First Full Year Of Implementation Research Articles

Restorative Practices: Using local evidence on costs and student outcomes to inform school district decisions about behavioral interventions

School disciplinary practices affect student academic and life outcomes. Many schools have recently shifted towards the prevention of behavioral disorders rather than the punishment of such disorders, but disciplinary actions are still disproportionately meted out to Black students. We took advantage of a natural experiment in a large school district to investigate the costs and effects of a school-wide intervention based on the principles of restorative justice on suspensions, referrals, and three school climate constructs. The study involved 14 elementary and middle schools, each of which was already implementing Positive Behavioral Interventions and Supports (PBIS). Six of the schools integrated Restorative Practices into their PBIS framework during the first year of the study, whereas the other eight served as comparison schools and implemented the program the following year. We tested a difference-in-difference regression model for each of our five outcomes of interest after 1 year of implementation using Quasi-Poisson models for referrals and suspensions. We found no statistically significant effects on four of the outcomes, either for the overall sample or by racial subgroup. We found negative effects on student-reported personal safety. An additional analysis 1 year later showed that Black students in schools implementing Restorative Practices for 2 years experienced a greater reduction in suspensions than Black students in schools implementing the program for only 1 year. We used the ingredients method to estimate start-up costs and ongoing costs for the first full year of implementation. Our reference case analysis results using a societal perspective, national average prices, and a 3% discount rate were $57,450 per school and $139 per student for the first year of Restorative Practices implementation. These estimates included training costs from the prior year and were incremental to the costs of PBIS, which served as the business-as-usual condition. We compared these costs to those of a number of other behavioral interventions and concluded that Restorative Practices are relatively low cost but may need to be implemented for several years with greater fidelity in order to produce the desired improvements in behavior events and school climate.

Implementation of a Departmental Female Emergency Medicine Physician Group.

Gender disparities exist in academic emergency medicine (EM). We developed and implemented a female EM physician group – Women in Academic Emergency Medicine (WAM) – to support female EM residents, fellows, and faculty. The goal of WAM is to provide a support system through mentorship, education, and outreach. A targeted needs assessment was completed to identify goals and objectives specific to our department. In the first full year of implementation, WAM hosted eight events, including three topical dinners and one formal panel. Of 42 female faculty and residents, 40 (95%) attended at least one WAM event, and all (20/20) of the female faculty strongly supported WAM. WAM advocated for increased female physician representation on the department’s Physician Executive Leadership Group and preservation of dedicated lactation space in the emergency department. Using a needs assessment, the process of developing WAM can be replicated in any department to create a female physician group.

Implementing an Electronic Data Capture System to Improve Clinical Workflow in a Large Academic Radiation Oncology Practice.

To describe the feasibility and benefits of implementing a custom radiation oncology electronic data capture (EDC) system in a large academic radiation oncology practice. A Web-based point-and-click EDC known as Brocade was internally developed and implemented systemwide in 2016. Brocade captures key data elements, such as stage, histology, and patient and treatment characteristics; links this information to radiation dose data extracted from the record and verify system; and creates clinical notes that are automatically exported to the hospital electronic health record. We report the number of unique radiation episodes captured by Brocade in its first full year of implementation and describe the notes generated, toxicities captured, compliance with staging and quality assurance, and time of day in which documentation occurred with Brocade versus our prior human transcription system. A median of 756 radiation episodes per month was captured for a total of 9,283 unique episodes captured in the first full year of implementation. The most common notes were for on-treatment visits (29,913) and simulations (13,220). Stage was captured for 92.2% of Brocade episodes (8,513 of 9,236) versus 29.7% of courses pre-Brocade (3,025 of 10,170; P < .001). Quality assurance was documented for 96.3% of completed courses (7,601 of 7,892). The most common grade ≥1 toxicities were pain (10,031), fatigue (7,490), and dermatitis (6,172). Brocade implementation was associated with a reduction in off-hours documentation and increase in the proportion of documentation created between 8:00 am and 12:00 pm. Brocade is a reliable Web-based EDC tool that improves clinical documentation without detracting from clinical workflow. Moreover, Brocade has the advantage of capturing data in a structured manner that facilitates real-time analytics and outcome reporting.

School turnaround in North Carolina: A regression discontinuity analysis

This paper examines the effect of a federally supported school turnaround program in North Carolina elementary and middle schools. Using a regression discontinuity design, we find that the turnaround program did not improve, and may have reduced, average school-level passing rates in math and reading. One potential contributor to that finding appears to be that the program increased the concentration of low-income students in treated schools. Based on teacher survey data, we find that, as was intended, treated schools brought in new principals and increased the time teachers devoted to professional development. At the same time, the program increased administrative burdens and distracted teachers, potentially reducing time available for instruction, and increased teacher turnover after the first full year of implementation. Overall, we find little evidence of success for North Carolina's efforts to turn around low-performing schools under its Race to the Top grant.

An Academic-Service Partnership: A System-Wide Approach and Case Report.

An academic-service partnership was formed to increase educational capacity, improve evidence-based nursing at the point of care, and engage staff nurses, clinical faculty, and students in patient and family care. This case report reflects an overview of the first year of full implementation, and survey results from nurse leaders and faculty at the 3-year time point. Following its third year of an academic-service partnership, the shared mission, vision, and values have resulted in stronger NCLEX-RN results, improved quality initiatives, and trends for improvements in patient outcomes. Alignment with faculty and mentors surrounding student expectations has improved, as well as shared evidence-based practices. Sustaining an academic-service partnership requires dedicated leaders, faculty, and mentors. This partnership continues to thrive and move toward excellence in patient- and family-centered outcomes and undergraduate clinical education. [J Nurs Educ. 2017;56(6):373-377.].

Take Out Your Cell Phones - Class is Starting

Traditionally, cell phones have been considered disruptive to classroom learning. Two years ago, a survey of students in a large first year design course indicated that 88% of students possessed cell phones in the classroom. Instead of trying to enforce acell phone ban, and fight a losing battle, we decided to use the cell phones to our pedagogical advantage. Previously, student interaction in the classroom was a challenge, due to a large class of students in a singlelecture theater. A primary issue was the inability of all except a few students with booming voices to ask questions. Informed primarily by a student design team (from the very course being discussed), we implemented a simple and inexpensive system that allowed students to use their cell phones in the classroom to send questions via Short Message Service (SMS), commonly referred to as “text messages”, to the instructor at the front of the classroom This system has been piloted through its first year of full implementation. Quantitative data on the usage of the system, student and instructor impressions of the system, and future work will be discussed.

Abstract P2-15-02: Web-Based Patient-Intake Process for Breast Care Center: The Patient Experience

Abstract Background: An important driver of health information technology will be an increased incorporation of self-reported patient health data into patient care workflow. We undertook this study to determine the feasibility, satisfaction, and challenges reported by patients related to the introduction of an electronic patient intake tool in an outpatient breast care clinic. Methods: A web-based self-reported new patient intake process was implemented in 2008 at an urban multi-disciplinary breast care clinic. The system was based on a platform developed by Dynamic Clinical Systems (DCS) which was designed to collect, warehouse, and provide reporting of data to inform patient treatment decisions. Patients new to the Breast Care Center with either breast symptoms or a newly diagnosed breast cancer were provided a weblink for data entry prior to the clinic visit. Patients were asked questions regarding medical/family history, symptoms, and psychosocial well-being. Data regarding the survey were compared among age groups using the chi square test. Results: The first full calendar year for which data were collected was 1/1/09-12/31/09 during which 1218 women responded to the survey. Data were evaluated among 4 age groups: 0-18 (n=9), 19-49 (n=508), 50-69 (n=586), and ≥70 (n=115). 400 women (36%) were newly diagnosed with breast cancer; 106 (10%) of respondents had stage IV breast cancer. Overall 94.3% of patients took the survey themselves; 87% took the survey at home, compared to 7% in the doctors’ office. 89% reported using a high-speed (DSL, cable, wireless) internet connection. 69% of respondents completed the survey in less than one hour. Patients who completed the survey in the clinic (n=55) cited lack of access to the internet as the most common reason the survey was not completed in advance of the clinic visit (n=21). 64% of patients indicated e-mail as their preferred contact method; fewer women over 70 preferred e-mail contact to phone compared to younger groups (43%; P&amp;lt;0.001), although even in this group, e-mail was the preferred mode of contact. 77% of patients reported satisfaction (41%) or high satisfaction (36%) with the survey system, with no difference in satisfaction seen among age groups (p=0.5). Conclusion: Assessment of patients’ experience using a self-reported web-based patient intake form was conducted during the first full year of implementation. Most patients successfully completed the survey and indicated a high satisfaction level with its use. However, some differences were seen between age groups. Overall, &amp;lt;2% of patients reported inability to access the internet. Electronic collection of self-reported patient data is not only feasible, but well accepted and has potential to facilitate patient care and treatment, reduce consultation time directed to collecting medical history, and allow standardized data collection for research and continuous quality improvement. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-15-02.

Keyskills for all? The key skills qualification and Curriculum 2000

It is widely recognized that the Key Skills Qualification - an important component of the Curriculum 2000 advanced level curriculum reforms - has experienced extensive problems during its first full year of implementation. This much is not in dispute. What is being keenly debated, however, are the ways in which this experience should be analysed and what lessons should be drawn. Is it a case of understandable ‘teething problems’ that will be overcome as the qualification ‘beds in’ or are there deeper and more fundamental problems of the purpose and design of the Key Skills Qualification for advanced level students? In order to address these questions, this article examines the Key Skills Qualification within its historical and policy context as well as bringing together a range of quantitative and qualitative evidence gathered as part of an Institute of Education (IOE)/Nuffield Foundation R esearch Project. The research suggests that while there is support for the concept of key skills, the Qualification has been met with considerable student and professional resistance due to its narrow skills focus and assessment regime within the context of increased study programmes at advanced level. We conclude that the Government's aim of ‘key skills for all’ at advanced level is unlikely to be achieved unless it takes a fundamentally different approach to policy in this area.

Re-engineering: an opportunity to advance clinical practice in a community hospital.

A hospital pharmacy's efforts to advance clinical pharmacy practice and reduce pharmacy costs as part of a hospitalwide re-engineering program are described. In 1995, a 321-bed community hospital in Wisconsin undertook a three-year re-engineering program aimed at reducing operating expenses, primarily labor costs. The pharmacy department focused its efforts within the program on improving the efficiency of product-related functions, mainly through automation, and redeploying staff to value-added clinical functions. This involved installation of a hospitalwide pneumatic-tube system, use of unit-based automated medication dispensing devices, and implementation of a dedicated clinical pharmacy services program. Implementation of this program was to occur incrementally, with the first 12 months to be used primarily in developing a service model, initiating a staff-development program, and hiring additional clinical staff. Services added under the program included i.v. to oral conversion, dosage adjustments for patients with renal impairment, advanced patient counseling, development of care plans, and rounds in all areas of the hospital. After the first full year of implementation of the program, a cost-benefit analysis was undertaken; costs were composed primarily of pharmacists' salaries and benefits, and benefits were composed primarily of drug cost savings. A benefit to cost ratio of 2.61:1 and a net saving of $217,551 were calculated. The introduction of clinical pharmacy services as part of a hospitalwide re-engineering program was associated with a positive benefit to cost ratio and a substantial net cost saving.

FQHC (Federally Qualified Health Center): harnessing the incentives of cost reimbursement.

Community health centers (CHCs) are federally supported primary care providers to the low-income and uninsured. The federally qualified health center (FQHC) legislation requires states to pay CHCs for Medicaid services on the basis of reasonable cost. The statute generated controversy, particularly in a time when, for most providers, cost-related reimbursement has given way to fixed payments and managed care. This article examines the impact of FQHC on revenue and utilization of CHCs, using data for 328 centers that were in continuous operation between 1989 (the year the legislation was enacted) and 1992, the first year of full implementation. During this period, the CHCs Medicaid revenue grew rapidly. FQHC is estimated to account for under one third of the total increase, while inflation and growth in utilization due to expanded Medicaid eligibility are estimated to account for the other two thirds. At the same time, the change to cost-related reimbursement had a significant increase in total service users and Medicaid recipients receiving care from CHCs. Although some expected that cost-reimbursement would lead to inflationary increase in utilization, this did not occur. There was no statistically significant relationship between the change in payment methodology and changes in encounters per user. The experience of FQHC indicates that, for safety net providers of primary care, cost-related reimbursement is not "inherently inflationary." Results of this study raise the question of whether payment within constraints, but bearing relationship to cost, is not an appropriate approach to developing primary care capitation rates for these providers--and assuring maintenance of the safety net for the uninsured.

Editorial

Mixed messages are emerging from the first year of full implementation of community care. While problems are apparent in the lack of services to fulfil assessment needs adequately, better working relationships have undoubtedly been developed and collaboration across professional boundaries is improving.

Influence of curricular changes in health promotion and disease prevention on residents' behaviors over a five-year period.

Residents' compliance with guidelines for health promotion and disease prevention (HPDP) often fall short of the ideal. After a year in which faculty developed clinical practice HPDP guidelines, an intervention consisting of curricular changes and chart modifications was planned and pilot-tested in 1985-86 at an ambulatory care clinic of the Family Practice Residency Program, University of Louisville School of Medicine. Approximately 24 residents per year (eight at each level of training) worked in the clinic throughout the study years. The HPDP curriculum required residents to attend 48 one-hour conferences conducted over a three-year period. Four retrospective chart audits were used to measure residents' compliance with the HPDP guidelines during (1) the year before the pilot test (104 charts), (2) the pilot year (113 charts), (3) the year after the pilot test--the first year of full implementation (100 charts), and (4) five years after the pilot test (100 charts). Data from the chart audits were analyzed by using a permutation test for decreasing trend. Although there was an increase in the residents' compliance with the HPDP guidelines during the pilot year, the residents' HPDP activities tended to return to baseline levels in the following years, despite the ongoing curriculum. The authors conclude that because the frequency of the residents' HPDP activities tended to return to baseline levels, clinical education alone is not enough to sustain residents' compliance with HPDP guidelines.

Cost Savings and Service Strategies in the British National Bibliographic Service

The British Library launched in 1986 a Catalogue Action Plan to deal with the long-term prospect of declining financial and manpower resources, the absence of growth in the market for its services, an unacceptably large backlog of uncatalogued materials, and a steadily increasing annual output of British publications to be catalogued. The initial phase of the Plan was designed to contain staff costs by reduction and simplification in data content in BNBMARC and other British Library records, predicating their future use primarily in an online (OPAC) environment. It has had significant success for the British Library's aims in the first full year of implementation, but it has raised questions of the cost-benefit in centralized cataloguing services for the library community, in respect both of the costs and sizing of OPAC systems in local libraries and of the necessity of sustaining indefinitely the high cost of adherence to international standards established before OPACs, the CD-ROMs and OSI had changed the technology.

Mongolia in 1988: Year of Renewal

Summing up the achievements of Mongolia's program of political and economic renewal in its first full year of implementation, President Jambyn Batmonh, the ruling Mongolian People's Revolutionary Party (MPRP) general secretary, claimed that basically it was proceeding successfully. However, it is only in the initial phase, and the results so far are not that tangible, Batmonh said. Besides the economy, the current reforms embraced ideology, education, and morality, in short, all spheres of public life. But for the moment it seems that we are talking in the new way but still working in the old way. Therefore we must begin renewal and restructuring with ourselves, and give up old-fashioned thinking and obsolete methods.l Today we have quite a lot of problems, Batmonh also said. It would be a serious delusion to imagine that restructuring will take place by itself according to our wishes and everything will turn out for the best.2