Empowering Effective Teachers: Readiness for Reform

Outlines a spectrum of conditions needed for the successful implementation of teacher effectiveness reform, including shared leadership, vision, and commitment; a culture of data-driven decision making; stakeholder engagement; and supportive policies

Family Decision-Making on International Migration

We use a unique survey of Danes who have emigrated between 1987 and 2002 to study intra-family decision-making on international migration. Our survey reached 582 respondents with a Danish partner who was the same as before emigration. We model family decision-making in a bargaining framework and derive comparative statics to test with our data. Empirically, we find that family migration decisions are usually a shared preference, but that they are often driven to a larger extent by the male preference, most pronouncedly if the female is not college educated. Moreover, an increase in male wages goes along with relatively stronger male preferences towards joint emigration, which is in line with our theory

Putting Community First: A Promising Approach to Federal Collaboration for Environmental Improvement: An Evaluation of the Community Action for a Renewed Environment (CARE) Demonstration Program

This report is an independent evaluation of the Environmental Protection Agency's (EPA) Community Action for a Renewed Environment (CARE) Demonstration Program, a community-driven process that uses the best available data to help communities set priorities and take action on their greatest environmental risks. CARE fosters local partnerships that seek participation from business, government, organizations, residents and EPA staff. It also supports a public, transparent planning and implementation process based on collaborative decision-making and shared action.Key FindingsThe National Academy Panel overseeing this effort was impressed by the dedication of the EPA staff to this unique initiative and commended the EPA for its efforts to partner with communities in achieving important long-term and sustainable environmental improvements at the local level. Recommended actions for the CARE Program include: (1) develop and implement a multifaceted information sharing approach; (2) coordinate and refine internal program management activities; and (3) develop a strategic plan and a business plan for CARE

Lifeline of New Products- Destination: The Patient\u27s Bedside

The lifeline of a new product begins with an innovative process driven by an on-line request through our academic medical center’s intranet system. The individual championing the new product completes the request. Staff nurses have a voice in the decision making process of the acceptance or the rejection of new product(s) being used in a hospital setting. All requested products are thoroughly investigated as the item relates to new technology, cost, reimbursement, medical evidence and evidence-based practice. These critical factors assist in the decision making process to improve the quality of patient care while ensuring cost-containment and standardization, thereby, translating into positive patient outcomes. A nurse educator is intimately involved in the Product Evaluation and Implementation Process. As the nurse coordinating the evaluation of a product, there is opportunity to work in concert with supply chain/contract buyers, inventory control/distribution managers, requestors and the sales representatives to produce an efficient evaluation. Clinical effectiveness, quality and acceptance are criteria used to evaluate the product. Once the evaluation period is complete, data is collected and analyzed. A summary report is generated and shared electronically with the appropriate organizational representatives. Based upon the results the product is either accepted or rejected. If a product is accepted, the process moves onto the implementation phase. The nursing website and the hospital intranet is used to provide the nursing staff with Product Announcements, Product Information, Summary of Committee Actions and communicates in what phase the product rests. Presented at: National Conference: National Nursing Staff Development Organization 2009 Conference, July 8-12, 2009, Philadelphia, PA

Improving shared decision-making about cancer treatment through design-based data-driven decision-support tools and redesigning care paths:an overview of the 4D PICTURE project

Background: Patients with cancer often have to make complex decisions about treatment, with the options varying in risk profiles and effects on survival and quality of life. Moreover, inefficient care paths make it hard for patients to participate in shared decision-making. Data-driven decision-support tools have the potential to empower patients, support personalized care, improve health outcomes and promote health equity. However, decision-support tools currently seldom consider quality of life or individual preferences, and their use in clinical practice remains limited, partly because they are not well integrated in patients' care paths.Aim and objectives: The central aim of the 4D PICTURE project is to redesign patients' care paths and develop and integrate evidence-based decision-support tools to improve decision-making processes in cancer care delivery. This article presents an overview of this international, interdisciplinary project.Design, methods and analysis: In co-creation with patients and other stakeholders, we will develop data-driven decision-support tools for patients with breast cancer, prostate cancer and melanoma. We will support treatment decisions by using large, high-quality datasets with state-of-the-art prognostic algorithms. We will further develop a conversation tool, the Metaphor Menu, using text mining combined with citizen science techniques and linguistics, incorporating large datasets of patient experiences, values and preferences. We will further develop a promising methodology, MetroMapping, to redesign care paths. We will evaluate MetroMapping and these integrated decision-support tools, and ensure their sustainability using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework. We will explore the generalizability of MetroMapping and the decision-support tools for other types of cancer and across other EU member states.Ethics: Through an embedded ethics approach, we will address social and ethical issues.Discussion: Improved care paths integrating comprehensive decision-support tools have the potential to empower patients, their significant others and healthcare providers in decision-making and improve outcomes. This project will strengthen health care at the system level by improving its resilience and efficiency.Improving the cancer patient journey and respecting personal preferences: an overview of the 4D PICTURE projectThe 4D PICTURE project aims to help cancer patients, their families and healthcare providers better undertstand their options. It supports their treatment and care choices, at each stage of disease, by drawing on large amounts of evidence from different types of European data. The project involves experts from many different specialist areas who are based in nine European countries. The overall aim is to improve the cancer patient journey and ensure personal preferences are respected

How do healthcare professionals working in accountable care organisations understand patient activation and engagement? Qualitative interviews across two time points.

ObjectiveIf patient engagement is the new 'blockbuster drug' why are we not seeing spectacular effects? Studies have shown that activated patients have improved health outcomes, and patient engagement has become an integral component of value-based payment and delivery models, including accountable care organisations (ACO). Yet the extent to which clinicians and managers at ACOs understand and reliably execute patient engagement in clinical encounters remains unknown. We assessed the use and understanding of patient engagement approaches among frontline clinicians and managers at ACO-affiliated practices.DesignQualitative study; 103 in-depth, semi-structured interviews.ParticipantsSixty clinicians and eight managers were interviewed at two established ACOs.ApproachWe interviewed healthcare professionals about their awareness, attitudes, understanding and experiences of implementing three key approaches to patient engagement and activation: 1) goal-setting, 2) motivational interviewing and 3) shared decision making. Of the 60 clinicians, 33 were interviewed twice leading to 93 clinician interviews. Of the 8 managers, 2 were interviewed twice leading to 10 manager interviews. We used a thematic analysis approach to the data.Key resultsInterviewees recognised the term 'patient activation and engagement' and had favourable attitudes about the utility of the associated skills. However, in-depth probing revealed that although interviewees reported that they used these patient activation and engagement approaches, they have limited understanding of these approaches.ConclusionsWithout understanding the concept of patient activation and the associated approaches of shared decision making and motivational interviewing, effective implementation in routine care seems like a distant goal. Clinical teams in the ACO model would benefit from specificity defining key terms pertaining to the principles of patient activation and engagement. Measuring the degree of understanding with reward that are better-aligned for behaviour change will minimise the notion that these techniques are already being used and help fulfil the potential of patient-centred care