A method for identifying comparison counties: application to a rural telemedicine evaluation project.

The evaluation of telemedicine activity in rural communities is complicated by the fact that most telemedicine sites are chosen because of their existing telecommunications infrastructure and institutional relationships, not by a random selection process. In addition, it is difficult to draw conclusions about the effects of telemedicine without a careful analysis of parallel changes in communities which do not have access to telemedicine services. We have developed a method of identifying comparable counties based on an aggregate measure of health status. A set of 66 variables was collected in a previous project to develop a model to evaluate the relative health status of the population in Missouri. A stepwise regression was used to identify a subset of 15 variables that had the highest predictive value for the health status of a county. Distance measures were then used to identify six counties which were most similar to three telemedicine counties. The method can be used with any study set chosen non-randomly, to identify similar objects that can be used for comparative purposes.

Health education practice and the literature.

A body of meaningful research on the effectiveness of some health education interventions is developing. The emerging health education literature changes the value of innovation for health educators. The growing availability of well-researched methods requires that health educators favor tested programs over innovation in most circumstances. But it is largely up to leaders in the field of health education to assure that, as the literature becomes more meaningful, health educators have access to that meaning. This could be accomplished in part by an ongoing program of small conferences among leading health educators designed to produce clear statements on the practice implications of new research findings. The availability and promotion of these perspectives on health education practice would help health educators deliver research-based programs despite the demand for trivia they frequently face.