Performance Measurement Program Research Articles

A Comprehensive, Community-Based Coalition to Address Racial Disparities in Chronic Disease: REACH in Allegheny County, Pennsylvania

Abstract: Background: Funded by the Centers for Disease Control and Prevention Racial and Ethnic Approaches to Community Health Initiative, Live Well Allegheny: Lifting Wellness for African Americans (LWA) in Allegheny County, Pennsylvania, aims to enhance health equity by addressing chronic disease in six African American communities via three key strategies: nutrition, physical activity, and community–clinical linkages. Objectives: This manuscript describes the coalition's partnership dynamics and evaluation methods with a focus on nutrition strategies. Methods: We have a network of committed partners implementing the strategies and we are evaluating our efforts using community asset mapping, county population-based survey data, qualitative process interviews, focus groups, and program performance measures. Results: The LWA coalition is the culmination of years of partnership building, which allows for more targeted activities related to health equity in the region. Thus far, the LWA coalition is thriving. The network of committed and talented partners in the nutrition strategy (healthy nutrition standards, food systems, and breastfeeding) reached 22 sites and more than 46,000 people during the first 2 years of the project. Process interviews conducted as part of the evaluation identified challenges and successes of implementation, and development of the coalition. Conclusions: This comprehensive evaluation approach supports formative processes, evaluation metrics, and prolonged sustainability plans of this community-based coalition.

Menuju Manajemen Talenta Sektor Publik: Faktor yang Memengaruhi, Tantangan, dan Strategi

Focus of this research was to describe of talent management in public sector, especially influencing factors, challenges, and strategies. This research applied descriptive qualitative analysis by combining library research and examining secondary data. There were four factors that played as influence, challenge, and strategy in talent management implementation for public sector, i.e. (1) cultural, (2) human resource, (3) managerial/structural, and 4) environmental. Cultural factor included making sustainable talent management. Human resource included capability, passion, and program performance measurement. Managerial factor included leadership, organizational commitment, and activists were needed in implementing TM consistently. Environmental factor included regulation, budget, and political support on the national scale.

Look-Back and Look-Forward Durations and the Apparent Appropriateness of Ambulatory Antibiotic Prescribing.

Ambulatory antibiotic stewards, researchers, and performance measurement programs choose different durations to associate diagnoses with antibiotic prescriptions. We assessed how the apparent appropriateness of antibiotic prescribing changes when using different look-back and look-forward periods. Examining durations of 0 days (same-day), -3 days, -7 days, -30 days, ±3 days, ±7 days, and ±30 days, we classified all ambulatory antibiotic prescriptions in the electronic health record of an integrated health care system from 2016 to 2019 (714,057 prescriptions to 348,739 patients by 2391 clinicians) as chronic, appropriate, potentially appropriate, inappropriate, or not associated with any diagnosis. Overall, 16% percent of all prescriptions were classified as chronic infection related. Using only same-day diagnoses, appropriate, potentially appropriate, inappropriate, and not-associated antibiotics, accounted for 14%, 36%, 22%, and 11% of prescriptions, respectively. As the duration of association increased, the proportion of appropriate antibiotics stayed the same (range, 14% to 18%), potentially appropriate antibiotics increased (e.g., 43% for -30 days), inappropriate stayed the same (range, 22% to 24%), and not-associated antibiotics decreased (e.g., 2% for -30 days). Using the longest look-back-and-forward duration (±30 days), appropriate, potentially appropriate, inappropriate, and not-associated antibiotics, accounted for 18%, 44%, 20%, and 2% of prescriptions, respectively. Ambulatory programs and studies focused on appropriate or inappropriate antibiotic prescribing can reasonably use a short duration of association between an antibiotic prescription and diagnosis codes. Programs and studies focused on potentially appropriate antibiotic prescribing might consider examining longer durations.

Evaluation of a Breast Cancer Screening Program in Nigeria using the Evaluability Assessment Model

There exists a paucity of policies and programs that support breast cancer screening in Nigeria. There is a clear need for effective programs that are cognizant of the local realities in Nigeria. The evaluability assessment model can be used as a cost effective and quick alternative to traditional evaluations to improve program practices and management and develop performance measures. This study uses an evaluability assessment to determine if a breast cancer screening program in Lagos, Nigeria was achieving its objectives and to adjust their activities to improve outcomes and processes to optimally serve its community. The evaluability assessment revealed the programs objectives are plausible given its resources and context. Program recommendations focused on improving staff management, developing benchmarks to measure outputs and outcomes, and examining more effective methods of disseminating program information to target population. This study is used as an example of how the six-step evaluability assessment model can be adapted to a multitude of programs to appraise program practices or performance measures.

Community‐led digital literacy training: Toward a conceptual framework

AbstractAn exploratory study investigated the factors affecting digital literacy training offered by local community organizations, such as public libraries. Theory based on the educational assessment and information literacy instruction literatures, community informatics, and situated learning theory served as a lens of investigation. Case studies of two public libraries and five other local community organizations were carried out. Data collection comprised: one‐on‐one interviews with administrators, instructors, and community members who received training; analysis of training documents; observations of training sessions; and a survey administered to clients who participated in these training sessions. Data analysis yielded the generation of a holistic conceptual framework. The framework identifies salient factors of the learning environment and program components that affect learning outcomes arising from digital literacy training led by local community organizations. Theoretical propositions are made. Member checks confirmed the validity of the study's findings. Results are compared to prior theory. Recommendations for practice highlight the need to organize and train staff, acquire sustainable funding, reach marginalized populations, offer convenient training times to end‐users, better market the training, share and adopt best practices, and better collect and analyze program performance measurement data. Implications for future research also are identified.

Assessing Multidimensional Approaches to Measure Program Outcomes in Human Service Organizations.

This study explores scholars’ approaches to measure performance in nonprofit human service organizations. While acknowledging that each human service organization’s unique mission makes it challenging to create a generalizable model across all nonprofit human service organizations, we propose three multidimensional frameworks for performance measurement derived from survey and qualitative data of organizations in this subsector. The frameworks will help researchers and practitioners rethink, adapt to, and reflect on the implications of their current methods of program performance measurement. While contributing to the academic discussion on the measurements used to evaluate human service organizations’ program performance, our research also offers important insights for researchers, managers, marketers, board members, and funders to use moving forward.

Improving the Delivery of High-Quality Cancer Care in Medically Underserved Communities: A Formative Evaluation Method.

In 2015, the American Society of Clinical Oncology launched a new program: Improving Quality of Care in Underserved Communities with the overarching aim of serving patients with cancer who have traditionally had difficulty accessing the care they need. Cancer care requires intense coordination of complex services to provide safe, effective, timely, and equitable care. If chemotherapy and/or radiation is needed, patients must navigate a complex system of care many times, a formidable challenge for many disadvantaged patients. Many practices believe that these patients face such significant issues that it is almost impossible to provide high-quality care. A grant from the Stavros Niarchos Foundation allowed us to select 4 oncology practices serving high proportions of racial minorities and persons of low socioeconomic status to participate in the new American Society of Clinical Oncology program. The program had 2 objectives: (1) to improve the capacity and capability of the participating practices to provide evidence-based, high-quality care; and (2) to identify and disseminate lessons learned for improving quality of care among oncology practices serving underserved patients. The program leveraged existing programs including the Quality Oncology Practice Initiative, which is a national performance measurement and improvement program that collects data about processes of care provided in the outpatient medical oncology setting, and the American Society of Clinical Oncology Quality Training Program, which provides training in how to apply the tools and methods of quality improvement in routine care settings. Training was provided in face-to-face and virtual meetings and participants were provided mentors throughout the program. At the conclusion, a formative evaluation method was used to assess whether the goals had been achieved. Objectives, activities, and desired outcomes were identified for each of the goals and thus became the framework for the evaluation. The program met the stated goals and objectives. The evaluation revealed many successes, some surprises, and a list of improvements that were incorporated in the next iteration of this program. Based on data from the evaluation, the Niarchos Foundation provided funds for an additional 10 practices to participate in a similar program in 2020. This article outlines the evaluation of a new program demonstrating that medical oncology practices can make improvements in the care of their underserved populations if provided with the proper tools, methods, and coaching. The use of formative evaluation methodology also identified opportunities for improvement and ultimately resulted in additional funding for more practices to participate in the program.

Kidney Exchange Program Reporting Standards: Evidence-Based Consensus From Europe.

Background: Kidney Exchange Programs can play an important role to increase access to the life saving and most cost-effective treatment for End Stage Renal Disease. The rise of national KEPs in Europe brings a need for standardized performance reporting to facilitate the development of an international evidence base on program practices.Methods: We systematically searched and reviewed the literature to extract kidney exchange program performance measures. Reported measures were initially categorized as structure, process, and outcome measures. Expert feedback was used to redefine categories and extend the set of measures to be considered. Using the Delphi method and a panel of 10 experts, the resulting measures were subsequently classified as mandatory (Base set), optional (Extended set), or deleted.Results: Out of the initial 1,668 articles identified by systematic literature search, 21 European publications on kidney exchange programs were included to collect performance measures, accompanied by three national program reports. The final measurement categories were Context, Population, Enrollment, Matching, Transplantation, and Outcomes. The set of performance measures resulting from the literature review was modified and classified as mandatory or optional. The resulting Base set and Extended set form the kidney exchange program reporting standard.Conclusions: The evidence-based and consensus-based kidney exchange program reporting standard can harmonize practical and scientific reporting on kidney exchange programs, thus facilitating the advancement of national programs. In addition, the kidney exchange program reporting standard can promote and align cross-national programs.

Survey of Practices on Performance Measurement of U.S. Inland Waterway Freight Transportation

The inland waterway freight transportation system plays a vital role in the trade and commerce of the U.S.A. To ensure that the system performs at an acceptable level, routine monitoring and performance evaluation of the system is critical. Individual states are responsible for developing and implementing suitable performance measurement systems for their respective inland waterways. This paper focuses on surveying, reviewing, and synthesizing current performance measurement practices adopted by different states in the U.S.A. It finds that, among the 38 states with inland navigability, only 12 states have established performance measures to monitor the performance of their inland water transportation systems. To aid the states in developing and enhancing inland waterway performance measurement programs, the paper further outlines the current state of research on inland waterways, recommendations from various federal and maritime organizations, and also current practice outside of the U.S.A. Based on a scan of the publicly available data sources, the paper proposes a two-dimensional performance measurement practice from the perspectives of performance areas and infrastructure types. Such an approach will help state Departments of Transportation to identify system needs and deficiencies while offering a comprehensive picture of performance of an inland water freight transportation system.

Substance Abuse Disorder in Nursing: Evaluation and Recommendation for Regulatory Monitoring Program Performance Measures and Enhancement.

Outcome measures for individual states' nursing professional alternative-to-discipline (ATD) programs have historically ceased beyond successful fulfillment of active program monitoring, leaving a gap in affirmation of sustained postprogram efficacy. The project objective challenges the absence of profession-specific postmonitoring practice, affording qualitative evaluation of the program's impact to professional nursing. The pilot study's 8-week process improvement PICO(T) seeks validation of incorporating postprogram monitoring to validate program efficacy, conceptualizing framework guidelines established by the Federation of State Physician Health Programs' Performance Enhancement Review. Study efforts encompass identified needs assessment, current practice through outcome recommendations, and access of developed online mixed-methods appraisal with an emphasis on qualitative analysis, questioning the alumni's state of sobriety, perspective related to program participation, workforce contribution to professional practice, and intent to remain in nursing. The proposed alumni graduate status between 2 and 5 years from program completion resulted in an 11% response rate: 90% reported zero relapse since program completion; greater than 50%, willingness to participate as ATD or peer mentors; 90%, nursing licensure in good standing; and 66%, intent to remain working in profession over the next 5 years. Limitations constitute sample size, inception groundwork, and project constraints. Findings offer insight from alumni perspective, validation of literary support, and organizational interest for implementation. Contributions to nursing practice embody care of the caregiver ideology and offer future collaboration with ATD programs at state, national, and global levels to support sustained recovery of professionals affected with substance use disorder.

Navigating the COVID-19 pandemic: Initial impacts and responses of the Organ Procurement and Transplantation Network in the United States.

COVID‐19 has been sweeping the globe, hitting the United States particularly hard with a state of emergency declared on March 13, 2020. Transplant hospitals have taken various precautions to protect patients from potential exposure. OPTN donor, candidate, and transplant data were analyzed from January 5, 2020 to September 5, 2020. The number of new waiting list registrations decreased, with the Northeast seeing over a 50% decrease from the week of 3/8 versus the week of 4/5. The national transplant system saw near cessation of living donor transplantation (−90%) from the week of 3/8 to the week of 4/5. Similarly, deceased donor kidney transplant volume dropped from 367 to 202 (−45%), and other organs saw similar decreases: lung (−70%), heart (−43%), and liver (−37%). Deceased donors recovered dropped from 260 to 163 (−45%) from 3/8 compared to 4/5, including a 67% decrease for lungs recovered. The magnitude of this decrease varied by geographic area, with the largest percent change (−67%) in the Northeast. Despite the pandemic, discard rates across organ has remained stable. Although the COVID‐19 pandemic continues to evolve, OPTN data show recent evidence of stabilization, an indication that an early recovery of the number of living and deceased donors and transplants has ensued.

Association of Electronic Health Record Use Above Meaningful Use Thresholds With Hospital Quality and Safety Outcomes

By 2018, Medicare spent more than $30 billion to incentivize the adoption of electronic health records (EHRs), based partially on the belief that EHRs would improve health care quality and safety. In a time when most hospitals are well past minimum meaningful use (MU) requirements, examining whether EHR implementation beyond the minimum threshold is associated with increased quality and safety may guide the future focus of EHR development and incentive structures. To determine whether EHR implementation above MU performance thresholds is associated with changes in hospital patient satisfaction, efficiency, and safety. This quantile regression analysis of cross-sectional data used publicly available data sets from 2362 acute care hospitals in the United States participating in both the MU and Hospital Value-Based Purchasing (HVBP) programs from January 1 to December 31, 2016. Data were analyzed from August 1, 2019, to May 22, 2020. Seven MU program performance measures, including medication and laboratory orders placed through the EHR, online health information availability and access rates, medication reconciliation through the EHR, patient-specific educational resources, and electronic health information exchange. The HVBP outcomes included patient satisfaction survey dimensions, Medicare spending per beneficiary, and 5 types of hospital-acquired infections. Among the 2362 participating hospitals, mixed associations were found between MU measures and HVBP outcomes, all varying by outcome quantile and in some cases by interaction with EHR vendor. Computerized provider order entry (CPOE) for laboratory orders was associated with decreased ratings of every patient satisfaction outcome at middle quantiles (communication with nurses: β = -0.33 [P = .04]; communication with physicians: β = -0.50 [P < .001]; responsiveness of hospital staff: β = -0.57 [P = .03]; care transition performance: β = -0.66 [P < .001]; communication about medicines: β = -0.52 [P = .002]; cleanliness and quietness: β = -0.58 [P = .007]; discharge information: β = -0.48 [P < .001]; and overall rating: β = -0.95 [P < .001]). However, at middle quantiles, CPOE for medication orders was associated with increased ratings for communication with physicians (τ = 0.5; β = 0.54; P = .009), care transition (τ = 0.5; β = 1.24; P < .001), discharge information (τ = 0.5; β = 0.41; P = .01), and overall hospital ratings (τ = 0.5; β = 0.97; P = .02). At high quantiles, electronic health information exchange was associated with improved ratings of communication with nurses (τ = 0.9; β = 0.23; P = .03). Medication reconciliation had positive associations with increased communication with nursing at low quantiles (τ = 0.1; β = 0.60; P < .001), increased discharge information at middle quantiles (τ = 0.5; β = 0.28; P = .03), and responsiveness of hospital staff at middle (τ = 0.5; β = 0.77; P = .001) and high (τ = 0.9; β = 0.84; P = .001) quantiles. Patients accessing their health information online was not associated with any outcomes. Increased use of patient-specific educational resources identified through the EHR was associated with increased ratings of communication with physicians at high quantiles (τ = 0.9; β = 0.20; P = .02) and with decreased spending at low-spending hospitals (τ = 0.1; β = -0.40; P = .008). Increasing EHR implementation, as measured by MU criteria, was not straightforwardly associated with increased HVBP measures of patient satisfaction, spending, and safety in this study. These results call for a critical evaluation of the criteria by which EHR implementation is measured and increased attention to how different EHR products may lead to differential outcomes.

Transplant Center Variability in Organ Offer Acceptance and Mortality Among US Patients on the Heart Transplant Waitlist

Under the current Centers for Medicare & Medicaid Services guidelines, there is incentivization to optimize posttransplant outcomes regardless of mortality among patients on the waitlist and transplant rates; few data exist with regard to transplant center acceptance practices and survival to heart transplant. To evaluate the extent of variability in organ acceptance practices in the US and whether this center-level behavior is associated with heart transplant candidate survival. In this retrospective cohort study, the US National Transplant Registry was queried for all match runs of adult candidates listed for isolated heart transplant between May 1, 2007, and March 31, 2017. Data analysis was conducted from October 30, 2018, to May 1, 2019. The final cohort included 93 transplant centers, 19 703 donors, and 9628 candidates. Center acceptance rates for heart allografts offered to the highest-priority candidates, association between center acceptance rate and mortality among patients on the waitlist, and posttransplant outcomes between candidates who accepted their first-rank offers vs those who accepted previously declined offers. Among 19 703 unique organ offers, 6302 hearts (32.0%) were accepted for first-rank candidates. After adjustment for donor, candidate, and geographic covariates, transplant centers varied in acceptance rates (12.3%-61.5%) of offers made to first-rank candidates. Higher acceptance rates were associated with lower cumulative incidence of 1-year mortality among patients on the waitlist. For every 10% increase in adjusted center acceptance rate, the risk of mortality decreased by 27% (subdistribution hazard ratio, 0.73; 95% CI, 0.67-0.80). No statistically significant difference was observed in 5-year adjusted posttransplant patient survival (adjusted hazard ratio, 1.02; 95% CI, 0.94-1.11) and graft failure (subdistribution hazard ratio; 0.95; 95% CI, 0.83-1.09) between hearts accepted at the first-rank compared with lower-rank positions. Variability in heart allograft acceptance rates appears to exist among transplant centers, with candidates listed at lower acceptance rate centers being more likely to experience mortality while on the waitlist. Comparable posttransplant survival suggests that allografts that were declined as a first offer perform as well as those that were accepted at their first offer. These findings suggest that organ acceptance rate or time to transplant from being added to the waitlist may be an additional measure of heart transplant program performance.

The Drug Court Team and Discretionary Decision-Making: A Mixed-Methods Examination of Sanctioning Responses to Continued Participant Alcohol and Other Drug Use

Drug courts attempt to gain participant compliance and alcohol and other drug (AOD) use abstinence through a strategy of moderate and progressive sanctioning, but its discretionary application possesses the capacity for disparity across participants and behaviors. The purpose of this study was to examine the drug court team’s (DCT) discretionary use of sanctions in response to continued participant AOD use. A mixed-methods approach was used for analyzing agency data ( n = 1,032) and interviews of five members of the DCT. Data were collected from an adult felony drug court over a 6-year period (2008–2013) and use to answer the following research question: “What participant characteristics and program performance measures affected sanctioning outcomes?” We found that offender attributes did play a role in the sanctioning decision, but program performance measures were stronger predictors of sanction type.

Discovering the performance criteria of education development centers of medical sciences universities: A qualitative study.

CONTEXT:Performance is a significant objective of any organization. To grow and develop and to improve the performance of the education development centers (EDCs) of medical sciences universities at Iran, the recognition of the performance criteria of these centers is important. This study was conducted with the aim of discovering the performance criteria of EDCs of medical science universities.SUBJECTS AND METHODS:This study was conducted using qualitative research and a semi-structured interview. Participants were selected using an expert sampling method is a sub-type of purposive sampling. Twenty-three faculty members and expert staff (11 males and 12 women) participated in the interview. Data were collected using the participant's perception. The data analysis was performed based on the interpretative analysis steps of Gillham and Rubin.RESULTS:From the analysis of data, seven categories including leadership, strategy, stakeholders, workforce, knowledge management, processes management, and results were obtained.CONCLUSIONS:The obtained criteria in this study assist managers to design and to develop self-assessment questionnaires and a performance measurement program for EDCs of medical sciences universities. This will facilitate performance evaluation of EDCs.

Infant, maternal and demographic predictors of delayed vaccination: A population-based cohort study

BackgroundReceiving vaccines at or close to their due date (vaccination timeliness) is a now key measure of program performance. However, studies comprehensively examining predictors of delayed infant vaccination are lacking. We aimed to identify predictors of short and longer-term delays in diphtheria-tetanus-pertussis (DTP) vaccination by dose number and ethnicity. MethodsPerinatal, notification, death and immunisation databases were linked for 1.3 million births in 2000–11 from two Australian states (Western Australia and New South Wales), with follow-up data until 2013. Ordinal logistic regression was used to estimate adjusted relative risks (RR) by degree of delay. Separate models were constructed for each vaccine dose and for Aboriginal and non-Aboriginal children. ResultsEach dose-specific cohort included at least 49,000 Aboriginal and 1.1 million non-Aboriginal children. Delayed receipt was more common among Aboriginal than non-Aboriginal children (eg for the first dose of DTP [DTP1] 19.4 v 8.1%). Risk factors for delayed vaccination were strongest for DTP1, and delayed receipt of DTP1 was a key driver of subsequent delays; every week DTP1 was delayed was associated with a 1.6 to 2-fold increased risk of delayed DTP2 receipt. For DTP1, ≥3 previous pregnancies (the only factor more strongly associated with longer than shorter delays; RR ≥5 compared to no previous pregnancies), and children born to mothers <20 years of age (RR ≥2 compared to ≥35 years) were at highest risk of delay. Other independent predictors were prematurity, maternal smoking during pregnancy, and being born in Western Australia (if Aboriginal) or another country in the Oceania region. ConclusionThe sub-populations at risk for delayed vaccination we have identified are likely generalisable to other high-income settings. Measures to improve their dose 1 timeliness, particularly for children with older siblings, are likely to have significant flow-on benefits for timeliness of later doses.

The Educational Situation Quality Model: A New Tool to Explain and Improve Academic Achievement and Course Satisfaction.

Students’ academic achievement is a major concern among countries. Governments spent a lot of money on education to improve students’ competences at all levels of education. Despite the enormous amount of money invested and the reforms made to curricula in many countries in recent years, these measures are not generally producing the desired results according to the data of International Performance Measurement programs for students (e.g., Program for International Student Assessment-PISA by OECD). Given the importance of this issue, this article presents an instructional-motivational model developed in the last decade to explain and improve students’ learning outcomes, e.g., academic achievement and course satisfaction, entitled the “The Educational Situation Quality Model” (MOCSE, acronym in Spanish). Unlike other educational models, MOCSE offers an integrative teaching-learning approach to explain learning outcomes. By taking the educational setting as a unit of analysis, this proposal introduces a new perspective into the existing literature to predict students’ achievement and course satisfaction by combining contributions from relevant psycho-educational theories, such as: “The Job Demands-Resources Model,” “The Expectancy-Value Theory,” and “The Achievement Goal Theory.” Besides being a conceptual framework to guide research, it also provides a methodological way to improve teacher practice and learning outcomes. In this article we first briefly explain the main model’s characteristics and functioning from the student perspective and, second, based on the MOCSE, we offer some keys for teachers to improve academic achievement and students’ course satisfaction for a specific curricular subject. Finally, future proposals and challenges are discussed. Questionnaires are provided in the Annex.

Investigating the role of contextual factors in effectively executing communication evaluation and measurement

PurposeEvaluation and measurement (E&M) remains a critical and debated topic among communication scholars and practice. Substantial research and professional efforts have been devoted to discussing what should be measured and which methods should be applied. Most of the E&M models seem to carry a positivist imprint. But, in real-life, organizations could not have clear aims, enough resources, or adequate informative systems to support E&M. Moreover, several contextual factors could affect the implementation of E&M management processes. The communication literature rarely highlights these factors. To fulfill this gap, the purpose of this paper is to theorize the contextual factors relevant to the management of the evaluation process.Design/methodology/approachA scoping literature review was carried out exploring the role of contextual factors and impact of contextual factors on E&M management processes. More specifically, the review examines the contribution provided by program evaluation and performance measurement (PM) fields of research.FindingsThe paper provides a scoping review of program evaluation and PM approaches. Additionally, it explains how both streams of thought argued the importance of contextual factors, such as organizational, relational, cultural and communicative factors, for the success of any evaluation processes. The study underlined that the main evaluation models used in the field of communication have overlooked these studies and put on evidence the role of contextual factors in effectively executing communication E&M.Originality/valueThe paper enriches the dominant rationale concerning the E&M management processes by incorporating literature on: program evaluation; and PM. The analysis could provide useful insights also from a professional perspective, by helping practitioners for a contextual assessment of strategic communication programs and activities.

Tuberculosis among northern Manitoba First Nations, 2008-2012: program performance on- and off-reserve.

The objectives of this study were to:(1) report tuberculosis (TB) program performance for northern First Nations in the province of Manitoba; (2) present methods for TB program performance measurement using routinely collected surveillance data; and (3) advance dialogue on performance measurement of Canadian TB programs. Data on a retrospective cohort of people diagnosed with TB in Manitoba between January 1, 2008 and December 31, 2010, and their contacts,were extracted from theManitoba TB Registry. Performance measures based on US-CDC were analyzed. Adjusted probability ratios (aPR) and 95% confidence intervals (CIs) werereported with comparisons between on-/off-reserve First Nations, adjusted for age, sex, and treatment history. A cohort of n = 149 people diagnosed with TB and n = 3560 contactswereidentified. Comparisons off-/on-reserve: Treatment completion (aPR = 1.03; 95% CI 0.995-1.07); early detection (aPR = 0.87; 95% CI 0.57-1.33); HIV testing and reporting (aPR = 0.42; 95% CI 0.21-0.83); pediatric TB (age < 15years) (aPR = 1.20; 95% CI 0.47-3.06); retreatment for TB (aPR = 0.93; 95% CI 0.89-0.97); contact elicitation (aPR = 0.94; 95% CI 0.84-1.05); contact assessment (aPR = 0.69; 95% CI 0.50-0.94). Pediatric (ages < 15years) TB incidence in northern Manitoba was 37.1 per 100,000/year. TB program performance varies depending on residence in a reserve or non-reserve community. Action is urgently needed to address TB program performance in terms of contact investigation and HIV testing/reporting for First Nations off-reserve and to address high rates of pediatric TB in northern Manitoba. First Nations collaboration and models of care should be considered both on- and off-reserve to improve TB program performance.

Evaluating planning strategies for prioritizing projects in sustainability improvement programs

Programs to improve the sustainability of building infrastructures often consist of project portfolios that need to be prioritized in an appropriate chronological fashion to maximize the program’s benefits. This is particularly important when a revolving-fund approach is used to leverage savings from the initial projects to pay for later improvements. The success of the revolving-fund approach is dependent on the appropriate prioritization of projects. Competing performance measures and scarce resources make this task of project prioritization during the planning stage a complex and challenging endeavour. The current study examined the impact of different project prioritization strategies for revolving-fund sustainability program performance. A novel modeling approach for sustainability decision-analysis was developed using the system dynamics method, and the model was calibrated using a campus sustainability improvement program at a major university. The model was applied to evaluate the effects of five common project-prioritization strategies on three program-performance measures, across a wide range of initial investment levels. For the university case study, we found that the strategy of prioritizing projects according to decreasing benefit/cost ratio performed best. The research demonstrated that using a system dynamics model can allow sustainability program managers to make better-informed sequencing decisions, leading to a financially and environmentally successful program implementations.