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Health Department (HD) managers at both state and local levels are in desperate need of tools to assist in monitoring and evaluating programs. The purpose of this study is to assess the feasibility and utility of linking program performance scores and expenditures into a Report of Performance Measures (RPM). We analyzed secondary data on performance indicators, selected by HD staff, and expenditures, related to six surveillance activities, from two, similar, high-incidence, tuberculosis (TB) programs in Florida from 2002 to 2003. We compared the findings between the county HDs as an illustration of basic cost-effectiveness benchmarking, based on the cost-effectiveness grid. Data included here provide examples of: (1) two instances in which one county was operating relatively inefficiently compared to the other; (2) two instances in which performance and expenditures were similar for the counties; and (3) two instances in which one county spent more for higher performance scores than the other. These data illustrate how the RPM can be used to facilitate benchmarking, a basic evaluation tool. They also demonstrate ways to identify potential operational inefficiencies in a single time period and ultimately over time. It is thus likely to be a feasible and useful management tool., (Copyright (c) 2010 Elsevier Ltd. All rights reserved.)

This study reports on secondary data, depression, fatigue and health-related quality of life (HRQOL), collected on people with advanced multiple sclerosis (MS) as part of a larger study of the impact of a telerehabilitation intervention on people with severe mobility impairment. People with spinal cord injuries (SCIs) (n=111) and the prevention of pressure sores were the primary group of interest of the project. The focus here is on data collected from people with advanced MS (n=27), who were included as an exploratory cohort, as they experience increased risk of pressure ulcer development as their level of mobility declines. The study consisted of a nine-week intervention with three randomized groups: video, telephone, and standard care. Aside from information on pressure sores, data were also collected on fatigue, depression, and HRQOL for a two-year follow-up period. For the video group HRQOL scores trended higher and fatigue and depression scores lower for 24 months. Fatigue scores were significantly lower for the video group at month six, 12, and 18. In the sample overall, fatigue symptoms were far more prominent than depressive symptoms and affected 100% higher rates of depression than women. At baseline, controlling for Extended Disability Status Score (EDSS), depression and fatigue were correlated. However, contrary to indications from previous cross-sectional studies, no consistent relationship was observed over time between the two. Telerehabilitation interventions for people with advanced MS warrant further investigation. Findings here suggest that such interventions may be beneficial, although the results need affirmation through larger samples. In addition, the higher prevalence of male depression merits serious attention.

Signal Detection Theory (SDT) has come to be used in a wide variety of fields where noise and imperfect signals present challenges to the task of separating hits and correct rejections from misses and false alarms. The application of SDT helps illuminate and improve the quality of decision-making in those fields in a number of ways. The present article is designed to make SDT more accessible to forensic scientists by: (a) explaining what SDT is and how it works, (b) explicating the potential usefulness of SDT to forensic science, (c) illustrating SDT analysis using forensic science data, and (d) suggesting ways to gain the benefits of SDT analyses in the course of carrying out existing programs of quality assessment and other research on forensic science examinations.

The Special Care Unit (SCU) is a new, rapidly proliferating mode of caring for people with Alzheimer's disease (AD). Approximately 10% of nursing homes within the U.S. have SCUs with the number expected to grow substantially in coming years. SCUs are largely unregulated and not uncontroversial. This article discusses their emergence over time, their origins, growth, and the call for standardization. Subsequent sections review the range of potential benefits and costs associated with SCUs, optimally defined as well as research evidence available on this mode of care. Recent cost-setting and reform pressures in the nursing home industry are discussed in the final sections along with the likely future of AD SCUs in this environment.

Background: Smoking is the single most preventable cause of premature mortality in the United States. In 13 double-blind, controlled trials, the nicotine transdermal patch has been demonstrated to be an effective aid to quitting smoking, even after 6 months of follow-up. Because physicians and payers may consider the cost of the patch to be prohibitive, we examine the cost-effectiveness of the nicotine patch as an adjunct to brief physician counseling during routine office visits., Methods: We estimate the effectiveness of both patch use with brief counseling and counseling alone from meta-analysis of clinical trials. Benefits are measured in terms of years of life gained by those who quit, discounted at 5%. Costs include physician time and patch prescriptions. The incremental cost-effectiveness is quantified as cost per additional year of life saved when patch plus counseling is compared with brief physician counseling alone., Results: Depending on age, the average costs per year of life saved range from $965 to $1,585 for men and from $1,634 to $2,360 for women. Incremental costs per year of life saved range from $1,796 to $2,949 for men and from $3,040 to $4,391 for women., Conclusion: The nicotine patch is cost-effective and less costly per year of life saved than other widely accepted medical practices. Physicians and third-party payers should recommend the nicotine patch to patients who wish to stop smoking.

While the concept of consumer-directed care is becoming increasingly popular in the U.S., little is known about how such programs work or the critical role of case managers within them. This article reviews a 5-year initiative in the United Kingdom in which severely disabled, chronically ill adults were given cash to pay for in-home care which they themselves arrange. The genesis of the program and how it operated are described here. In particular, the responsibilities of case managers are outlined along with their role in determining the amount of assistance needed by clients in the program. A profile of program clients is also provided with data on their levels of in-home support.

This study uses regression analyses to examine the relationship between staff turnover in the British National Health Service (NHS) and a range of labour market, job and worker characteristics. Data relating to nine staff groups in up to 103 District Health Authority areas, and covering over 300,000 employees, form the basis for the analysis. In the regression analysis, two variables consistently emerge as significantly related to turnover across a range of staff groups: the size of the private nursing homes, and the pay of the staff group relative to the local average for comparable workers. The results suggest that staff groups of different skill levels each have distinct labour markets, and this needs to be recognised in the future design of human resources management policies.

This paper presents the results of a formal labor supply model for nurses in Great Britain. It corrects for misspecification and sample selection bias which affected earlier research on women's labor supply generally in the United Kingdom and tests for the existence of discontinuities in the supply curve of nurses. Estimates of labor market participation elasticities with respect to the wage rate, non-labor income, and to the costs incurred through work are reported for nurses, qualified and unqualified. Participation is found to be highly responsive to wage changes and some discontinuity is found in the supply function.

Objective: To examine the volume and distribution of formal and informal care received by severely disabled adults living at home in the community on low incomes according to type of disease., Design: Analysis of computerised reports from social workers which include information on disabling conditions and on the weekly hours of care at home from formal and informal sources., Subjects: 1298 severely disabled people aged 16 to 98 who received financial assistance from the Independent Living Fund in 1991-2., Results: Over half (733; 56.6% (53.8 to 59.2)) of the sample were completely unable to perform five or more of the basic activities of daily living. On average the whole sample received 6.8 (6.1 to 7.6) hours of care at home a week from formal sources and 64.2 (62.4 to 65.9) hours from informal sources. In seven out of 14 disease groups, less than half in each group received any formal help at home. There were large differences in the volume of formal care within groups. In most cases no significant differences were found within diagnostic groups between those receiving care at home from district health authorities or local authorities, or both, and those who received no help at home with regard to age, dependency score, and duration of disability. Weekly hours of informal care were an important determinant of who received formal help in nine out of 14 groups., Conclusions: The amount of care received at home by low income, severely disabled people from formal sources differs across and within diagnostic groups. The fact that the variation was not systematically related to age, dependency, or duration suggests that the existing distribution of community care resources needs to be examined. Weekly hours of informal care and diagnosis seem to affect the volume and type of care received. The methods by which people in need of assistance receive help merit further investigation.

Using information collected from more than 100 district health authorities in England for the year 1989-1990, this paper examines turnover rates amongst a range of nursing and other staff groups in the National Health Service (NHS), and their relationship to the age and length of service characteristics of the labour force. The evidence collected suggests that the NHS employs a significantly younger workforce than is found in the economy as a whole. The age profile of nurses is even more skewed towards younger age groups than that of non-nursing staff working in the NHS. Nurses tend on average to have longer lengths of service than non-nursing staff groups, and it would seem that the average length of service has increased over the last 20 years, certainly amongst registered nurses. Overall, the study found an annual turnover rate amongst all NHS staff of 13.6%. Turnover rates were significantly higher among full-time staff than part-time, and amongst non-nursing staff groups compared with nurses. Broadly, turnover rates decline with age then rise close to retirement. However, there is a more complex relationship between length of service and turnover: turnover rates tend to be high in the first year of service, and to remain high or even rise during the second year of service, before declining. Turnover remains a poorly understood issue in the NHS. The evidence presented here should move some aspects of debate onto a more solid empirical foundation.