Cost of informal caregiving associated with stroke among the elderly in the United States.

Objectives: We estimated the informal caregiving hours and costs associated with stroke.

Methods: We selected persons aged 65 years and older in 2006 and who were also included in the 2008 follow-up survey from the Health and Retirement Study. We adapted the case-control study design by using self-reported occurrence of an initial stroke event during 2006 and 2008 to classify persons into the stroke (case) and the nonstroke (control) groups.

Costs of hospitalization for stroke patients aged 18-64 years in the United States.

Background: Estimates for the average cost of stroke have varied 20-fold in the United States. To provide a robust cost estimate, we conducted a comprehensive analysis of the hospitalization costs for stroke patients by diagnosis status and event type.

Methods: Using the 2006-2008 MarketScan inpatient database, we identified 97,374 hospitalizations with a primary or secondary diagnosis of stroke.

A cost analysis of a community health worker program in rural Vermont.

Studies have shown that community health workers (CHWs) can improve the effectiveness of health care systems; however, little has been reported about CHW program costs. We examined the costs of a program staffed by three CHWs associated with a small, rural hospital in Vermont. We used a standardized data collection tool to compile cost information from administrative data and personal interviews.

Using evaluability assessment to support the development of practice-based evidence in public health.

Practice-based evidence arises from programs implemented in real-world settings. Program success may be judged on the basis of experience; however, formal evaluation studies of methodological rigor can provide a high level of credible evidence to inform public health practice. Such studies can be lengthy and expensive.

Facilitators and barriers to implementing a local policy to reduce sodium consumption in the County of Los Angeles government, California, 2009.

Introduction: This qualitative study explores facilitators and barriers to a proposed food procurement policy that would require food purchasers, distributors, and vendors of food service in the County of Los Angeles government to meet specified nutrition standards, including limits on sodium content.

Methods: We conducted 30 key informant interviews. Interviewees represented 18 organizations from the County of Los Angeles government departments that purchased, distributed, or sold food; public and private non-County entities that had previously implemented food procurement policies in their organizations; and large organizations that catered food to the County.

Using the Extended Health Belief Model to understand siblings' perceptions of risk for hereditary hemochromatosis.

Objective: this research focuses on individuals' reactions to news that a sibling has been diagnosed with hereditary hemochromatosis (HH). We used the Extended Health Belief Model (EHBM) to frame our analysis of siblings' perceptions of risk for HH and decision of whether to obtain diagnostic testing.

Method: 60 patient and 25 sibling interviews were transcribed and thematically analyzed for the six components of the EHBM.

Promising practices in promotion of healthy weight at small and medium-sized US worksites.

Introduction: We developed a new evaluation method to identify promising practices for promoting healthy weight among employees at small and medium-sized worksites.

Methods: We used a structured rating and selection process to select 9 worksites with approximately 100 to 3,000 employees from a pool of worksites with health promotion programs reputed to be exemplary. A site visit over 2 sequential half-days at each site included interviews with senior management, program staff, vendors, and wellness committees; observation guided by a written environmental assessment; and structured review of program data on health outcomes of wellness program participants.

A new evaluation tool to obtain practice-based evidence of worksite health promotion programs.

Introduction: The Centers for Disease Control and Prevention developed the Swift Worksite Assessment and Translation (SWAT) evaluation method to identify promising practices in worksite health promotion programs. The new method complements research studies and evaluation studies of evidence-based practices that promote healthy weight in working adults.

Methods: We used nationally recognized program evaluation standards of utility, feasibility, accuracy, and propriety as the foundation for our 5-step method: 1) site identification and selection, 2) site visit, 3) post-visit evaluation of promising practices, 4) evaluation capacity building, and 5) translation and dissemination.

Using evaluation to guide successful development of an online training course for healthcare professionals.

Aim: The Centers for Disease Control and Prevention developed an online training course to address a lack of knowledge among healthcare professionals regarding the identification of patients at risk for hemochromatosis and recognition of its related early symptoms. A multilevel evaluation design was used to (a) guide course development, (b) test course efficacy, and (c) assess training impact.

Methods: Highly focused, brief evaluation activities with the intended audience (N = 642) provided a stream of qualitative and quantitative data that guided course design, development, and implementation.

Family-based detection for hereditary hemochromatosis.

The purpose of this study was to examine motivators for and barriers to family-based detection for hereditary hemochromatosis (HH). HH patients (n = 60) and HH siblings (n = 25) participated in one-on-one or group interviews. Patients and siblings understood that HH "runs in families," but not that siblings are at higher HH risk than other family members.

Stakeholder-focused evaluation of an online course for health care providers.

Introduction: Different people who have a stake or interest in a training course (stakeholders) may have markedly different definitions of what constitutes "training success" and how they will use evaluation results.

Methods: Stakeholders at multiple levels within and outside of the organization guided the development of an evaluation plan for a Web-based training course on hemochromatosis. Stakeholder interests and values were reflected in the type, level, and rigor of evaluation methods selected.

State Plan Index: a tool for assessing the quality of state public health plans.

Introduction: The State Plan Index is an evaluation instrument that uses a Likert scale to assess 60 indicators of the quality of state public health plans. The State Plan Index was needed to enable evaluation of plans that were developed using a variety of public health planning models.

Methods: Federal, state, and academic partners participated in developing and testing the instrument.

Using the State Plan Index to evaluate the quality of state plans to prevent obesity and other chronic diseases.

Introduction: Implicit in public health planning models is the assumption that good public health plans lead to good programs, and good programs lead to desired health outcomes. Despite considerable resources that are devoted to developing plans, public health agencies and organizations have lacked a tool for evaluating the finished product of their planning efforts -- the written plan itself -- as an important indicator of progress. To address the need for an instrument to assess the quality of state plans designed to prevent and control chronic diseases, we created and tested the State Plan Index and used it to evaluate the quality of nine state plans aimed at preventing and reducing obesity.

Expanding the evidence for health promotion: developing best practices for WISEWOMAN.

Implementing effective programs to prevent chronic disease holds the promise of reducing morbidity and mortality, reducing health disparities, and promoting health. Yet many programs have demonstrated success only in highly controlled research settings and few address the needs of low-income, uninsured, minority women. Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN), a demonstration program funded by the Centers for Disease Control and Prevention (CDC), that provides chronic disease risk factor screening and lifestyle interventions for low-income, 40-64-year-old women is learning from our own successful programs but is also charting new territory.

Variation in average costs among federally sponsored state-organized cancer detection programs: economies of scale?

Background: Societal cost-effectiveness analysis and its variants help decision makers achieve an efficient allocation of resources across the set of all possible health interventions. Sometimes, however, decision makers are focused instead on the efficient allocation of resources within a particular intervention program that has already been implemented. This is especially true when the intervention is being delivered at several different sites.