Phases Of Program Implementation Research Articles

Reducing barriers to promote engagement and retention in adolescent substance use treatment: results from a quality improvement evaluation

IntroductionAlthough research on the development and efficacy of adolescent substance use treatment has made recent strides, many models do not translate into practice, especially when working with underserved youth who often face barriers to treatment. Meal incentives, rolling admission, and transportation assistance may be promising approaches to decrease barriers, thereby increasing treatment engagement, retention, and completion. The purpose of this evaluation was two-fold: (1) to examine treatment engagement amongst diverse, underserved youth in an intensive outpatient program for substance misuse in an urban metropolitan area, and (2) to investigate the role of meal incentives, rolling admission, and transportation assistance in youth engagement.MethodsThe intervention was 8 weeks of Acceptance and Commitment Therapy and trauma-focused group intervention, combined with contingency management, meal incentives, and transportation assistance. Treatment engagement, retention, and completion was compared against selected demographic variables (i.e., race and insurance coverage) and at three phases of program implementation: cohort admissions with transportation assistance (phase 1); rolling admissions with transportation assistance (phase 2); and rolling admissions with transportation assistance and meal incentives (phase 3). Data was analyzed using two-way ANOVAs; identified interactions were probed.ResultsParticipants were 110 adolescents (ages 13–17) consecutively admitted to an intensive outpatient substance treatment program. Racial identities of participants were 40.0% Latinx, 3.6% Black, 0.9% American Indian or Alaska Native, 6.4% two or more races, and 49.1% White. A total of 67 of 110 (60.9%) youth had state-funded Medicaid or no insurance. Of the youth that engaged in treatment across all implementation phases, 68.7% were provided transportation assistance. Analyses illustrated no difference in outcomes based on selected demographic variables. The percentage of youth completing treatment was 22.7% and the average number of groups attended was 6.32 (SD = 6.49). Results showed a significant improvement in outcomes with the implementation of incentives such that engagement and retention in treatment was significantly higher for those in phase 3 compared to those in phase 1 (p < .001) and phase 2 (p = .021).DiscussionThis evaluation shows that previously documented health disparities in substance treatment engagement and retention are not found when certain barriers are addressed.

AN ADAPTIVE DECISION-MAKING SUPPORT MODEL IN THE MANAGEMETN OF ENGINEERING INFRASTRUCTURE RECONSTRUCTION PROGRAMS AND PROJECTS

Reconstruction of engineering infrastructure has become an important topic for Ukraine since the beginning of the full-scale invasion of russian federation in 2022. Standard approach to implementation of programs and projects is inefficient for turbulent environments and therefore the use adaptive approach is relevant. The concept of adaptive management has been analyzed. Means and instruments of adaptive management were analyzed. It was defined that different means and instruments of adaptive management are relevant for different program implementation phases. For the delivery phase these are learning and forecasting, for the closure phase – analysis of obtained experience for more efficient implementation of the next programs, for the definition phase – instruments that can ensure the further implementation of adaptivity to the management processes. An adaptive decision-making support model concept is proposed for adaptive engineering infrastructure reconstruction programs and projects management. The model is based on machine learning methods and can be used for program architecture and project work structure development and management. In this case the decision-making consists in choosing the optimal composition and configuration of the system that is the reconstruction object from among the available alternatives by predicting the values of the parameters of its elements in order to minimize the costs of implementing the program or the project. The model is created with Microsoft Azure Machine Learning Studio, the user interface is created in Microsoft Excel. The distinguishing features of the model are adaptivity due to the use of machine learning methods, possibility of scaling of the model to ensure its application to different system levels and presence of post-processing instruments for different use cases including calculation of additional parameter values, parameter values dependency graphs construction etc. The dataset for the model consists of several parameter categories that characterize the system modelled: technical and technological parameters, environmental parameters, energy efficiency parameters, energy security parameters, economic parameters, operational safety parameters. Keywords: adaptive program management, adaptive project management, decision support systems, machine learning.

Temporal Trends in Reperfusion Delivery and Clinical Outcomes Following Implementation of a Regional STEMI Protocol: A 12-Year Perspective

BackgroundThe Vancouver Coastal Health (VCH) ST-elevation myocardial infarction (STEMI) program aimed to increase access to primary percutaneous coronary intervention (PPCI) and reduce first-medical-contact-to-device times (FMC-DTs). We evaluated the long-term program impact on PPCI access and FMC-DT, and overall and reperfusion-specific in-hospital mortality. MethodsWe analyzed all VCH STEMI patients between June 2007 and November 2019. The primary outcome was the proportion of patients receiving PPCI over 4 program implementation phases over 12 years. We also evaluated overall changes in median FMC-DT and the proportion of patients achieving guideline-mandated FMC-DT, in addition to overall and reperfusion-specific in-hospital mortality. ResultsA total of 3138 of 4305 VCH STEMI patients were treated with PPCI. PPCI rates increased from 40.2% to 78.7% from 2007 to 2019 (P < 0.001). From phase 1 to 4, median FMC-DT improved from 118 to 93 minutes (percutaneous coronary intervention [PCI]-capable hospitals, P < 0.001) and from 174 to 118 minutes (non-PCI-capable hospitals, P < 0.001), with a concomitant increase in those achieving guideline-mandated FMC-DT (35.5% to 66.1%, P < 0.001). Overall in-hospital mortality was 9.0% (P = 0.20 across phases), with mortality differing significantly by reperfusion strategy (4.0% fibrinolysis, 5.7% PPCI, 30.6% no reperfusion therapy, P < 0.001). Mortality significantly decreased from phase 1 to phase 4 at non-PCI-capable centres (9.6% to 3.9%, P = 0.022) but not at PCI-capable centres (8.7% vs 9.9%, P = 0.27). ConclusionsA regional STEMI program increased the proportion of patients who received PPCI and improved reperfusion times over 12 years. Although no statistically significant decrease occurred in overall regional mortality incidence, mortality incidence was decreased for patients presenting to non-PCI-capable centres.

RSA Over-Encryption Employing RGB Channels through a Steganography Variant

This study aims to provide a solution for RSA over-encryption based on steganography variant to hide sensitive information that requires security. The current study describes a software program's implementation phases that allow technicians to re-encrypt a message, first encoded using RSA cryptosystems as an extra security layer. Subsequently, this text was converted into an array of bytes stored in Red, Green, and Blue (RGB) layers of one or more generated images, which will finally be sent to the receiver. The programming recursion technique was used to determine the number of images that need to be sent and the bytes corresponding to each of them. These images were created, reorganized, and encrypted according to pre-defined rules. The security of the proposed method relies heavily on the probability theory. Each of the possible patterns that can store data is equally likely to be chosen by an attacker. The program also uses as a conceptual base the Least Significant Bit Substitution (LSB) technique, with the difference that it directly stores bytes for the RGB values of the generated image(s). Our results indicate that the re-encryption is independent of a carrier image. The number of different ways to organize the pixels and the generated images suggests an acceptable security level. Moreover, it requires a not negligible computational power to decipher the pixels' original order and the channels containing relevant information.

The Effect of Brachytherapy Safety Education on Knowledge, Performance, and Attitude of Radiology Nurses

Context: Brachytherapy is one of the cancer treatment modalities. Like any treatment, it can produce acute and delayed side effects. Unfortunately, patients getting brachytherapy experience many side effects that may affect their all quality of life aspect. So, nurses working in radiotherapy settings must be confident about their knowledge, competence, and technical skills. Therefore, holding continuing education programs for nurses is necessary. &#x0D; Aim: This study aimed to determine the effect of brachytherapy safety education on radiology nurses' knowledge, attitude, and performance.&#x0D; Methods: Quasi-experimental one group pre-posttest design was utilized to achieve the aim of this study on nurses working on Ayadi El Mostakabal Hospital, Alexandria, Egypt. Four tools were used to collect the necessary data. The self-administered questionnaire was designed to collect the necessary data about the nurses. Radiology Nurses’ Knowledge Assessment Questionnaire to assess nurses' knowledge regarding nursing interventions for patients getting brachytherapy. Nurses’ Performance Observational Checklist to assess the actual nurses’ performance provided to patients getting brachytherapy. Radiology Nurses' Attitude Assessment Scale (RNAAS) measures nurses' professional attitude and the influence of safety training programs on nurses' attitudes.&#x0D; Results: There was a statistically significant difference between nurses' knowledge, performance, and attitude between the initial assessment, immediate, two weeks later, and three months of educational program implementation at p=0.001. Regarding the relationship between studied nurse's knowledge and their characteristics, there was a relationship found between nurses’ knowledge in the initial assessment and their age, marital status, and nurses’ years of experience at p=0.001, 0.002, and 0.0, respectively. While in the post-program implementation, the only relation was found between the nurses’ knowledge score and years of experience p=0.007, 0.053, and0.011 in immediate, two weeks later, and after three months of program implementation, respectively. There was no relation found between nurses' performance and their characteristics throughout program implementation phases.&#x0D; Conclusion: The current study findings concluded that radiation safety education for nurses regarding brachytherapy resulted in a statistically significant improvement in nurses' knowledge, performance, and attitude. Periodic and consistent update in-services training of nurses to improve their knowledge and practice enforces nurses to follow the approved guideline. Future studies are recommended to investigate nurses' knowledge and performance of radiation protection in the general ward or specialized departments.

Impact of Training Program About Occupational Stress Among Teaching Staff Members in Faculty of Nursing at Suez Canal University

Background: Occupational stress is often used as a term to denote the emotions people feel in upsetting circumstances. Teaching staff in faculty are stressed also are additional seemingly to be unhealthy, poorly motivated and fewer productive and fewer safe at work. Aim: the study aimed to assess impact of occupational stress among teaching staff members. Design: A quasi- experimental design was utilized in this study. Setting: the study was conducted in the faculty of nursing at Suez Canal University. Subject: all teaching staff members working in the previous study setting. Tools of the study: Two tools were used to conduct this study; tool I: occupational stress questionnaire which was used to assess stress level, tool II: observation checklist which was used to assess occupational stressors Results: The study revealed that, above half of the studied group (56.1%) was high occupational stress level in preprogram, with stress slightly decrease in the post immediate program (52.6%) and high decreased (12.3%) in the follow-up, with significant difference between pre/ post and follow up phases of program implementation (p<0.0001). The total mean score for occupational stressors among studied sample was high in administrative stressors (35.532±6.8430) and was also high in organization stressors (27.035±5.0339). While, lowest was in social stressors (8.906±2.1808). Conclusion: There was statistically significant improvement in teaching staff occupational stress level before and after the implemented program Recommendation: providing occupation stress management program periodically to improving personal coping mechanism and institute work/life balance strategies.

Using the Practical, Robust Implementation and Sustainability Model (PRISM) to qualitatively assess multilevel contextual factors to help plan, implement, evaluate, and disseminate health services programs.

There is consensus in dissemination and implementation (D&I) science that addressing contextual factors is critically important for understanding translation of health care delivery interventions but little agreement on which contextual factors are key determinants of implementation outcomes. We describe the application of the Practical Robust Implementation and Sustainability Model (PRISM), which expands the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to identify contextual factors across four diverse programs. Multiple qualitative methods were used to collect multilevel, multistakeholder perspectives from the adopting organizations and staff. We identified measures for evaluating context through the various domains of PRISM to guide health services research across the phases of program implementation. The PRISM domains of Recipients, Implementation and Sustainability Infrastructure, and External Environment identified important multilevel contextual factors, including variability in operational processes and available resources. These domains helped to facilitate planning and implementation phases of the four interventions and guide purposeful adaptations. We found assessments of PRISM domains useful to systematically assess multilevel contextual factors across various content areas as well as phases of program implementation. Additionally, these contextual factors were found to be relevant to RE-AIM outcomes. Lessons learned can be applied to future research as there is a need to investigate the measurement properties of PRISM and continue to test which contextual factors are most important to successful implementation and for which outcomes.

The participation of non-industrial private forest owners in forest certification programs: The role and effectiveness of intermediary organisations

Group forest certification programs are a relatively new policy tool designed to enhance the inclusion of small-holder foresters in forest certification systems. However, our understanding of the institutional arrangements that facilitate the participation of small-holder foresters in certification programs is limited. We assessed the role and effectiveness of intermediary organisations in promoting the participation of Non-Industrial Private Forest Owners (NIPFOs) in a forest management certification program. We focused on the Eastern Ontario Model Forest (EOMF) – an intermediary organization in Canada – which facilitates the certification of NIPFOs in a group certification program. We employed a mixed method approach involving questionnaires, document review, semi-structured interviews, and direct observations. Our findings show that the EOMF's role in the certification of NIPFOs falls under three broad categories and program implementation phases. These are program design and implementation (early-phase), routine administrative and organisational work (take-off phase), and organisational and financial sustainability (long-term phase). Across the different phases of the program, attributes of the EOMF that enhanced its effectiveness were its capacity to (a) build social capital and run the certification at relatively low cost, (b) optimize the program to provide services required by landowners, and (c) innovate to respond to stakeholder demands. However, poor market benefits, instability in donor funding and perceived inequity in group dynamics limit the EOMF's effectiveness. Intermediaries are important not only to reduce the challenges that limit the participation of small-holders in certification but also in optimizing certification to better respond to the needs and interests of small-holder operators.

Health Needs Management Program and Compliance with Therapeutic Regimen among Postoperative Liver Transplant Recipients

Liver transplant recipients suffer from a chronic condition, which by itself entails risks and health problems, so they need to understand the transplantation process so as to change their living experience for better life post transplantation. The aim of this study was to The aim of this study was to assess the effect of health needs management program on liver transplant recipients' needs and their compliance to therapeutic regimen .Research design: A quasi experimental design was utilized to meet the aim of the study. Setting: The study was conducted in liver transplantation outpatient clinic at El Manial Cairo University hospital. Subjects: A purposive subjects of 40 patients post liver transplantation surgery from the liver transplantation outpatient clinic. Tools: A) Patient structured interviewing questionnaire to assess demographic characteristics among study subjects. B) Patients 'needs assessment tool to assess the following: 1. physical needs, 2. psychological needs, 3. social needs, 4. spiritual needs.5.educational needs C) Patients’ compliance questionnaire. Results: there were statistically significant differences among study subjects between pre and post program implementation regarding physical, psychological, social and educational needs. Furthermore, there were highly statistically significant differences between pre and post program implementation phases regarding all items of compliance among study group subjects. Conclusion: this study concluded that health needs management program had a positive effect in improvement of overall physical, psychological, social and educational needs of the recipient a well as their compliance to the therapeutic regime post program implementation. Recommendation: Health care providers specially nurses should develop time specific education programs based on liver transplant recipients’ educational needs at different post transplant times to maintain patients’ compliance .

Transcending jurisdictions: developing partnerships for health in Manitoba First Nation communities

The article describes national, regional and community-level activities that contributed to the Manitoba First Nation partnership in maternal and child health programming. The activities reveal a potential for health change that is possible through working together across jurisdictional boundaries. Although we are only in the early phases of program implementation, the Manitoba First Nation Strengthening Families Maternal Child Health Program already suggests considerable successes and measurable outcomes. The article encourages development of further partnerships in the promotion of First Nation health and wellness programming.

Cost to primary care practices of responding to payer requests for quality and performance data.

We wanted to determine how much it costs primary care practices to participate in programs that require them to gather and report data on care quality indicators. Using mixed quantitative-qualitative methods, we gathered data from 8 practices in North Carolina that were selected purposively to be diverse by size, ownership, type, location, and medical records. Formal practice visits occurred between January 2008 and May 2008. Four quality-reporting programs were studied: Medicare's Physician Quality Reporting Initiative (PQRI), Community Care of North Carolina (CCNC), Bridges to Excellence (BTE), and Improving Performance in Practice (IPIP). We estimated direct costs to the practice and on-site costs to the quality organization for implementation and maintenance phases of program participation. Major expenses included personnel time for planning, training, registry maintenance, visit coding, data gathering and entry, and modification of electronic systems. Costs per full-time equivalent clinician ranged from less than $1,000 to $11,100 during program implementation phases and ranged from less than $100 to $4,300 annually during maintenance phases. Main sources of variation included program characteristics, amount of on-site assistance provided, experience and expertise of practice personnel, and the extent of data system problems encountered. The costs of a quality-reporting program vary greatly by program and are important to anticipate and understand when undertaking quality improvement work. Incentives that would likely improve practice participation include financial payment, quality improvement skills training, and technical assistance with electronic system troubleshooting.

Co-Location of Health Care Services for Homeless Veterans: A Case Study of Innovation in Program Implementation

ABSTRACT This case study examines how the Veterans Affairs Greater Los Angeles Healthcare System (GLA) improved homeless veteran service utilization through program innovation that addressed service fragmentation. The new program offered same-day co-located mental health, medical, and homeless services with a coordinated intake system. The program is analyzed using a framework proposed by Rosenheck (2001) that has four phases: the decision to implement, initial implementation, sustained maintenance, and termination or transformation. GLA was able to successfully implement a new program that remains in the sustained maintenance phase five years after the initial decision to implement. Key factors from the Rosenheck innovation model in the program's success included coalition building, linking the project to legitimate goals, program monitoring, and developing communities of practicing clinicians. The key lesson from the case study is the need for a coalition to persistently problem solve and act as advocates for the program, even after successful initial implementation. Social work leadership was critical in all phases of program implementation.

Materials quality assurance for VLSI manufacturing

The VLSI process quality, and resulting product quality, depends significantly on the material characteristics of the permanent and temporary structures manufactured in the silicon wafer which, in turn, depend on the properties of processing materials. Therefore, materials quality control is the backbone of any VLSI quality assurance and improvement program. Instrumental analysis of the chemical and physical properties of materials involved forms the program's starting point. Cost-benefit analysis, careful evaluation of applicable instrumentation, people skills and experience, as well as managerial considerations of local cultural paradigms, are the key issues to be considered during both decision and program implementation phases. Cautious generalizations, resulting from Hewlett-Packard Fort Collins Integrated Circuit Division's experience with their materials quality program, are presented here along with conclusions regarding the program's favorable impact on VLSI products' quality and overall business objectives.

Citizen participation and health care: problems of government induced participation.

In this paper we trace the implications of some common contradictions in government-inspired efforts to increase citizen participation in health care delivery. We cover general problems of generating citizen participation, specific difficulties in community organization resulting when issues of health are the organizing focus, and the benefits that were thought to result from efforts to increase citizen participation in social programs in the 1960's. When programs focused on increased citizen participation were initiated program administrators attempted to maximize citizen involvement quickly by: projecting an image of maximal social impact; minimizing or ignoring questions of long-term fiscal uncertainty; projecting an image of maximal control by citizens; and projecting images of institutional solidarity and of experimentation and innovation. They tended to recruit to the staff social activists taken to be representative of the community (although they might not be), promising opportunities for upward mobility. They also tended to adopt conciliatory administrative styles in keeping with their experimental non-elitist orientations. These tendencies characteristic of the initiation phase of projects conflicted with the demands placed upon programs in later phases of program implementation. These demands resulted from later perceived needs to: evaluate programs; limit spending; counter internal organizational opposition; and respond to sponsors' shifting interests. Paraprofessionals recruited to the staff tended to lose their "community" orientation, and administrative style tended to focus considerably more on program accountability. These shifting program demands substantially account for what otherwise appears to be the failure of efforts to increase citizens' participation in health delivery programs, and, by extension, in other areas where the impetus for increased citizen participation comes from government initiatives.