Interventions evaluation

Controlled mirror-image studies of clozapine (Table 2.2) show primarily that all interventions evaluated seem to reduce healthcare costs by reducing hospitalization, but that the effect of clozapine is greater. These results are more compelling than those from the uncontrolled studies, not only because of the inclusion of a contemporary control, but also because these studies tended to be larger and longer. 

Economic studies should consider the costs of all the resources and services used in the process of care. In addition, the outcomes that are a consequence of the health or social care interventions evaluated need to be included. For dementia, these include the costs of hospital inpatient and out-patient care, primary and community-based health-care services, social welfare services, and care provided by voluntary agencies or by femily and friends. Ideally, a broad perspective reflecting the costs and outcomes to society should be adopted. As a minimum, the perspective of the analysis should include the costs and outcomes to key health and social care providers or funders and to patients and their families. 

Work Injuries How to Show Whether a Safety Intervention Really Works. This is a NIOSH publication. It s free. Its message to me is that safety professionals can bring the measurement systems they use up to generally accepted standards to determine the effectiveness of the safety interventions they propose, and that this text will show them how. Since I have been a proponent of defining the problem before solutions are applied, I was pleased that the first in a Mst of seven t) es of intervention evaluations discussed is a Needs Assessment. The Purpose of a Needs Assessment, the text says, Defines what type of intervention is needed. This is an impressive, thought provoking, valuably informative discussion of measurement systems. Excerpts from it appear in the addendum to this chapter. 

Zohar, D. and Luria, G. 2003. The Use of Supervisory Practices as Leverage to Improve Safety Behavior A Cross-level Intervention Model. NOIRS-2003 Intervention Evaluation Contest March, 2003. Available at http //www.cdc. gov/niosh/noirs/2003/contest2003.html (last accessed on 30 April 2014). 

Monitor the intervention, evaluate the results and provide feedback... 

For the documentation of tumor size, tumor location and tumor vascularization unenhanced and contrast-enhanced MR or CT images should be obtained before planning the TACE treatment. Thereby exposure of the liver vessels should be performed for pre-interventional evaluation of the anatomy and patency of the vessels. 

Continuous improvement demands proper evaluation. This chapter explains how to evaluate the impact of safety interventions from an environment, behavior, and person perspective. More employees need to contribute information pertinent to intervention evaluation. This chapter shows you fejw to make this happen. The principles described here will make you a smarter consumer of marketed safety programs and help you evaluate your own customized intervention process. 

I am sure you have noted the similarity between this scheme for intervention evaluation and the DO IT process introduced in Chapter 8. The "T," or test phase, of DO IT implies a comparison of the target behaviors before and after the "I," or intervention phase, is initiated. 

Expected outcomes define the expected behavior of the patient or family that indicates that the problem is being resolved or that progress toward resolution is occurring. Expected outcomes serve as a basis for evaluating the effectiveness of nursing interventions. For example, if the nursing intervention is to monitor the blood pressure every hour, the expected outcome is that the patient experiences no further elevation in blood pressure ... 

In other substance use disorders, the use of 12-step interventions is also popular, and participation in 12-step groups is correlated with better outcomes in cocaine abusers (e.g., McKay et al. 1994). However, a smdy of 128 cocaine abusers found that cognitive-behavioral therapy was more efficacious than 12-step facilitation in engendering cocaine abstinence (Maude-Griffm et al. 1998). Thus, the relative efficacy of 12-step approaches for drug use disorders requires further investigation. No known studies have systematically evaluated the efficacy of 12-step treatments in opioid-dependent patients, either alone or in conjunction with pharmacotherapies. 

O Neill K, Baker A, Cooke M, et al Evaluation of a cognitive-behavioural intervention for pregnant injecting drug users at risk for HIV infection. Addiction 91 1115— 1125, 1996... 

This chapter adds the socio-economic dimension to the medical or technical perspectives of the proceeding contributions of this book. As its health economic terminology and approach might be unfamiliar to some readers, we start with a section on methodology. In particular, we present an overview of the concept of Cost-of-Illness (COI) and of relevant health economic evaluation techniques. In Sect. 2, we present the basic findings of a meta-analysis of the socio-economic costs of HIV/AIDS and of the socio-economic impact of antiviral intervention. The major findings are reflected in Sect. 3. The chapter closes with a speculation on long-term socio-economic costs of antiviral intervention. 

The health economic evaluation model and the COl model are closely related. The consumption of agents of production causes direct costs. Indirect costs are a monetary expression for the loss of economic wealth, that is, the impact of a health intervention is the reduction of indirect costs. The increase of health is reflected by the reduction of intangible costs. 

The most recently developed mode of economic evaluation is cost-utility analysis (CUA). It is similar to CFA with the important exception that it gauges the impact of an intervention, not in terms of a single... 

Various forms of psychotherapy are regarded as effective interventions in mild to moderate depression, but studies comparing the economics of psychotherapy and pharmacotherapy are few (Rosenbaum and Hylan, 1999). One study found that the total health-care costs for patients who received psychotherapy were no different from those for patients who received an antidepressant. However, no efficacy measure was used (Edgell and Hylan, 1997). A randomized, prospective study which evaluated the treatment of depression with nortriptyline, interpersonal therapy or treatment as usual, with outcomes expressed in quality-adjusted life years, found that nortriptyline but not interpersonal therapy was a cost-effective alternative to treatment as usual (Lave et al, 1998). 

The objective of economic evaluations of health and social care interventions is to inform decision-makers about the relative costs and benefits to society of two or more methods of providing care. In the context of dementia these may be comparisons of different drug therapies (pharmacoeconomic... 

There are four types of economic evaluation cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis. The analytic framework chosen will depend upon the economic questions posed and the clinical evidence of effectiveness for the interventions (Gold et al, 1996 Dmmmondetal, 1997). 

Economic studies should cover the full period over which the interventions could be expected to have an effect on resource use, survival and health-related quality of life. However, the economic evaluations of donepezil were based on effectiveness data from a limited number of trials, which were short in duration. This has a number of implications. First, the analysis can be limited to the effect of the drug during the period for which effectiveness data were available. In this case, it may be assumed that the treatment effect ceased after 6 months (Stewart et al, 1998). This assumption would only be valid if the donepezil were also discontinued at 6 months. If this is not the case, then the overall costs of the dmg may be underestimated and the benefits overestimated. 

The interventions compared need to be relevant to the health and social care choices faced by decision-makers. Unless do nothing is a valid management strategy, comparison of a new intervention with placebo is not appropriate for an economic evaluation. Since there are a number of dmg therapies and non-pharmacological approaches to the management of people with dementia, the relative cost-effectiveness of these needs to be... 

To be useful to those concerned with choices in the allocation of health and social care resources, the data for economic evaluations need to be timely, relevant, credible and accurate (Davies, 1998). As a minimum, the costs associated with the interventions should be estimated from activity data, which quantify resources used, and price or unit cost data. Often evidence from well-controlled prospective trials with high internal validity is required to establish whether differences in economic end points are directly attributable to the interventions. However, the economic evaluations of acetylcholinesterase inhibitors estimated costs from retrospective analysis of available datasets Qonsson et al, 1999b), analysis of published literature (e.g. Stewart et al, 1998) and expert opinion (e.g. O Brien et al, 1999 Neumann et al, 1999). This means that it is not clear whether differences in costs were due to the anticholinesterase inhibitors or to other factors such as availability of services in different areas, the living situation of the patient, or disease severity. 

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