Identifying and explaining the variability in development and implementation costs of disease management programs in the Netherlands

BACKGROUND: In the Netherlands, disease management programs (DMPs) are used to treat chronic diseases. Their aim is to improve care and to control the rising expenditures related to chronic diseases. A bundled payment was introduced to facilitate the implementation of DMPs. This payment is an all-inclusive price per patient per year for a pre-specified care package. However, it is unclear to which extent the costs of developing and implementing DMPs are included in this price. Consequently, the organizations providing DMPs bear financial risk because the development and implementation (D&I) costs may be substantial. The aim of this paper is to investigate the variability in and drivers of D&I costs among 22 DMPs and highlight characteristics th

An exploratory cluster randomised controlled trial of knowledge translation strategies to support evidence-informed decision-making in local governments (The KT4LG study)

Background: Childhood overweight and obesity is the most prevalent and, arguably, politically complex child health problem internationally. Governments, communities and industry have important roles to play, and are increasingly expected to deliver an evidence-informed system-wide prevention program. However, efforts are impeded by a lack of organisational access to and use of research evidence. This study aims to identify feasible, acceptable and ideally, effective knowledge translation (KT) strategies to increase evidence-informed decision making in local governments, within the context of childhood obesity prevention as a national policy priority.Methods/Design: This paper describes the methods for KT4LG, a cluster randomised controlled trial which is exploratory in nature, given the limited evidence base and methodological advances. KT4LG aims to examine a program of KT strategies to increase the use of research evidence in informing public health decisions in local governments. KT4LG will also assess the feasibility and acceptability of the intervention. The intervention program comprises a facilitated program of evidence awareness, access to tailored research evidence, critical appraisal skills development, networking and evidence summaries and will be compared to provision of evidence summaries alone in the control program. 28 local governments were randomised to intervention or control, using computer generated numbers, stratified by budget tertile (high, medium or low). Questionnaires will be used to measure impact, costs, and outcomes, and key informant interviews will be used to examine processes, feasibility, and experiences. Policy tracer studies will be included to examine impact of intervention on policies within relevant government policy documents.Discussion: Knowledge translation intervention studies with a focus on public health and prevention are very few in number. Thus, this study will provide essential data on the experience of program implementation and evaluation of a system-integrated intervention program employed within the local government public health context. Standardised programs of system, organisational and individual KT strategies have not been described or rigorously evaluated. As such, the findings will make a significant contribution to understanding whether a facilitated program of KT strategies hold promise for facilitating evidence-informed public health decision making within complex multisectoral government organisations.<br /

Missing and accounted for: gaps and areas of wealth in the public health review literature

<p>Abstract</p> <p>Background</p> <p>High-quality review evidence is useful for informing and influencing public health policy and practice decisions. However, certain topic areas lack representation in terms of the quantity and quality of review literature available. The objectives of this paper are to identify the quantity, as well as quality, of review-level evidence available on the effectiveness of public health interventions for public health decision makers.</p> <p>Methods</p> <p>Searches conducted on <url>http://www.health-evidence.ca</url> produced an inventory of public health review literature in 21 topic areas. Gaps and areas of wealth in the review literature, as well as the proportion of reviews rated methodologically strong, moderate, or weak were identified. The top 10 topic areas of interest for registered users and visitors of <url>http://www.health-evidence.ca</url> were extracted from user profile data and Google Analytics.</p> <p>Results</p> <p>Registered users' top three interests included: 1) healthy communities, 2) chronic diseases, and 3) nutrition. The top three preferences for visitors included: 1) chronic diseases, 2) physical activity, and 3) addiction/substance use. All of the topic areas with many (301+) available reviews were of interest to registered users and/or visitors (mental health, physical activity, addiction/substance use, adolescent health, child health, nutrition, adult health, and chronic diseases). Conversely, the majority of registered users and/or visitors did not have preference for topic areas with few (≤ 150) available reviews (food safety and inspection, dental health, environmental health) with the exception of social determinants of health and healthy communities. Across registered users' and visitors' topic areas of preference, 80.2% of the reviews were of well-done methodological quality, with 43.5% of reviews having a strong quality rating and 36.7% a moderate review quality rating.</p> <p>Conclusions</p> <p>In topic areas in which many reviews are available, higher level syntheses are needed to guide policy and practice. For other topic areas with few reviews, it is necessary to determine whether primary study evidence exists, or is needed, so that reviews can be conducted in the future. Considering that less than half of the reviews available on <url>http://www.health-evidence.ca</url> are of strong methodological quality, the quality of the review-level evidence needs to improve across the range of public health topic areas.</p

Knowledge translation strategies to improve the use of evidence in public health decision making in local government: intervention design and implementation plan

Background:&nbsp;Knowledge translation strategies are an approach to increase the use of evidence within policy and practice decision-making contexts. In clinical and health service contexts, knowledge translation strategies have focused on individual behavior change, however the multi-system context of public health requires a multi-level, multi-strategy approach. This paper describes the design of and implementation plan for a knowledge translation intervention for public health decision making in local government. Methods: Four preliminary research studies contributed findings to the design of the intervention: a systematic review of knowledge translation intervention effectiveness research, a scoping study of knowledge translation perspectives and relevant theory literature, a survey of the local government public health workforce, and a study of the use of evidence-informed decision-making for public health in local government. A logic model was then developed to represent the putative pathways between intervention inputs, processes, and outcomes operating between individual-, organizational-, and system-level strategies. This formed the basis of the intervention plan. Results: The systematic and scoping reviews identified that effective and promising strategies to increase access to research evidence require an integrated intervention of skill development, access to a knowledge broker, resources and tools for evidence-informed decision making, and networking for information sharing. Interviews and survey analysis suggested that the intervention needs to operate at individual and organizational levels, comprising workforce development, access to evidence, and regular contact with a knowledge broker to increase access to intervention evidence; develop skills in appraisal and integration of evidence; strengthen networks; and explore organizational factors to build organizational cultures receptive to embedding evidence in practice. The logic model incorporated these inputs and strategies with a set of outcomes to measure the intervention\u27s effectiveness based on the theoretical frameworks, evaluation studies, and decision-maker experiences. Conclusion: Documenting the design of and implementation plan for this knowledge translation intervention provides a transparent, theoretical, and practical approach to a complex intervention. It provides significant insights into how practitioners might engage with evidence in public health decision making. While this intervention model was designed for the local government context, it is likely to be applicable and generalizable across sectors and settings.</div

William Carleton, the Writer as Witness

William Carleton (1794-1869), was the first significant Irish writer to emerge from the Gaelic speaking peasant world. He was an artful storyteller, fluent in Irish and English, who merged the techniques and themes of his native oral tradition with those of English prose. Two stories which illustrate Carleton 's merits as a writer are «The Battle of the Factions» and «Wildgoose Lodge». The former is an excellent piece of satire ; the latter, a gothic tale of tribal murder and revenge. In both stories Carleton bears witness to the violent, politicized world of pre-famine Ireland. He has generated considerable interest among the Northern writers, Seamus Heaney, Benedict Kiely and John Montague.William Carleton (1794-1869) fut le premier écrivain irlandais d'importance à sortir du monde des paysans qui parlent le gaélique. Il était fin conteur, maniant également irlandais et anglais, et amalgamant les techniques et les thèmes de sa tradition orale native avec celles de la prose anglaise. Deux contes qui illustrent les mérites de Carleton en tant qu'écrivain sont «The Battle of the Factions» et «Wildgoose Lodge». Le premier est une excellente satire ; le deuxième, un conte «gothique» d'un meurtre tribal et de vengeance. Dans ces deux contes Carleton témoigne du monde violent et politisé de l'Irlande avant la famine. Il a intéressé considérablement les écrivains du Nord, Seamus Heaney, Benedict Kiely and John Montague.Waters Maureen. William Carleton, the Writer as Witness. In: Études irlandaises, n°11, 1986. pp. 51-63

D’ARCY MCNICKLE. LE ROMAN AMÉRINDIEN AU CARREFOUR DE LA MODERNITÉ ET DE LA TRADITION

TO BE ADDE

The benefits and challenges of conducting an overview of systematic reviews in public health: a focus on physical activity

Introduction The ultimate aim of Cochrane systematic reviews is to inform policy and practice decisions for better health outcomes. However, due to the increasing numbers of scientific publications, wading through the available evidence of both individual studies and systematic reviews can be challenging and overwhelming even for avid authors and readers. This paper briefly describes the first overview (a systematic review of reviews) of the Cochrane Public Health Group (CPHG) in development and proposes a way forward for the methodologies under consideration

L'américanité (perspectives états-uniennes, franco-canadiennes et amérindiennes)

Nous effectuons dans notre présent travail une étude comparée de la littérature nord-américaine du vingtième siècle par rapport à la notion de l'américanité. La relecture des romans classiques nord-américains nous permet de retracer l'émergence et l'évolution de l'américanité chez des auteurs tels que Jack London, Ralph Ellison et Alain Grandbois. À travers les écrits de Scott Momaday et de D'Arcy McNickle, notre compréhension de l'américanité s'enrichit des perspectives amérindiennes. Les derniers chapitres reprennent le mythe de l'errance dans son rapport avec la représentation de l'exil et de la production artistique chez Germaine Guèvremont et Gabrielle Roy. Jack Kerouac, pourvu d'origines franco-canadiennes, sert de lien continuel entre le roman états-unien et le roman franco-canadien. Lecteur et grand admirateur de Thomas Wolfe, le célèbre auteur de la génération beat inspire à son tour Jacques Poulin, avec Volkswagen blues. Cette thèse vise à ouvrir de nouvelles perspectives sur de vieux débats, à susciter une vision plus équilibrée de l'américanité et à récuser ce que nous estimons être un faux discours sur la notion d'américanisation.The present study consists of a comparative study in North American literature in regards to the notion of l'américanité. As we re-read the classic North American novel, we trace the emergence and evolution of l'américanité in the works of authors such as Jack London, Ralph Ellison and Alain Grandbois. The novels of Scott Momaday and D'Arcy McNickle further our comprehension of l'américanité from the Native American perspective. The final chapters look at the myth of wandering in relation to exile and artistic production in the works of Germaine Guèvremont and Gabrielle Roy. Jack Kerouac, given his French Canadian heritage, serves as a constant bridge between the United States and French Canadian novel. Reader and great admirer of Thomas Wolfe, the famous beat generation writer comes to inspire Jacques Poulin with Volkswagen blues. With this thesis we aim to open up new perspectives on old debates, encourage a more balanced view of l'américanité, and challenge what we consider to be a false discourse on the notion of Americanization.PARIS3-BU (751052102) / SudocSudocFranceF