Program Evaluation Approaches, Successes, and Lessons Learned from the Massachusetts Working on Wellness (WoW) Program

Introduction: The WoW program is a two-year training program to expand employer-based health promotion and prevention. This methodology poster describes the mixed-method program evaluation design and analysis. Methods: Data collection instruments were designed to measure key program outputs and outcomes and pre/post-intervention comparisons. Enrollment surveys, satisfaction surveys, and wellness planning and evaluation tools and surveys were designed to capture organizational characteristics, training program quality, employer wellness program and policies, and employee health status and program interests at program initiation and 12-month follow-up for four cohorts of participating organizations. The All Payer Claims Database will be used to examine changes in healthcare utilization and expenditures. Mid-course focus groups with the program team assessed opportunities to improve training efficiency and quality. Follow-up interviews with wellness champions assessed satisfaction, sustainability and future program needs. These qualitative data are examined by main themes to describe contextual factors related to program delivery. Results: The multi-layered evaluation approach was effective for evaluating this employer training program. The instruments gathered valuable data on employer and workforce characteristics and employee health concerns and program needs. Evaluation activities provided quality monitoring that contributed to satisfaction and effectiveness. Evaluating health impacts proved difficult due to insufficient follow up period. Evaluators had partial success with estimating possible health impacts using existing intervention research literature. Conclusion: Using a multi-layered, mixed-method evaluation approach has many advantages for process and outcome evaluation. At least two years post-program implementation data is needed to measure health and cost outcomes for worksite wellness initiatives

Comparison of Medicine Availability Measurements at Health Facilities: Evidence from Service Provision Assessment Surveys in Five Sub-Saharan African Countries.

With growing emphasis on health systems strengthening in global health, various health facility assessment methods have been used increasingly to measure medicine and commodity availability. However, few studies have systematically compared estimates of availability based on different definitions. The objective of this study was to compare estimates of medicine availability based on different definitions. A secondary data analysis was conducted using data from the Service Provision Assessment (SPA) - a nationally representative sample survey of health facilities - conducted in five countries: Kenya SPA 2010, Namibia SPA 2009, Rwanda SPA 2007, Tanzania SPA 2006, and Uganda SPA 2007. For 32 medicines, percent of facilities having the medicine were estimated using five definitions: four for current availability and one for six-month period availability. 'Observed availability of at least one valid unit' was used as a reference definition, and ratios between the reference and each of the other four estimates were calculated. Summary statistics of the ratios among the 32 medicines were calculated by country. The ratios were compared further between public and non-public facilities within each country. Across five countries, compared to current observed availability of at least one valid unit, 'reported availability without observation' was on average 6% higher (ranging from 3% in Rwanda to 8% in Namibia), 'observed availability where all units were valid' was 11% lower (ranging from 2% in Tanzania to 19% in Uganda), and 'six-month period availability' was 14% lower (ranging from 5% in Namibia to 25% in Uganda). Medicine availability estimates vary substantially across definitions, and need to be interpreted with careful consideration of the methods used

日本の相続税法における土地の評価に関する研究

本研究は，日本の相続税法における財産評価（property evaluation）について，納税者（taxpayers）の視点から検討するものである。特に土地（land）の評価について，利用可能な客観的な基準（objective criteria）としてどのようなものがあるのかを考察した後で，財産評価基本通達で示されている路線価方式（route value method）と倍率方式（magnification method）の二つの内容について論及する。相続税法における土地の時価評価は，極めて難しい問題の一つであると言える。相続税法第22条によって，相続財産の評価は取得時の時価（market value at the time of acquisition）によることが規定されているところである。しかし，その時価の解釈（interpretation of market value）については，長い間の議論があるにも拘わらず，明確になっていない現状である。実務においては，財産評価基本通達による路線価方式や倍率方式も，時価にapproachするための簡便な方法（simple method）であると言われている。特に路線価方式は，一般の国民にとっては理解し難い。例えば，奥行補正率や路線の影響加算率などが示されている。また，ほとんどの土地はいびつな形（irregular shape）の不整形地であるため，不整形地の補正率も乗ずるなどその計算過程は複雑過ぎるものと言える。財産を継承した相続人（heirs）は，相続税の申告納税に当たって，相続財産の評価を相続税法（inheritance tax law）という法律ではなく『財産評価基本通達』に従って計算することを半ば強制されている。筆者はそのことに疑問を持っている。筆者は，路線価方式や倍率方式よりも簡単に土地の評価をする別の方法があると考えている。本研究の結論は，納税者の視点から見て「相続財産である土地の評価は固定資産税評価額をもって行うことが望ましい」ということである。その主たる理由は次の二つである。第一に，固定資産税評価額（property tax assessment amount）は，公示価格（公示地価）の7割の水準に設定されているからである。土地の売却を前提としたとしても，現行の路線価方式は，相続税路線価を使用するため，公示価格の8割の水準であることから，この程度の減額は許容範囲（acceptable range）であると考えられる。第二に，土地の所有者は，毎年，固定資産税の納税通知書（tax notice）によって確認できるため，一般に国民が最も首肯しやすい金額であり，様々な補正を行った後の価額であり，複雑な計算を省略できる。この方法を採用することによって，納税者の税務申告が簡単なものになる。それと同時に課税の公平性も担保することができると考えられる。1．はじめに 1．1研究の対象 1．2研究の目的 1．3研究の前提 1．4問題意識 2．「土地」の評価基準に関する考察 2．1土地評価における5つの客観的基準 2．1．1実際の市場で売買される「市場価格」 2．1．2国土庁が定める「公示地価」 2．1．3都道府県が定める「基準価格」 2．1．4国税庁が定める「相続税路線価」 2．1．5市町村が定める「固定資産税評価額」 2．2小括 3．相続税法及び評価通達における財産評価に関する考察 3．1相続税法第22条の「時価」の意義 3．2『財産評価基本通達』の存在理由 3．3『財産評価基本通達』における評価の原則 3．4土地の価値を形成する三つの要因 3．5小括 4．土地の評価方法としての路線価方式と倍率方式 4．1「路線価方式」による土地の評価 4．2「倍率方式」による土地の評価 4．3小括 5．おわりに 5．1本研究の総括 5．2筆者の見

Building a house on shifting sand: methodological considerations when evaluating the implementation and adoption of national electronic health record systems

Background: A commitment to Electronic Health Record (EHR) systems now constitutes a core part of many governments’ healthcare reform strategies. The resulting politically-initiated large-scale or national EHR endeavors are challenging because of their ambitious agendas of change, the scale of resources needed to make them work, the (relatively) short timescales set, and the large number of stakeholders involved, all of whom pursue somewhat different interests. These initiatives need to be evaluated to establish if they improve care and represent value for money. Methods: Critical reflections on these complexities in the light of experience of undertaking the first national, longitudinal, and sociotechnical evaluation of the implementation and adoption of England’s National Health Service’s Care Records Service (NHS CRS). Results/discussion: We advance two key arguments. First, national programs for EHR implementations are likely to take place in the shifting sands of evolving sociopolitical and sociotechnical and contexts, which are likely to shape them in significant ways. This poses challenges to conventional evaluation approaches which draw on a model of baseline operations → intervention → changed operations (outcome). Second, evaluation of such programs must account for this changing context by adapting to it. This requires careful and creative choice of ontological, epistemological and methodological assumptions. Summary: New and significant challenges are faced in evaluating national EHR implementation endeavors. Based on experiences from this national evaluation of the implementation and adoption of the NHS CRS in England, we argue for an approach to these evaluations which moves away from seeing EHR systems as Information and Communication Technologies (ICT) projects requiring an essentially outcome-centred assessment towards a more interpretive approach that reflects the situated and evolving nature of EHR seen within multiple specific settings and reflecting a constantly changing milieu of policies, strategies and software, with constant interactions across such boundaries

Cross-Lingual Zero Pronoun Resolution

In languages like Arabic, Chinese, Italian, Japanese, Korean, Portuguese, Spanish, and many others, predicate arguments in certainsyntactic positions are not realized instead of being realized as overt pronouns, and are thus called zero- or null-pronouns. Identifyingand resolving such omitted arguments is crucial to machine translation, information extraction and other NLP tasks, but depends heavilyonsemanticcoherenceandlexicalrelationships. WeproposeaBERT-basedcross-lingualmodelforzeropronounresolution,andevaluateit on the Arabic and Chinese portions of OntoNotes 5.0. As far as we know, ours is the first neural model of zero-pronoun resolutionfor Arabic; and our model also outperforms the state-of-the-art for Chinese. In the paper we also evaluate BERT feature extraction andfine-tune models on the task, and compare them with our model. We also report on an investigation of BERT layers indicating whichlayer encodes the most suitable representation for the task. Our code is available at https://github.com/amaloraini/cross-lingual-Z

A Cluster Ranking Model for Full Anaphora Resolution

Anaphora resolution (coreference) systems designed for theCONLL2012 dataset typically cannot handle key aspects of the full anaphoraresolution task such as the identification of singletons and of certain types of non-referring expressions (e.g., expletives), as these aspectsare not annotated in that corpus. However, the recently releasedCRAC2018 Shared Task and Phrase Detectives (PD) datasets can nowbe used for that purpose. In this paper, we introduce an architecture to simultaneously identify non-referring expressions (includingexpletives, predicativeNPs, and other types) and build coreference chains, including singletons. Our cluster-ranking system uses anattention mechanism to determine the relative importance of the mentions in the same cluster. Additional classifiers are used to identifysingletons and non-referring markables. Our contributions are as follows. First of all, we report the first result on theCRACdata usingsystem mentions; our result is 5.8% better than the shared task baseline system, which used gold mentions. Our system also outperformsthe best-reported system onPDby up to 5.3%. Second, we demonstrate that the availability of singleton clusters and non-referringexpressions can lead to substantially improved performance on non-singleton clusters as well. Third, we show that despite our model notbeing designed specifically for theCONLLdata, it achieves a very competitive result

分裂病者の描画研究における全体的評価に関する一考察

The purpose of this paper was to consider the significance of the whole evaluation in the researches of drawings of schizophrenic patients. Statistical researches have developed index for diagnosing schizophrenia by their drawings. But in most of these researches, constituent elements were evaluated, and researches evaluating the drawing as a whole were insufficient. In this paper, the reason for insufficient researches on the whole evaluation was considered. And also it was considered that the features obtained by the whole evaluation are more adequate to explain the features of the drawings of schizophrenic patients, and that the whole evaluation can be a reliable statistical index. Furthermore, it was suggested that the features of drawings of schizophrenic patients, obtained by the whole evaluation, can be the key to access the essense of the pathology in schizophrenia

Resummed event-shape variables in DIS

We complete our study of resummed event-shape distributions in DIS by presenting results for the class of observables that includes the current jet mass, the C-parameter and the thrust with respect to the current-hemisphere thrust axis. We then compare our results to data for all observables for which data exist, fitting for alpha_s and testing the universality of non-perturbative 1/Q effects. A number of technical issues arise, including the extension of the concept of non-globalness to the case of discontinuous globalness; singularities and non-convergence of distributions other than in the Born limit; methods to speed up fixed-order Monte Carlo programs by up to an order of magnitude, relevant when dealing with many x and Q points; and the estimation of uncertainties on the predictions.Comment: 41 page

Perceptions about data-informed decisions: an assessment of information-use in high HIV-prevalence settings in South Africa

BACKGROUND: Information-use is an integral component of a routine health information system and essential to influence policy-making, program actions and research. Despite an increased amount of routine data collected, planning and resource-allocation decisions made by health managers for managing HIV programs are often not based on data. This study investigated the use of information, and barriers to using routine data for monitoring the prevention of mother-to-child transmission of HIV (PMTCT) programs in two high HIV-prevalence districts in South Africa. METHODS: We undertook an observational study using a multi-method approach, including an inventory of facility records and reports. The performance of routine information systems management (PRISM) diagnostic ‘Use of Information’ tool was used to assess the PMTCT information system for evidence of data use in 57 health facilities in two districts. Twenty-two in-depth interviews were conducted with key informants to investigate barriers to information use in decision-making. Participants were purposively selected based on their positions and experience with either producing PMTCT data and/or using data for management purposes. We computed descriptive statistics and used a general inductive approach to analyze the qualitative data. RESULTS: Despite the availability of mechanisms and processes to facilitate information-use in about two-thirds of the facilities, evidence of information-use (i.e., indication of some form of information-use in available RHIS reports) was demonstrated in 53% of the facilities. Information was inadequately used at district and facility levels to inform decisions and planning, but was selectively used for reporting and monitoring program outputs at the provincial level. The inadequate use of information stemmed from organizational issues such as the lack of a culture of information-use, lack of trust in the data, and the inability of program and facility managers to analyze, interpret and use information. CONCLCUSIONS: Managers’ inability to use information implied that decisions for program implementation and improving service delivery were not always based on data. This lack of data use could influence the delivery of health care services negatively. Facility and program managers should be provided with opportunities for capacity development as well as practice-based, in-service training, and be supported to use information for planning, management and decision-making