Using the evaluation process as a lever for improving health and healthcare accessibility: The case of HCV services organization in Quebec

BackgroundThe evaluation process can be a lever to improve pathways of access to healthcare. The objective of this article is to show how an evaluation strategy can both contribute to knowledge development and have direct impacts on health services provision. We use the case of hepatitis C (HCV) services organization to illustrate the use and the value of this evaluative approach.MethodInspired by empowerment evaluation, the transformative–participatory approach involved overlapping phases of knowledge development and discussion with stakeholders. We conducted several knowledge development activities to discern the needs of people with HCV, the resources available, and the facilitators and impediments along the care pathway, starting from prevention and screening, all the way through to treatment. Using an overlapping approach allowed us to regularly transfer acquired knowledge back to the participants in the study settings and also to gather their impressions, interpretations, and suggestions during periods of deliberation.ResultsThe knowledge development activities made it possible to document the needs, resources, and experiences of people affected by HCV. In the discussion sessions, viable solutions were identified to improve health and healthcare access for people with HCV and to prioritize certain actions. This project demonstrated that using the evaluation process can enable an instrumental, conceptual use of results and, in fact, can have a transformative impact on services organization.     

A visual management tool for program planning,project management and evaluation in paediatric health care

This article describes the development and implementation of a custom-designed Excel-based visual management tool. The tool’s purpose was to support program planning and evaluation by our resource support team within a paediatric health care setting. Our aims in developing it were to 1) establish a streamlined process and supporting tools to efficiently plan and prioritize program directions and activities; 2) track progress; and 3) evaluate and report on our performance, outputs and outcomes. A collaborative approach based on the ADKAR (Awareness, Desire, Knowledge, Ability, Reinforcement) change management model and the LEADS (Lead self, Engage others, Achieve results, Develop coalitions, Systems transformation) leadership framework was used to guide the design and implementation processes. Team members reported high perceived effectiveness and efficiency with respect to the tool’s utility in supporting its proposed aims. A graded approach to building knowledge and skills in using the tool, to individual responsibility for data entry, and to accountability by team members facilitated its successful implementation. Administrative support is important for sustainability and continual improvement of the tool to address changing team needs over time.     

Does the Andersen Behavioral Model of Health Services Use predict college students’ use of on-campus mental health services?

Abstract

Objective: 10–50% of college students meet the diagnostic criteria for one or more mental illnesses; unfortunately, less than half seek treatment. This study assessed the predictive power of specific variables on students’ use of on-campus mental health resources using the American College Health Association’s National College Health Assessment (ACHA-NCHA) II. Participants: Respondents included undergraduate and graduate students ages 18–35?years (n?=?96,121). Methods: We analyzed data from the ACHA-NCHA II Fall 2014 and Spring 2015. Andersen’s Behavioral Model of Health Services Use enabled selection of predisposing, enabling, and need predictor variables; these were analyzed individually and collectively. Results: Predisposing, enabling, and need variables accounted for 9%, 2.3%, and 17% of the overall variance. Significant variables associated with a student’s decision to access on-campus mental health services accounted for 23% of variance total. Conclusions: This insight could allow universities to better recognize students at-risk for needing but not accessing mental health services.     

Barriers to substance use disorder treatment in a sub-acute setting

ABSTRACT

With the changing times, it is essential integrate behavioral health within the primary care of patients. The need is based on the research that links a number of health issues being directly to substance use and mental health diagnosis. With the current opioid epidemic there is a need to address substance use disorders when treating patients in different health care settings. Despite the necessity of integrated care, there are barriers to addressing addiction in sub-acute care settings. With the lack of buy-in from the patients and health care providers and the stigma surrounding addiction it is time to address the barriers that prevents integration of care where it is most needed.     

Stratified Double Sampling with Continuous Outcomes: Design and Analysis

We provide a method for estimating the sample mean of a continuous outcome in a stratified population using a double sampling scheme. The stratified sample mean is a weighted average of stratum specific means. It is assumed that the fallible and true outcome data are related by a simple linear regression model in each stratum. The optimal stratified double sampling plan, i.e. , the double sampling plan that minimizes the cost of sampling for fixed variances, or alternatively, minimizes the variance for fixed costs, is found and compared to a standard sampling plan. The design parameters are the total sample size and the number of doubly sampled units in each stratum. We show that the optimal double sampling plan is a function of the between-strata and within-strata cost and variance ratios. The efficiency gains, relative to standard sampling plans, under broad set of conditions, are considerable.     

大整数分解的多个多项式二次筛法及其微机实现

通过讨论Silverman提出的多个多项式二次筛法（MPOS），提出了MPQS的计算步骤，并在486微机上实现了MPQS．     

C472. The expected value of a conditional variance: An upper bound

The article derives Bartlett corrections for improving the chi-square approximation to the likelihood ratio statistics in a class of symmetric nonlinear regression models. This is a wide class of models which encompasses the t model and several other symmetric distributions with longer-than normal tails. In this paper we present, in matrix notation, Bartlett corrections to likelihood ratio statistics in nonlinear regression models with errors that follow a symmetric distribution. We generalize the results obtained by Ferrari, S. L. P. and Arellano-Valle, R. B. (1996). Modified likelihood ratio and score tests in linear regression models using the t distribution. Braz. J. Prob. Statist., 10, 15–33, who considered a t distribution for the errors, and by Ferrari, S. L. P. and Uribe-Opazo, M. A. (2001). Corrected likelihood ratio tests in a class of symmetric linear regression models. Braz. J. Prob. Statist., 15, 49–67, who considered a symmetric linear regression model. The formulae derived are simple enough to be used analytically to obtain several Bartlett corrections in a variety of important models. We also present simulation results comparing the sizes and powers of the usual likelihood ratio tests and their Bartlett corrected versions.     

国际电子合同的形式要求探析——兼评《国际合同使用电子通信公约》第9条

《国际合同使用电子通信公约》作为联合国贸法会第一部电子商务公约，对跨国电子合同的形式要求、要约邀请等进行了规范。从公约的条文入手，结合我国及他国电子商务方面的立法，分析了国际电子合同的形式要求。     

郭平的叙事法——评郭平小说集《后来呢》

主要论述了郭平小说集《后来呢》的叙事特征,指出了郭平小说在叙事上具有从经验叙事进入到精神叙事、从文本叙事进入到意象叙事的特征。叙事方法是作者叙事态度的体现,由此可以深入地思考中国当代文学创作在叙事层面上超越现实,进行个人化创作的基本问题。     

How was a national moving and handling people guideline intended to work? The underlying programme theory

In healthcare, moving and handling people (MHP) often cause musculoskeletal disorders. To prevent musculoskeletal disorders due to MHP, many national evidence-based guidelines have been developed. However, little is known about how these guidelines were intended to work, i.e. their ‘programme theory’, how implementation by intended users is influenced by contextual factors and mechanisms to produce outcomes. This paper identifies the programme theory of a national MHP guideline (MHPG) using thematic analysis of the MHPG document, three organisational planning documents, and interviews with MHPG developers. The analysis identified the intended users of the MHPG as health and safety managers and MHP coordinators. The programme theory comprised contextual factors, potentially hindering (e.g. budget constraints) or facilitating (e.g. changing demographics) implementation, being influenced by mechanisms mainly based on ethical (quality of care, evidence-based practices), and economic reasoning (reducing cost of MHP, return on investment) to reduce injuries caused by MHP – the intended outcome.