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Policy makers, school practitioners, and scholars around the world have been searching for better school improvement models. The purpose of this study was to understand how an instrument we developed, Orientation to School Renewal, can be used to predict school-level academic achievement. We used the instrument to predict the academic performance of 83 schools as measured by the Michigan Student Test of Educational Progress (M-STEP) and the Scholastic Achievement Test (SAT) for mathematics and language. We found our instrument was more sensitive to M-STEP. We found that school renewal efforts were able to predict school academic performance with M-STEP in both mathematics and language. The three leading dimensions for predicting achievement on M-STEP were (a) focus on students and their achievement, (b) internal responsibility, and (c) continuous improvement. The renewal model provides a new perspective on school improvement, and future studies in other countries and international settings are recommended.

A study examined the practices of 121 school-based intervention teams from Michigan, Illinois, and Wisconsin. Findings revealed several positive practices by teams from all states; however, teams from Illinois displayed consistent superiority across several measures. Discussion focuses on implications for practice and educational and legal reform. (Author/CR)

A telemedicine network has operated in the Upper Peninsula (UP) region of Michigan since 1995. The Marquette General Health System (MGHS) is the tertiary hospital that provides telemedicine services to 14 surrounding rural health facilities and another seven clinics. In order to assess the state of telemedicine in the UP region and its potential for development, three main factors were assessed: organizational development, telemedicine activity and perceptions of the key players. Data were collected through interviews with five MGHS telemedicine staff, 10 physicians (five from the MGHS and five from surrounding rural areas), 13 of the 14 chief executive officers (CEOs) of the remote telemedicine sites and a survey of 21 telemedicine site coordinators. This information was analysed in order to outline job roles and responsibilities; to document the process of doing telemedicine; and to understand current policies and procedures. Telemedicine activity from 1995 to 1999 was analysed in terms of the purpose of the session. In 1999, a total of 515 telemedicine sessions were conducted, 323 being non-educational and 192 being educational. Most CEOs of the rural hospitals were interested in furthering their use of clinical telemedicine applications. The data also indicated a great need for education, particularly of the rural physicians. The overall view of those surveyed about MGHS's telemedicine programme was positive. Respondents were quick to compliment the staff whenever possible. New telemedicine staff have been employed, which will allow responsibilities to be reassigned in such a way as to create a more efficient system. [ABSTRACT FROM AUTHOR]

Two large hospice organizations in Kansas and Michigan began a telehospice project with the goal of improving care at the end of life using telemedicine. Hospice nurses provided services using video directly to the homes of hospice patients. The telemedicine equipment operated over ordinary telephone lines. Nursing services included symptom assessment and psychospiritual evaluations. Patients lived in both urban and rural settings. Studies were designed to evaluate utilization patterns, access to care, patient/carer acceptance, medical outcomes and cost. During the first year of the project, telehospice care was initiated at five rural sites (two in Michigan and three in Kansas) and three urban sites (two in Michigan and one in Kansas). There was greater telehospice activity in Michigan than in Kansas, with 118 and 44 patients served, respectively. The urban site in Kansas withdrew from the study after participating for only nine months. In an effort to understand the difference in utilization patterns and reasons for withdrawing from the project, in-depth interviews of key study participants, including hospice administrators, nurses and research personnel, were conducted. Human factors appear to be important in the adoption of novel telemedicine applications. [ABSTRACT FROM AUTHOR]

Asthma is a chronic disease and a growing health problem worldwide. The objective of this pilot study was to test the feasibility and utilization of tracking asthma symptoms through an innovative mobile phone application. The subjects for this research project consisted of 4 individuals who are currently receiving treatment for asthma from a primary care physician in Ingham County, Michigan. Participants took their peak flow reading each day and used the short message service (SMS) function on their phone and sent it to a Web server. If they did not send it by 11 AM, they received a reminder via an automated SMS to their phone. The resulting data suggest that this method of management is feasible. The data also demonstrate participants' satisfaction in monitoring their asthma in this manner. Using mobile phones for asthma management could improve compliance with asthma action plans and reduce adverse asthma events. Future research could further demonstrate that mobile phones are a new and effective method for providing healthcare.

In Michigan, the use of telemedicine for dialysis patients began in three centres in 2005. A total of 747 clinical consultations was conducted in the following 22 months. Telephone surveys were conducted with 34 patients and four providers. The patients and providers all had positive perceptions of the telemedicine system and the care that was delivered. Most of the clinical measures of the patients met or exceeded the recommendations made by Renal Network 11. In addition to the clinical work, the telemedicine equipment was used for educational events. Twenty-six professional educational events were provided with a total audience of 105 individuals, and 35 administrative meetings were provided with 286 staff members in attendance. The study showed that patients and providers could participate in educational events that might not be available locally. Despite the success of dialysis telemedicine, the Marquette General Health System discontinued its use in 2007 when the Center for Medicare and Medicaid Services re-affirmed that dialysis centres were not approved sites for telemedicine.

The potential for Information Technology (IT) to enhance the healthcare provision has long been recognized. One application of IT in healthcare, Electronic Medical Records (EMR) systems, has generated particular interest. Technical and structural barriers are often analyzed to understand EMR deployment. This study sought to examine cultural barriers to better explain the potential success and failure of EMRs. Successful EMR implementations are of interest to telemedicine researchers as they provide an IT infrastructure on which many telemedicine applications can be built. This investigation sought to understand the role and impact of individual and organizational issues on perceptions regarding EMRs by providers now employing an EMR system at Michigan State University (MSU). A 144-item survey was administered to 41 participants and descriptive statistics were employed for data analyses. Data indicated that providers reported mixed results regarding perceptions of EMRs at MSU. More than 45% of the respondents reported that they consider the MSU EMR system a bad choice. Yet, these same providers reported high levels of satisfaction across multiple aspects of system usability. Demographic variables did not emerge as highly correlated with perceptions of the EMR system at MSU. However, positive perceptions about EMRs in general were highly correlated with positive perceptions of the EMR system at MSU. Because results indicate that perceptions of the impacts of EMRs in general are more often correlated with perceptions of a specific EMR implementation than demographic variables, health organizations should focus their energies on EMR education and training.

Telehospice (TH) utilizes telemedicine technology to provide care at the end of life. A bistate project was launched in 1998 to study the use of home-based telemedicine for routine hospice care. Videophones were deployed for telenursing visits and evaluations by social workers. In order to determine what proportion of home hospice visits could be performed using currently available telemedicine technology, we reviewed clinical records retrospectively for hospice nurse home visits. Clinical notes documenting home nursing visits were obtained from two large hospices, one based in Kansas, and the other in Michigan. Records were randomly selected for patients who received hospice nurse visits during the month of January 2000. The charts were reviewed for patient demographic information, patient assessments, teaching activities, and interventions. Five hundred ninety-seven nursing notes were analyzed using an 85-item coding instrument. After careful review of the records, the coders also made a subjective observation regarding the suitability of each visit for telemedicine. As part of this analysis, we found that 64.5% of home hospice nursing visits could be performed by telemedicine. Using TH, it is possible to reduce the number of in-person visits, thereby significantly decreasing the cost of providing hospice care.

Over the last few years, telepsychiatry services in Michigan have been developed by LifeWays, a Medicaid-managed behavioural health-care organization. The project had four phases, involving the introduction of telepsychiatry services between a rural and an urban clinic, to a crisis intervention centre, to a youth detention centre and to patients' homes. The role of organizational issues in the success of the programme was examined through patient interviews, provider interviews, patient and provider pre- and post-project focus groups, and service documents. Utilization data were obtained from activity logs and patient charts. During the study, 297 clients received 578 teleconsultations. Almost 97% of the telepsychiatry visits were scheduled. Telemedicine usage varied between the four project phases. The reasons for its variation in use included provider roles, existing organizational strategic goals and resources, the inherent organizational culture and quirks, and leadership and managerial factors. The major difficulties stemmed from the providers and the organization itself. There is tremendous potential for telepsychiatry and the ways in which organizational variables can be managed to influence the success of telepsychiatry programmes deserve further study.

Outline the positive and negative predictors of telehospice use, namely its impact on organizational and management issues.

The Marquette General Health System (MGHS) initiated its telehealth program in 1995 with eight network sites in Michigan's Upper Peninsula. There are currently almost 30 active sites in this network that provide clinical, educational, and administrative services. In this article, MGHS is assessed against four criteria, namely, integration, evaluation, expansion, and acceptance. Several assessment data collection strategies were employed among patients, providers, administrators, and rural community members. This paper delineates the extent to which the MGHS program meets the definition of success as defined by this four-level model. Data and anecdotal evidence are presented that illustrate that the MGHS program has been successful in its attempt to increase access to medical services for the rural population of the Michigan Upper Peninsula, as well as facilitate medical and health education, and home care services.

We studied two rural telemedicine projects in the state of Michigan: one that enjoyed success and steady growth in activity, and one that experienced frustration and a lack of clinical utilization. Multiple data collection strategies were employed during study periods, which lasted approximately one year. Both projects enjoyed a grassroots approach and had dedicated project coordinators. However, the more successful project benefited from resources and expertise not available to the less successful project. In addition, the more successful project possessed a more formalized organizational structure for the telemedicine application. A comparison of the two projects leads to a simple conclusion. Telemedicine programmes are positioned within larger health organizations and do not operate in a vacuum. It is crucial that the organization in which it is intended to launch telemedicine is examined carefully first. Each organization operates within a larger environment, which is often constrained by fiscal, geographical and personnel factors. All these will affect the introduction of telemedicine.

Telemedicine programmes are often complex undertakings that result in combinations of success and failure. Michigan State University and LifeWays received a grant for a four-phase telepsychiatry research project in 2000. We employed multiple data-collection techniques, including patient and provider surveys, in-depth interviews, observation, patient chart analyses, and organizational archival data analyses. Of the four phases in the project, two proved to be successful, one failed in its initial goal but succeeded with a redefined goal, and one failed completely. Issues that affected success or failure included human resource conflicts, organizational structure, inter-organizational relationships and allocated resources.