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51.
Part I of this article ("Six Design and Implementation Lessons," Physician Executive, Sept.-Oct. 1993, pp. 46-50) described an ambulatory utilization review (AUR) program designed and implemented by Metropolitan Life Insurance Company and reviewed some of the lessons learned over the past five years. Those lessons pertained to the tasks of inventing a new information technology to measure and evaluate ambulatory care and some of the practical implementation issues associated with review of 30,000 small dollar value claims per day in 19 claim offices nationwide. This article turns to the basic purpose of AUR--to review the medical necessity and appropriateness of ambulatory utilization. One lesson learned about AUR in this context is that AUR works: savings from the program outweigh costs by almost 5:1. The more important lessons, however, stem from understanding how the savings are achieved, and what some of the other unintended benefits of the program are.  相似文献   
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New Public Management reforms have been argued to intensify the use of strategic management in public organizations, but there is a need to understand how reforms influence specific aspects such as strategy processes and strategy content. The NPM reforms are expected to formalize and professionalize strategy processes and strategy content towards greater competitiveness, but this may counter cooperation between organizations, which is essential in many areas for overall service provision. Research has provided little empirical knowledge about the simultaneous competition and cooperation in the public sector. This study offers such knowledge via a panel case study of five Danish upper secondary schools over a ten‐year period during a large NPM reform. The study includes three rounds of interviews with school principals before, during and after the reform, combined with secondary data. The study shows that, during reform implementation, strategy processes become more formalized and professionalized, and that teachers, in particular, lose influence. Regarding strategy content, the authors find an increase in external focus and competition, though schools maintain a focus on cooperation. The results suggest that NPM reforms can significantly change strategic management in public organizations, and that this is not necessarily at the expense of cooperation, at least in the short run.  相似文献   
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This article discusses challenges that educators face in attempting to develop culturally competent social workers who understand the dynamics of oppression and embrace a commitment to promoting social justice. An educational model is described, focusing on the use of an interactive Web forum aimed at providing a safe vehicle for student dialogue. Usage patterns of the website are summarized and data from student evaluations are analyzed. The authors provide recommendations based on evaluating the use of computer technology to meet the challenges inherent in teaching and learning processes related to combining cultural diversity and societal oppression content.  相似文献   
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Abstract

Objective: To evaluate the psychometric properties of a new self-report questionnaire designed to assess college students’ intentions to employ 31 specific alcohol-reduction strategies. Method: Students attending a large public university were recruited to complete alcohol-reduction, drinking history, and personality questionnaires online. Results: Based on item–total correlations and principal components analysis, the authors eliminated 3 items and calculated average intention ratings across the remaining 28 items. The resulting scale had appropriate unidimensionality and excellent internal consistency. Correlations of intention questionnaire scores with measures of drinking history, alcohol outcome expectancies, sensation seeking, and impression management provided some support for criterion and discriminant validity of the questionnaire. Conclusion: This questionnaire could be employed as an outcome measure to evaluate prevention programs and as a clinical tool to identify clients who have little intention to employ drinking reduction strategies in heavy drinking situations.  相似文献   
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