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Empowerment-oriented design teams were structured in four states to promote collaborative practices among professionals and former clients. These teams were structured to serve as both learning and training systems, and they identified competencies for collaborative practices. Because these design teams represent a new learning and improvement system for child welfare and related service systems, and because these systems need more effective approaches to learning, training, and improvement, outcomes-oriented evaluations are imperative. The outcomes evaluation reported here relied on two evaluation strategies. First, 48 design team members completed follow-up surveys; these surveys explored individuals' perceptions of their design team involvement. Second, 22 design team members were interviewed directly; they were asked questions about the benefits and accomplishments resulting from their design team experience. These data from both evaluation strategies indicate that design teams promoted family-centered practice and interprofessional collaboration; enhanced service delivery and an understanding of co-occurring needs; and fostered personal growth and self-awareness among participants. These commonalties and similarities were surprising and interesting because design teams in the four states proceeded differently. These findings are discussed in relation to emergent theory on collaborative learning processes and products.

Organizations have expended enormous resources to restructure care delivery. Despite the growing literature describing these organizational innovations, there is a paucity of credible data that reflects systematic measurement and evaluation of such changes. This report not only describes a comprehensive research based restructuring effort in a 720 bed acute-care hospital, but it also describes an outcomes evaluation strategy and associated findings that may serve as a model and a guide for other healthcare institutions.

238 Background: Ordering and administration of chemotherapy was performed on paper in Kaiser Permanente until 2008. Chemotherapy is complex because treatments can be given over more than one day and over multiple cycles. Side effects may occur which require additional medications. Within the KP system, oncologists used more than 1,400 chemotherapy protocols. Each patient's regimen was physician dictated and standardization was rare. Reliable chemotherapy adminstration data did not exist for clinical quality, utilization and outcomes evaluation. The KP HealthConnect Oncology Beacon Module was created to standardize chemotherapy, enhance safety, and simplify ordering and administration of complex medications. This project required collaboration among oncologists, nurses, pharmacists and information technologists throughout the organization. This process assures that the right patient gets the right drug at the right dose at the right time. Methods: In 2005, a collaborative group of oncologists, nurses, pharmacists and IT from across KP began to develop chemotherapy protocols which included orders for medications, fluids, rates and routes of administration and nursing instructions. They worked with deployment teams to communicate change, assess workflows, develop and deliver training.The guiding principles for protocol development were: Evidence Based Effectiveness, Safety, Efficiency and Cost. Results: Decreased number of Chemotherapy Protocols through evidence review and consensus from 1,400 to 433 standardized templates. 84% or higher adherence to evidence-based templates. Reduced adverse events per 1,000 chemotherapy related medications by 9% at the San Jose Medical Center (pilot site). Increases capability to manage pharmacy and biotechnology resources and respond quickly to new knowledge about treatments or drug efficacy ( incorporated use of Gcsf to Docetaxol-Cyclophosphamide when excessive febrile neutropenia was found). Provides database for treatment outcomes research that is likely to generate important findings. Conclusions: The KP Health Connect Oncology Beacon Module exemplifies what KP is uniquely able to deliver: integration, standardization and use of technology to offer the highest quality care for our members.

e19039 Background: Canada has a national cancer registry that tracks patterns across the population; British Columbia (BC) has the lowest lung cancer mortality in the country. The BC Cancer Agency (BCCA) operates five regional cancer centres and community outreach sites that deliver cancer care using evidence-based standards and guidelines established by the BCCA. The province is 945,000 km2; the population is distributed 85% urban and 15% rural. We hypothesize that adherence to provincial cancer control programs results in equitable services in all geographic locations. Methods: A retrospective population-based review of stage IIIb/IV NSCLC patients (pts) diagnosed from Jan 2008 to Dec 2010 referred to the BCCA was done. Pt characteristics and time intervals between diagnosis, referral, oncology consultation and palliative therapy were extracted. The Kruskal-Wallis test was used to compare wait times (WT). The Kaplan-Meier method and log rank test was used for OS. Results: 1,431 pts were identified. Median time from diagnosis (DX) to referral (RF) was similar across all geographic regions (11-13 days). Median time from RF to oncology consultation ranged from 7-16 d. Table 1 describes medical oncology (MO) WT to chemotherapy (CT) and radiation oncology (RO) WT to radiotherapy (RT). Conclusions: While WT varied between key events in the pts’ lung cancer trajectory by geographic location, the overall survival from diagnosis was similar in all groups. Provision of provincially mandated guidelines and care conferred equitable outcomes in advanced NSCLC across BC. [Table: see text]

Ernest Amory Codman MD (1869–1940) was a Boston surgeon. Like all of us he was human and made mistakes. Unlike others he made a lifelong systematic effort to follow up each of his patients years after treatment and recorded the end results of their care. He recorded diagnostic and treatment errors and linked these errors to outcome in order to make improvements. He was sufficiently disgusted with the lack of such outcomes evaluation of care at the Massachusetts General Hospital where he was on the staff that he resigned to start his own private hospital which he called the “End Result Hospital”. From 1911 to 1916 there were 337 patients discharged from Codman's hospital. He recorded 123 errors and measured the end results for all these patients. He grouped errors by type. There were errors due to lack of knowledge or skill, surgical judgment, lack of care or equipment, and lack of diagnostic skill. In addition to the errors there were four “calamities of surgery or those accidents and complications over which we have no known control. These should be acknowledged to our selves and to the public and study directed to their prevention”. The difference between Codman's hospital and your healthcare organisation is that he admitted his errors in public and in print. They are all described in the annual report of his hospital. Codman paid out of his own pocket to publish this report so that patients could judge for themselves the quality and the …

One of the challenges for educators is composing well-written, specifically stated outcomes of student learning. Developmental teacher training is a program designed to improve the effectiveness of university instructors. The program focuses on improving course methodology by guiding instructors through the development of correctly written and structured course objectives, effective and efficient delivery methodology including implementation of technology as a delivery medium, and proper outcomes evaluation of course effectiveness measured against the course objectives. This paper evaluates the effectiveness of the training. The outline used in the training is included in the appendix.

E-participation is a relatively new approach, so it is necessary to evaluate it carefully so that we can improve e-participation practice. This paper describes a framework that has been developed for evaluating a number of e-participation pilots in the legislation development processes of parliaments. The framework is based on the objectives and basic characteristics of 'traditional' public participation, e-participation and the legislation development processes, as well as the existing frameworks for the evaluation of Information Systems (ISs), e-participation and traditional public participation. It includes three perspectives: process, system and outcomes evaluation; each of them is analysed into a number of evaluation criteria.

Commencing March, 2007, patients and clinicians in the DHMC Pain Center completed an Internet-based survey instrument to improve the care provided to patients and to be used for quality improvement, outcomes analysis, and research. Data acquired from patients included a personal summary, work disability history, health history, health habits survey, review of systems, and a history of present illness. For the Pain Center, the Brief Pain Inventory (BPI), SF-12v2, Screener for Opioid Abuse in Pain Patients (SOAPP), and Oswestry Disability Index (ODI) were acquired from patients. The patient survey data was made available to clinicians before the patients were seen. Clinician survey information included opioid use, an aberrant behavior survey (Modified PAD-T), treatment provided and diagnosis, as well as clinician opioid suitability data. Over a six-month period, patients completed surveys at 74.8% of their visits for a total of 3,631 surveys. The average time to complete surveys was 33 minutes. Clinicians completed surveys at 62% of their encounters for a total of 2,942 surveys. Preliminary data analysis showed that at initial versus follow-up visits there was no difference between the: Mental Component Score of the SF-12v2 (45.2 v. 45.5); the Physical Component Score of the SF-12v2 (30.8 v. 30.1); the ODI (41.8 v. 44.7); the BPI Interference Score (6.6 v. 6.4); or the BPI Severity Score (6.6 v. 6.5). Combined household income of patients seen in our center was less than $15,999 for 29.6% of our patients; $16,000$49,999 for 32.7%; $50,000$99,999 for 16.4%; $100,000$149,999 for 3.8%; $150,000$199,999 for 1.8%; “Don’t know” for 3.5%, and; “other” for 1%. No correlations have yet been calculated. To our knowledge, this is the first time large quantities of patientand clinician-generated information has been collected electronically for analysis and presented real-time to clinicians before patient encounters. Partial funding from Medtronic.

The field of program evaluation has seen a number of new developments over the past several years. One of those developments has been a shift toward oufcomes evaluation, in an attempt to identify and measure program effects on client knowledge, skills, attitudes, behaviors, or conditions. This shift has impacted virtually all not-for-profit organizations, who now need to demonstrate to donors, decision-makers, taxpayers, clients, and other stakeholders that a given program is achieving its intended goals and objectives. This focus on client change has been advocated by a host of individuals and organizations (see, e.g., Drucker, 1990; Hatry, et al., 1992; United Way of America, 1996). Schalock’s Outcome-Based Evaluation continues this shift by providing a primer on outcome evaluation, intended for both consumers and producers of program evaluations. This focus on outcomes is a welcome addition to the program evaluation textbook market, because so many of the major texts have yet to dedicate any meaningful space to outcomes-for example, Rossi and Freeman’s (1993) highly regarded text, even in its fifth edition, spends little time on outcomes evaluation. This book would probably best serve as a text in a program evaluation course for graduate students. Its strengths are, first, in its coverage of an important new approach in evaluation (a “paradigm shift,” according to the author); and among others, a very fine chapter covering the specifics of data management, with details on collecting and organizing data. Most other evaluation texts tell the reader about the importance of data collection and management, but fail to provide adequate instruction on the techniques. Another plus for the reader of this book is the inclusion of “study questions” at the end of each chapter, which help to crystallize the major points contained in the chapter. While the book claims it also is written for a “consumer” of evaluations and evaluation reports, I would guess that the organization of the book is a bit too confusing for someone not already versed in some of the techniques and issues of program evaluation. Part of the confusing organization of the book, at least for me, is the placement of the topics-for example, the treatment of evaluation designs is left until chapter 8. Moreover, the “Benefit-Cost Analysis” chapter is mostly a rendering of a traditional “efficiency” model, rather than a cost-effectiveness (cost per positive outcome) approach. While the author briefly mentions and recognizes cost-effectiveness as an approach, he does not explore it further, and the discussion seems to

A utilization-focused approach in evaluating this program would have placed more emphasis on clearly identifying evaluation users, their information needs, and likely use of findings. With the advantages of hindsight, it appears that such an approach might have led to greater focus on critical implementation issues that affected the eventual decision not to continue the program despite seemingly positive outcomes evaluation findings. Other methods options are also discussed, including the potential usefulness of critical case studies. Finally, there is discussion of how to prepare decision makers for utilization and work with them to interpret and apply findings.

This program evaluation reports the effects of a week long nursing education program to improve professional nurses' (N = 96) abilities to assess and manage clients with rheumatological disorders. The program was conducted over a three year period. Participant achievement of program objectives was measured at two time points: immediately after program conclusion and again 3-6 months after program completion. Data collection instruments included a written knowledge test, patient record audits, and a semi-structured interview. Data analysis revealed positive program effects as demonstrated by: (1) statistically significant knowledge test score increments that persisted after program completion; and (2) self-report indicating clinical utilization of content and skills acquired in the program. Educational measurement issues relevant to evaluation of other professional continuing education programs also are discussed.

Objective: To evaluate functional outcomes, radiographic findings and complications of proximal humeral fractures treated with locking plates and to determine prognostic factors for successful clinical outcomes. Methods: Forty patients undergoing internal fixation of fractures of the proximal humerus with the Philos(r) plate were included in the study. The surgeries were performed between 2004 and 2011 and the patients underwent radiographic and clinical evaluation, by Constant -Murley and Dash score. Outcomes were analyzed by use of multivariate regression with several different variables. Results: Patients were on average of 61.8 ± 16.28 years, and most were female (70%). The Constant -Murley score was 72.03 ± 14.01 and Dash score was 24.96 ± 19.99. The postoperative radiographs showed a head-shaft angle of 135.43º± 11.82. Regression analysis showed that the patient's age and the Hertel classification influenced the Constant -Murley scale (p = 0.0049 and 0.012, respectively). Other prognostic criteria such as Neer and AO classification, head-shaft angle, the presence of metaphyseal comminution and extension of the humeral metaphyseal fragment showed no effect on prognosis. Complications occurred in four patients (10%). Conclusion: The fixation with the Philos(r) plate provided good clinical and radiographic results in fractures of the proximal humerus, with a low complication rate. Patient's age and Hertel classification were defined as prognostic factors that led to worse functional outcomes. Objetivo: Avaliar os resultados clínicos e radiográficos e as complicações das fraturas do terço proximal do úmero tratadas com a placa Philos(r) e correlacionar esses resultados com critérios prognósticos. Métodos: Foram estudados 40 pacientes submetidos a osteossíntese de fraturas do terço proximal do úmero com a placa Philos(r). As cirurgias foram feitas entre 2004 e 2011 e os pacientes foram submetidos a avaliação funcional (escalas de Constant-Murley e Dash [Disability of Arm-Shoulder-Hand]) e radiográfica. Os resultados funcionais foram correlacionados com variáveis clínicas e radiográficas por meio de regressão múltipla. Resultados: Os pacientes apresentavam em média 61,8 ± 16,28 anos e a maioria era do sexo feminino (70%). Observamos pontuação de 72,03 ± 14,01 pela escala de Constant-Murley e 24,96 ± 19,99 pela de Dash. A radiografia pós-operatória evidenciou um ângulo cabeçadiáfise de 135,43º± 11,82. A análise por regressão demonstrou que a idade do paciente e a classificação de Hertel exercem influência direta na escala de Constant-Murley (p =0,0049 e 0,012, respectivamente). Outros critérios prognósticos, como a classificação de Neer e AO, o ângulo cabeça-diáfise, a presença de cominuição metafisáriaeaextensão do fragmento metafisário não demonstraram influência no prognóstico em nossa amostra. Complicações ocorreram em quatro pacientes (10%). Conclusão: A osteossíntese com a placa Philos(r) proporcionou, em nossa amostra, bons resultados clínicos e radiográficos, com baixo índice de complicações. A idade do paciente e a classificaçãode Hertelforamdemonstradascomo fatores preditores doresultado funcional.