating. Responses to the questionnaire after the final testing revealed the instrument to have good face and content validity and to be generally applicable. CONCLUSIONS: DISCERN is a reliable and valid instrument for judging the quality of written consumer health information. While some subjectivity is required for rating certain criteria, the findings demonstrate that the instrument can be applied by experienced users and providers of health information to discriminate between publications of high and low quality. The instrument will also be of benefit to patients, though its use will be improved by training.     

Coaching in the health setting: an approach to its viability

OBJECTIVE: To analyse the contributions that the participants in a formative activity elaborated respect the viability of the coaching in the health environment. METHOD: Qualitative study of the contributions of the 18 participants in the workshop upon applications of the coaching in the health environment carried out the month of March 2002 at the Institute of Health Studies (IHS). RESULTS: The contributions deal with: a) the opportunities: help to healthcare professionals that become to exercise directive responsibilities and strategies to help for the cultural change, and b) the objections: resistance to change, utilization as punishment, results difficult to measure. CONCLUSIONS: The methodology of the coaching is susceptible of being applied in persons that they should exercise a key paper in a health organization, above all in process of change.     

Effectiveness of an online computer-tailored physical activity intervention in a real-life setting

The aim of this study was to evaluate the effectiveness of a computer-tailored physical activity intervention delivered through the Internet in a real-life setting. Healthy adults (n=526), recruited in six worksites, between 25 and 55 years of age were randomized to one of three conditions receiving, respectively, (i) online-tailored physical activity advice + stage-based reinforcement e-mails, (ii) online-tailored physical activity advice only, (iii) online non-tailored standard physical activity advice. At 6-month follow-up, no differences in physical activity between study conditions were found; total physical activity, physical activity at moderate intensity and physical activity in leisure time significantly increased in all study conditions between baseline and follow-up. Further evaluation of the intervention materials showed that the tailored advice was more read, printed and discussed with others than the standard advice. Most of the respondents in the e-mail group indicated to be satisfied about the number, frequency and usefulness of the stage-based e-mails. In conclusion, although tailored advice was appreciated more than standard advice, no evidence was found that an online-tailored physical activity intervention program outperformed online standard information.     

Managing the quality effort in a health care setting: an application

Recent marketplace realities and trends have forced health care institutions to adopt strategic orientations that stress a customer focus. Central to such strategic orientations is the effective utilization of service quality practices and philosophies. Toward that end, this research offers health care institutions an affordable methodology. A real-life application of the rapid assessment methodology (RAM) in a health care operational setting is presented. Finally, a framework to guide the implementation of the RAM methodology is outlined and explored.     

Learning from disasters to improve patient safety: applying the generic disaster pathway to health system errors

In a previous paper we developed a generic disaster pathway model drawing from disaster inquiries in the space, shipping, aviation, mining, rail and nuclear industries. To test our hypothesis that our generic disaster model can be applied to healthcare errors, we ustilised three exemplar cases featuring different types and sources of errors. We found that it is possible to apply our generic disaster pathway to healthcare errors, and to identify the combination of human, organisational and design risk factors which contribute to the severity and speed at which errors occur. We conclude that error pathways provide a useful tool from which healthcare services can learn to appreciate and potentially circumvent or ameliorate errors, prior to their reaching the no-return threshold.     

The reality of applying an assessment guideline to a telemedicine mental health programme

A guideline for assessment of telemedicine applications was used by the Alberta Mental Health Board (AMHB) in its evaluation of a telemedicine mental health (TMH) service. Many attributes referred to in the guideline were well covered in the AMHB evaluation. However, there were limitations on the assessment of outcomes and cost-effectiveness. From the perspective of the AMHB, the guideline was helpful, although more so in the earlier stages of the TMH service than for its appraisal as it reached maturity. The measures of performance suggested by the guideline did not fully match local operational conditions. Constraints on the assessment of the mature TMH service included the complexity of the network, the limited resources available for evaluation and the routine administrative demands of decision makers. This experience points to the usefulness of standardized assessment approaches to telemedicine, but also to their limitations.     

Occupational health management: an audit tool

BACKGROUND: Organizations must manage occupational health risks in the workplace and the UK Health & Safety Executive (HSE) has published guidance on successful health and safety management. AIMS: This paper describes a method of using the published guidance to audit the management of occupational health and safety, first at an organizational level and, secondly, to audit an occupational health service provider's role in the management of health risks. The paper outlines the legal framework in the UK for health risk management and describes the development and use of a tool for qualitative auditing of the efficiency, effectiveness and reliability of occupational health service provision within an organization. The audit tool is presented as a question set and the paper concludes with discussion of the strengths and weaknesses of using this tool, and recommendations on its use.     

一个中国化医学临床指南评价工具的研发

目的:开发一个适合我国医疗实践实际的本土化临床指南评价工具。方法:在比较国外各种医学临床指南评价工具的基础上,根据AGREE工具并采用Delphi法进行了专家咨询和分析。结果:开发出一个适合我国情况的本土化临床指南评价工具。结论:开发出的首个临床指南评价工具,对于今后我国临床指南的开发制定具有一定指导意义。     

Supporting evidence-based service delivery and organisation: a comparison of an emergent realistic appraisal technique with a standard qualitative critical appraisal tool

A major component of current policies aimed at promoting the delivery of an effective health service is to ensure that practitioners base their practice on research findings. Considerable attention has been focussed on the research community and developing appropriate methods and tools to support these objectives at the national and international level. The appraisal needs of individual practitioners, who might wish to inform local service delivery and organisation and who are often not methodological experts, has been hitherto ignored. This paper reports on the application and testing of a technique for the appraisal of evaluation studies, which is being developed for use by practitioners to inform local service delivery. This technique has previously been applied to a quantitative evaluation. In this paper we report on its application to the appraisal of a qualitative paper. Our aim is to compare it with a standard tool to establish which generates more meaningful information for use by practitioners for the purposes of informing service delivery and organisation. The emergent technique successfully extracted relevant methodological and contextual information, with developmental issues being identified.     

Programme budgeting: an aid to planning and priority setting in health care

Programme budgeting can assist in overcoming some of the current problems besetting health care planning and management. In particular, health services suffer from lack of (i) explicit objectives; (ii) comprehensive overviews; (iii) knowledge of production functions; (iv) incentives for efficiency; and (v) inappropriate budgeting structures. Programme budgeting while not in itself capable of overcoming all these problems can create an information framework which first highlights but secondly fosters amelioration of these problems. In essence programme budgeting links outputs and inputs by health care programme. This facilitates monitoring, planning, control and the fostering of evaluation. Two examples of the use of programme budgets are presented.