Health Technology Assessment of Public Health Interventions Published 2012 to 2016: An Analysis of Characteristics and Comparison of Methods.

OBJECTIVES: The aim of this study was to provide an overview of the methodological characteristics and compare the assessment methods applied in health technology assessments (HTAs) of public health interventions (PHIs). METHODS: We defined a PHI as a population-based intervention on health promotion or for primary prevention of chronic or nonchronic diseases. HTAs on PHIs were identified by systematically searching the Web pages of members of international HTA networks. We included only full HTA reports published between 2012 and 2016. Two reviewers extracted data on the methods used to assess effectiveness/safety, as well as on economic, social, cultural, ethical, and legal aspects using a-priori standardized tables. RESULTS: We included ten HTAs provided by four different organizations. Of these, all reports assessed the effectiveness of the interventions and conducted economic evaluations, seven investigated social/cultural aspects, and four each considered legal and ethical aspects, respectively. Some reports addressed applicability, context/setting, and intervention fidelity issues in different ways. We found that most HTAs adapted their methods to some extent, for example, by including nonrandomized studies, expanding the search strategy, involving stakeholders, or applying a framework to guide the HTA process. CONCLUSIONS: Our analysis provides a comprehensive overview of methods applied in HTAs on public health interventions. We found that a heterogeneous set of approaches is used to deal with the challenges of evaluating complex public health interventions.

[Quality prevention and health promotion programming in long-term care: the QualiPEP Project]. / Qualitätsorientierte Prävention und Gesundheitsförderung in Einrichtungen der Pflege: Das Projekt QualiPEP.

With the demographic shift, the number of persons in need of long-term care is continuing to grow, as is the need for nursing care staff and specialists. Stress levels within the long-term care sector are very high. Multiple legislative reforms have given rise to societal and political awareness of the resulting challenges: Preventive Health Care Act (2015), First and Second Acts and Third Bill to Strengthen Long-term Care (2015-17), Federal Participation Act (2017), and the Bill to Strengthen Nursing Care Staff (2019).To meet these challenges, in May 2017 the four-year project quality-oriented prevention and health promotion in institutions for persons with disabilities and of long-term care (QualiPEP) was founded. It is administered by the AOK-Bundesverband and promoted by the federal health ministry. The project addresses part- and full-stationary residential long-term care settings and residential home settings for persons with disabilities. It pursues three goals: 1. Developing a quality concept to improve effectiveness and sustainability of prevention and health-promotion programming; 2. Strengthening the health literacy of home residents, employees and organizations (therefore, a framework concept will be developed); 3. Expanding upon existing workplace health-promotion measures for employees. The ultimate impact objective is to increase health-related quality of life for the target groups.The process of developing quality indicators begins with a needs assessment, followed by phases of conceptualization, implementation, evaluation and adaptation. The present article illustrates QualiPEP project objectives with a specific focus on long-term care facilities and further describes the project's research design and planned execution.

Health technology assessment of public health interventions: an analysis of characteristics and comparison of methods-study protocol.

BACKGROUND: Conducting a health technology assessment (HTA) of public health interventions (PHIs) poses some challenges. PHIs are often complex interventions, which affect the number and degree of interactions of the aspects to be assessed. Randomized controlled trials on PHIs are rare as they are difficult to conduct because of ethical or feasibility issues. The aim of this study is to provide an overview of the methodological characteristics and to compare the applied assessment methods in HTAs on PHIs. METHODS: We will systematically search HTA agencies for HTAs on PHIs published between 2012 and 2016. We will identify the HTAs by screening the webpages of members of international HTA organizations. One reviewer will screen the list of HTAs on the webpages of members of international HTA organization, and a second review will double-check the excluded records. For this methodological review, we define a PHI as a population-based intervention on health promotion or for primary prevention of chronic or non-chronic diseases. Only full HTA reports will be included. At maximum, we will include a sample of 100 HTAs. In the case that we identify more than 100 relevant HTAs, we will perform a random selection. We will extract data on effectiveness, safety and economic as well as on social, cultural, ethical and legal aspects in a priori piloted standardized tables. We will not assess the risk of bias as we focus on exploring methodological features. Data extraction will be performed by one reviewer and verified by a second. We will synthesize data using tables and in a structured narrative way. DISCUSSION: Our analysis will provide a comprehensive and current overview of methods applied in HTAs on PHIs. We will discuss approaches that may be promising to overcome the challenges of evaluating PHIs.

Healthcare providers' perceptions and self-reported fall prevention practices: findings from a large new york health system.

Among older adults, falls are the leading cause of injury-related deaths and emergency department visits, and the incidence of falls in the United States is rising as the number of older Americans increases. Research has shown that falls can be reduced by modifying fall-risk factors using multifactorial interventions implemented in clinical settings. However, the literature indicates that many providers feel that they do not know how to conduct fall-risk assessments or do not have adequate knowledge about fall prevention. To help healthcare providers incorporate older adult fall prevention (i.e., falls risk assessment and treatment) into their clinical practice, the Centers for Disease Control and Prevention's (CDC) Injury Center has developed the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool kit. This study was conducted to identify the practice characteristics and providers' beliefs, knowledge, and fall-related activities before they received training on how to use the STEADI tool kit. Data were collected as part of a larger State Fall Prevention Project funded by CDC's Injury Center. Completed questionnaires were returned by 38 medical providers from 11 healthcare practices within a large New York health system. Healthcare providers ranked falls as the lowest priority of five conditions, after diabetes, cardiovascular disease, mental health, and musculoskeletal conditions. Less than 40% of the providers asked most or all of their older patients if they had fallen during the past 12 months. Less than a quarter referred their older patients to physical therapists for balance or gait training, and <20% referred older patients to community-based fall prevention programs. Less than 16% reported they conducted standardized functional assessments with their older patients at least once a year. These results suggest that implementing the STEADI tool kit in clinical settings could address knowledge gaps and provide the necessary tools to help providers incorporate fall-risk assessment and treatment into clinical practice.

Marijuana Use from Middle to High School: Co-occurring Problem Behaviors, Teacher-Rated Academic Skills and Sixth-Grade Predictors.

Rising marijuana use and its lowered perceived risk among adolescents highlight the importance of examining patterns of marijuana use over time. This study identified trajectories of marijuana use among adolescents followed from middle through high school, characterized these by co-occurring problem behaviors and teacher-rated academic skills (study skills, attention problems, and learning problems), and tested sixth-grade predictors of trajectory membership. The sample consisted of a randomly-selected cohort of 619 students assessed annually from sixth to twelfth grade. Using group-based modeling, we identified four trajectories of marijuana use: Abstainer (65.6%), Sporadic (13.9%), Experimental (11.5%), and Increasing (9.0%). Compared to Abstainers, students in the Sporadic, Experimental and Increasing trajectories reported significantly more co-occurring problem behaviors of alcohol use, cigarette smoking, and physical aggression. Sporadic and Experimental users reported significantly less smoking and physical aggression, but not alcohol use, than Increasing users. Teachers consistently rated Abstainers as having better study skills and less attention and learning problems than the three marijuana use groups. Compared to Abstainers, the odds of dropping out of high school was at least 2.7 times higher for students in the marijuana use trajectories. Dropout rates did not vary significantly between marijuana use groups. In sixth grade, being male, cigarette smoking, physical aggression and attention problems increased the odds of being in the marijuana use trajectories. Multiple indicators--student self-reports, teacher ratings and high school dropout records--showed that marijuana was not an isolated or benign event in the life of adolescents but part of an overall problem behavior syndrome.

Preventing falls with Tai Ji Quan: A public health perspective.

Falls among people aged 65 and older are a significant public health problem and one that is expected to increase as the population ages. Randomized controlled trials have demonstrated that Tai Ji Quan can reduce falls and associated injuries among older adults. In this paper, we describe how Tai Ji Quan community programs are being utilized by public health and aging services organizations to reduce older adult falls. We conclude that, to have a population-level impact on reducing falls and improving the health of older adults, Tai Ji Quan interventions must be translated into community programs that meet the needs and abilities of older adults. These programs must be adapted to fit into existing community structures, disseminated through multiple delivery channels, adopted and implemented broadly by organizations, and institutionalized to ensure sustainability.

Circumstances and outcomes of falls among high risk community-dwelling older adults.

BACKGROUND: For older adults, falls threaten their health, independence, and quality of life. Knowing the circumstances surrounding falls is essential for understanding how behavioral and environmental factors interact in fall events. It is also important for developing and implementing interventions that are effective and acceptable to older adults. This study investigated the circumstances and injury outcomes of falls among community-dwelling older adults at high risk of falling. METHODS: In this secondary analysis, we examined the circumstances and outcomes of falls experienced by 328 participants in the Dane County (Wisconsin) Safety Assessment for Elders (SAFE) Research Study. SAFE was a randomized controlled trial of a community-based multifactorial falls intervention for older adults at high risk for falls, conducted from October 2002 to December 2007. Participants were community-dwelling adults aged ≥65 years who reported at least one fall during the year after study enrollment. Falls were collected prospectively using monthly calendars. Everyone who reported a fall was contacted by telephone to determine the circumstances surrounding the event. Injury outcomes were defined as none, mild (injury reported but no treatment sought), moderate (treatment for any injury except head injury or fracture), and severe (treatment for head injury or fracture). RESULTS: Data were available for 1,172 falls. A generalized linear mixed model analysis showed that being age ≥85 (OR = 2.1, 95% confidence interval [CI] = 1.2-3.9), female (OR = 2.1, 95% CI = 1.3-3.4), falling backward and landing flat (OR = 5.6, 95% CI = 2.9-10.5), sideways (OR = 4.6, 95% CI = 2.6-8.0) and forward (OR = 3.3, 95% CI = 2.0-5.7) were significantly associated with the likelihood of injury. Of 783 falls inside the home, falls in the bathroom were more than twice as likely to result in an injury compared to falls in the living room (OR = 2.4, 95% CI = 1.2-4.9). CONCLUSIONS: Most falls among these high risk older adults occurred inside the home. The likelihood of injury in the bathroom supports the need for safety modifications such as grab bars, and may indicate a need for assistance with bathing. These findings will help clinicians tailor fall prevention for their patients and have practical implications for retirement and assisted living communities and community-based fall prevention programs.

Fall prevention in community settings: results from implementing tai chi: moving for better balance in three States.

Tai Chi: Moving for Better Balance (TCMBB) is an evidence-based fall prevention exercise program being disseminated in selected communities through state injury prevention programs. This study: (1) describes the personal characteristics of TCMBB participants; (2) quantifies participants' functional and self-reported health status at enrollment; and (3) measures changes in participants' functional and self-reported health status post-intervention. There were 421 participants enrolled in 36 TCMBB programs delivered in Colorado, New York, and Oregon. Of the 209 participants who completed both baseline enrollment and post-intervention surveys, the average age of participants was 75.3 (SD ± 8.2) years. Most participants were female (81.3%), non-Hispanic (96.1%), White (94.1%), and described themselves as in excellent or very good health (52.2%). Paired t-test and general estimating equation models assessed changes over the 3-month program period. Pre- and post-assessment self-reported surveys and objective functional data [Timed Up and Go (TUG) test] were collected. On average, TUG test scores decreased (p < 0.001) for all participants; however, the decrease was most noticeable among high-risk participants (mean decreased from 18.5 to 15.7 s). The adjusted odds ratio of reporting feeling confident that a participant could keep themselves from falling was five times greater after completing the program. TCMBB, which addresses gait and balance problems, can be an effective way to reduce falls among the older adult population. By helping older adults maintain their functional abilities, TCMBB can help community-dwelling older adults continue to live independently.

Circumstances and outcomes of falls among high risk community-dwelling older adults.

BACKGROUND: For older adults, falls threaten their health, independence, and quality of life. Knowing the circumstances surrounding falls is essential for understanding how behavioral and environmental factors interact in fall events. It is also important for developing and implementing interventions that are effective and acceptable to older adults. This study investigated the circumstances and injury outcomes of falls among community-dwelling older adults at high risk for falls. METHODS: In this secondary analysis, we examined the circumstances and outcomes of falls experienced by 328 participants in the Dane County (Wisconsin) Safety Assessment for Elders (SAFE) Research Study. SAFE was a randomized controlled trial of a community-based multifactorial falls intervention for older adults at high risk for falls, conducted from October 2002 to December 2007. Participants were community-dwelling adults aged ≥65 years who reported at least one fall during the year after study enrollment. Falls were collected prospectively using monthly calendars. Everyone who reported a fall was contacted by telephone to determine the circumstances surrounding the event. Injury outcomes were defined as none, mild (injury reported but no treatment sought), moderate (treatment for any injury except head injury or fracture), and severe (treatment for head injury or fracture). RESULTS: Data were available for 1,172 falls. A generalized linear mixed model analysis showed that being aged ≥85 (OR = 2.1, 95% confidence interval [CI] = 1.2-3.9), female (OR = 2.1, 95% CI = 1.3-3.4), falling backward and landing flat (OR = 5.6, 95% CI = 2.9-10.5), sideways (OR = 4.6, 95% CI = 2.6-8.0) and forward (OR = 3.3, 95% CI = 2.0-5.7) were significantly associated with the likelihood of injury. Of 783 falls inside the home, falls in the bathroom were more than twice as likely to result in an injury compared to falls in the living room (OR = 2.4, 95% CI = 1.2-4.9). CONCLUSIONS: Most falls among these high risk older adults occurred inside the home. The likelihood of injury in the bathroom supports the need for safety modifications such as grab bars, and may indicate a need for assistance with bathing. These findings will help clinicians tailor fall prevention for their patients and have practical implications for retirement and assisted living communities and community-based fall prevention programs.

With graduation in sight: perceptions of high- and low-aggression students of the journey to high school completion.

This study explores students' perceptions of the paths to high school graduation using an ecological framework. Specifically, it identifies the challenges, influences, and motivations differentiating students who remained in school despite being at high risk for dropping out-defined as consistently high levels of aggression-from students at low risk of high school dropout. We analyzed inductively 16 focus groups conducted in Northeast Georgia with 81 eleventh graders participating in the Healthy Teens Longitudinal Study. Eight focus groups consisted of 11th graders who consistently scored high on aggression from 6th to 10th grade on the Problem Behaviors Frequency Scales (n = 40; 56% boys; 54% Caucasian, 39% African American; 7% Hispanic), and 8 groups consisting of students scoring low in aggression at all time points (n = 41; 40% boys; 45% Caucasian, 50% African American; 3% Hispanic). Findings derived from the constant comparative method revealed 4 distinguishing themes. High aggressive students highlighted a) the salience of structural barriers, b) stress due to external (vs. internal) factors, c) preference for concrete sources of motivation, and d) the strong influence of coaches. At the microsystem level of the ecological model, school psychologists can engage students through cognitive behavioral methods to foster realistic academic goals and to improve management of external sources of stress. At the mesosystem level, school policies can target 9th grade as a critical juncture for academic success. The final finding supports the involvement of adults at the mesosystem level, and coaches in particular, to promote positive social and academic development.