Measurement and evaluation for health educators ebook free download

There are several reasons for this. First, professional licensure is structured through individual licensing boards for each regulated profession in the state. Within states, there is little coordination of management or dissemination of information among different boards. Variation in what is considered a "complaint" influences what is investigated and what can be shared and when.

A call to the licensing board may be considered a complaint, or a complaint may be recognized only when there is a formal. It is not clear, therefore, when information can be shared: when something is filed which may or may not lead to a charge , while it is being investigated, after there is a charge, or only if disciplinary action is taken.

Inconsistencies permit unsafe practitioners to move to different jurisdictions before a complaint can be investigated and handled. Although not a comprehensive measure of effectiveness, there is wide variation in the rate at which state licensing boards take serious disciplinary actions against physicians, ranging from 0. States that appeared to be doing a better job more disciplinary actions tended to have better funding, and more staff, conducted proactive investigations as opposed to waiting for complaints , used other available data e.

Board action can also be quite slow. For example, the Virginia Board of Medicine takes an average of more than two and a half years to resolve a case. The National Council of State Boards of Nursing has endorsed a mutual recognition model for interstate nursing practice to encourage reciprocal arrangements between states for licensing and disciplinary action Carolyn Hutcherson, National Council of State Boards of Nursing, personal communication, June 1, That is, licensure is recognized across state lines, but the nurse would still be subject to the rules of a state while in that state e.

Another issue related to professional licensure is that there is no continuing assessment or required demonstration of performance after initial licensure is granted, except for physician assistants and emergency medical technicians. For example, physicians may voluntarily seek board certification through one of 24 specialty medical boards that have been approved by the American Board of Medical Specialties ABMS. Initial certification is granted by passing written and.

Recertification occurs at seven- to ten-year intervals, although not all boards require recertification. Recertification is granted based on self-assessment, examinations, and credentialing e. A minimum number of continuing education credits may also be required. At the present time, there is no assessment of practice skills, although some specialty boards have committed a broader and more timely assessment of competence. AMAP is a voluntary process, begun in , for the accreditation of individual physicians that is designed to measure and evaluate individual physicians against national standards and peer performance.

Although this is a national program, it is being implemented on a state-by-state basis. A comparable process is found in nursing, which recognizes specialty practice through board certification.

Specialty certifying boards set professional and educational standards for the defined specialty and determine a mechanism for establishing continued competency through the recertification process, which occurs every three to five years, depending on the specialty.

Although safety is not an explicit focus of certification exams, areas covered may relate to safety, for example, medication errors. Nurses may pursue certification voluntarily, although some states require it for licensure at advanced levels such as nurse practitioner Ann Carey, R. Certifying organizations are exploring alternative ways to validate continued competency in addition to continuing education.

Health care organizations are also involved in assessing the continued performance of professionals when hiring nurses or credentialing physicians. Again, there is little consistency in the standards used and little opportunity for communication across organizations. For example, an unsafe provider may be dismissed from one hospital, with no notification to the licensing board and limited ability for the next hospital to find out the reasons for the dismissal.

The Pew Health Professions Commission conducted an extensive investigation of licensure and continued competency issues. Its report identifies four places in which assessment of competency can occur: upon entry into practice, for continuing authorization to practice, reentry to practice, and after disciplinary action.

The trend toward computer-based testing should facilitate greater attention to skill assessment in the future. Physician licensure tests and physician recertification are moving toward interactive, computer-based testing, and nursing is also testing a computerized system for initial licensure. Professional societies, groups, and associations can play an important role in improving patient safety by contributing to the creation of a culture that encourages the identification and prevention of errors.

Few professional societies or groups have demonstrated a visible commitment to reducing errors in health care and improving patient safety. Although it is believed that the commitment exists among their members, there has been little collective action. The exception most often cited is the work that has been done by anesthesiologists to improve safety and outcomes for patients. Anesthesiology has successfully reduced anesthesia mortality rates from two deaths per 10, anesthetics administered to one death per ,—, anesthetics administered see Chapter 2.

This success was accomplished through a combination of:. To explore the ways that professional societies could improve patient safety, the Institute of Medicine IOM convened a one-day workshop on September 9, with 14 health professionals representing medicine, nursing, and pharmacy workshop participants are included in the acknowledgments. These leaders are interested and involved in issues related to patient safety and are active in professional societies, although they did not participate in the workshop as representatives of these societies.

Four broad roles were identified that could be employed, individually or in combination, to create a culture of safety. These roles are: 1 defining standards of practice; 2 convening and collaborating among society members and with other groups; 3 encouraging research, training and education opportunities; and 4 advocating for change. One way that professional societies contribute to standards of practice is through the promulgation and promotion of practice guidelines.

A number of professional groups have produced practice guidelines and defined best practices in select areas. They have produced sixteen guidelines ranging from coronary artery bypass graft CABG to management of chronic angina. Pharmacy has also devoted significant attention to patient safety.

Reduction of medication errors has been an identified priority for a decade and is reflected through publications in professional and scientific journals, educational programming, and advocacy. Included among the standards and guidelines is a widely disseminated list of the top priority actions for preventing adverse drug events in hospitals. Practice guidelines can also be written through a more interdisciplinary approach, such as the perinatal guidelines published jointly by the American.

There is now a fourth edition of these guidelines. As recognition has grown that errors are caused by failures in systems, interdisciplinary collaboration may become increasingly necessary for redesigning complex systems of care.

Participants at the workshop suggested that professional societies develop guidelines devoted specifically to patient safety and the incorporation of patient safety considerations into other guidelines.

One of the most visible activities of professional groups is their convening function. Through annual conferences and specialty meetings, professional groups can develop and communicate standards, values, and policy statements to membership and key opinion leaders. Meeting conclusions may also be disseminated through their own and other journal publications.

There are few examples of specialty meetings or conferences where patient safety has been explicitly included on the agenda.

Additionally, there are few interdisciplinary conferences devoted to issues of patient safety. Participants at the workshop proposed a national conference that would bring together all health professions and professionals from other disciplines e.

Clinical training and education is a key mechanism for cultural change. Colleges of medicine, nursing, pharmacy, health care administration, and their related associations should build more instruction into their curriculum on patient safety and its relationship to quality improvement.

One of the challenges in accomplishing this is the pressure on clinical education programs to incorporate a broadening array of topics. Many believe that initial exposure to patient safety should occur early in undergraduate and graduate training programs, as well as through continuing education. Clinical training programs also need to ensure that teaching opportunities are safe for patients. One workshop participant told of a monitoring device used to alert staff to possible problems with the patient that was turned off because it was seen as interfering with the teaching experience.

The need for more opportunities for interdisciplinary training was also identified. Most care delivered today is done by teams of people, yet training often remains focused on individual responsibilities leaving practitioners inadequately prepared to enter complex settings.

Improving patient safety also requires some understanding of systems theory in order to effectively analyze the many contributing factors that influence errors. Again, the "silos" created through training and organization of care impede safety improvements.

Instruction in safety improvement requires knowledge about work-. A background in other disciplines is also relevant, such as cognitive psychology, systems theory, and statistics. Training should also emphasize better communications across disciplines. This is important when the members of a care team are in one physical location, such as a hospital or office setting, but becomes even more important when the care team may not be in one place, such as a team providing home care.

Few professional groups have sufficient resources to devote to research support, although many have established research and education foundations. The need for greater collaboration in developing regional databases was noted.

A key advantage of establishing these at the regional level is the ability to obtain a sufficient number of cases for meaningful analysis. The number of cases of any particular event in a single hospital or clinical setting is usually too small to be able to generalize across cases and identify a way to make system improvements.

Regional data systems can increase numbers to improve analytic power and can facilitate collaboration to understand the extent and nature of errors in health care. Professional societies and groups could participate in efforts to coordinate a research agenda and the development of databases to provide information on the extent and nature of errors in health care. Professional groups can also serve as advocates for change.

Professional groups have been able to call attention to a health risk and create awareness. For example, pediatricians have been active in promoting increased immunization rates, the American Heart Association has promoted diet and exercise to prevent heart disease, and the American Medical Association AMA has been an outspoken opponent against smoking. Professional groups have not been as visible in advocating for patient safety and communicating such concerns to the general public and policy makers.

The NSPF has taken a visible role in advocating for improvements in patient safety and communicating with a broad array of audiences.

Professional societies can play a role not only in informing their members about patient safety, but also in calling attention to the issue among the general public. Implementation of activities to increase the role of health professionals in patient safety must occur at multiple levels. Although some professional.

For example, the American Board of Medical Specialties has the potential to influence 24 professional medical societies. The Accreditation Council for Graduate Medical Education and the American Association of Colleges of Nursing have the potential to influence numerous training programs.

The Association of American Medical Colleges can influence multiple medical schools and academic medical centers. There are many other similar groups that coordinate across multiple organizations. These "high leverage" groups are critical players in encouraging action among their constituent organizations. They should use their influence to promote greater awareness of patient safety and to consistently reinforce its importance. The Food and Drug Administration is a major force in setting standards for medical products and monitoring their safety.

FDA regulates prescription and over-the-counter drugs, medical and radiation-emitting devices, and biologics, among other things. This discussion focuses on its activities related to drugs and devices. It should be noted, however, that the FDA regulates manufacturers, not health care organizations or professionals. There are two opportunities for FDA to ensure and enhance patient safety: during its approval process for drugs and devices, and through postmarketing surveillance.

FDA has regulatory authority over the naming, labeling, and packaging of drugs and medical devices. FDA approves a product when it judges that the benefits of using the product outweigh the risks for the intended population and use.

For devices, FDA looks at the safety and effectiveness of the device compared to devices already on the market or else looks for reasonable assurance of safety and effectiveness. A major component of postmarketing surveillance is conducted through adverse event reporting.

For medical devices, manufacturers are required to report deaths, serious injures, and malfunctions to FDA. User facilities hospitals, nursing homes are required to report deaths to both the manufacturer and FDA, and to report serious injuries to the manufacturer. For suspected adverse events associated with drugs, report-. All reports are entered into the Adverse Event Reporting System AERS or another database, which is used to identify problem areas or increased incidence of an event.

FDA receives approximately , reports annually for adverse drug events and approximately 80,—85, reports on device problems. Despite the extensive testing that FDA requires before drugs and devices are approved, side effects or other problems invariably show up after they have been released and used widely. Not all risks are identified premarketing because study populations in premarketing trials are often too small to detect rare events, studies may not last long enough to detect some events, and study populations may be dissimilar from the general population.

The problem is likely to continue and possibly worsen in the future because of the number of new drugs being introduced. In alone, FDA approved 90 new drugs, 30 new molecular entities drugs that have never been marketed in this country before , new or expanded uses of already approved drugs, generic drugs, 8 over-the-counter drugs, and 9 orphan drugs, or almost two actions every day of the year. FDA has three general strategies it pursues for corrective action.

The first and most commonly pursued is negotiation with the manufacturer to make the desired changes. The extent of cooperation from the manufacturers can vary. In terms of drugs, names are the most difficult to change, particularly once a name has been trademarked by the company Jerry Phillips, OPDRA, personal communication, May 4, Second, FDA may take regulatory action against manufacturers to require changes.

This could include name changes or withdrawal of a product from the market. The final type of action that FDA can take is communication about risks, including letters to physicians, pharmacists, and other health professionals, postings on the Internet, and publication of clinical and consumer journals.

FDA decisions about corrective action are made on a case-by-case basis, by considering the unexpectedness and seriousness of the event, the vulnerability of the population affected, and the preventability of the event.

Some concerns have been expressed over the responsiveness of FDA to reported problems. Permission is given to duplicate this electronic document for personal use only, as long as it is unaltered and complete. Copies may not be duplicated for commercial purposes. The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis.

RAND's publications do not necessarily reflect the opinions of its research clients and sponsors. Read Online. Research Questions What outcome metrics could be used to assess readiness among soldiers and adult family members who receive behavioral health care?

How do BH providers assess soldier readiness, and how could the readiness assessment be improved? Stakeholders reported that psychiatric symptoms, diagnoses, treatment, and impaired functioning are important indicators of lack of readiness among soldiers and adult family members BH expert and provider responses were consistent with the Army's current policies regarding BH conditions and their potential negative impact on readiness.

Stakeholder interviews highlighted the importance of the Army's ongoing symptom monitoring as a key component of monitoring readiness.

Stakeholders also highlighted the significant role of multiple aspects of functioning related to readiness. No existing data source or patient self-report instrument met criteria for Army-wide implementation of a readiness metric for soldiers, but one instrument is promising The Walter Reed Functional Impairment Scale assesses important components of soldier readiness, is feasible to use, and appears valid and reliable, but further pilot testing is needed.

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