Improving access for community health and sub-acute outpatient services: protocol for a stepped wedge cluster randomised controlled trial

BACKGROUND: Waiting lists for treatment are common in outpatient and community services, Existing methods for managing access and triage to these services can lead to inequities in service delivery, inefficiencies and divert resources from frontline care. Evidence from two controlled studies indicates that an alternative to the traditional "waitlist and triage" model known as STAT (Specific Timely Appointments for Triage) may be successful in reducing waiting times without adversely affecting other aspects of patient care. This trial aims to test whether the model is cost effective in reducing waiting time across multiple services, and to measure the impact on service provision, health-related quality of life and patient satisfaction.

METHODS/DESIGN: A stepped wedge cluster randomised controlled trial has been designed to evaluate the impact of the STAT model in 8 community health and outpatient services. The primary outcome will be waiting time from referral to first appointment. Secondary outcomes will be nature and quantity of service received (collected from all patients attending the service during the study period and health-related quality of life (AQOL-8D), patient satisfaction, health care utilisation and cost data (collected from a subgroup of patients at initial assessment and after 12 weeks). Data will be analysed with a multiple multi-level random-effects regression model that allows for cluster effects. An economic evaluation will be undertaken alongside the clinical trial.

DISCUSSION: This paper outlines the study protocol for a fully powered prospective stepped wedge cluster randomised controlled trial (SWCRCT) to establish whether the STAT model of access and triage can reduce waiting times applied across multiple settings, without increasing health service costs or adversely impacting on other aspects of patient care. If successful, it will provide evidence for the effectiveness of a practical model of access that can substantially reduce waiting time for outpatient and community services with subsequent benefits for both efficiency of health systems and patient care.

The value of the sense of community and neighbouring

Today, urbanites are less involved in local communities which has resulted in a claim that the significance of local communities and the role of space and neighbourhood layout in the creation of local communities has been exaggerated. Such claims imply that feeling a sense of community among neighbourhood’s residents or an attachment to the community is not a value to the neighbourhood. Community research has developed a few indices for evaluating the sense of community and community attachment, but has not focused on the significance of a sense of community in neighbourhoods. The aim of this paper is to explore and review the significance of the sense of community, community attachment and neighbouring in the context of neighbourhoods. This review suggests that feeling a sense of community, attachment to community and neighbouring relationships can increase the feeling of safety and security, residential satisfaction, community identity, civic participation and mental health and well-being.

Tocqueville in Miami : political culture and political organizing in Miami's Cuban community

This study examines the effectiveness of civic organizations focusing on leadership and the role of culture in politics. The study is based on a quasi-experimental research design and relies primarily on qualitative data. The study focuses on Miami's Cuban community in order to examine the role of public initiative in grassroots civic and community organizations. The Miami Cuban community is a large, institutionally complex and cohesive ethnic community with dense networks of community organizations. The political and economic success of the community makes it an opportune setting for a study of civic organizing. The sheer number of civic organizations to be found in Miami's Cuban community suggests that the community's civic organizations have something to do with the considerable vibrancy and civic capacity of the community. How have the organizations managed to be so successful over so many years and what can be learned about successful civic organizing from their experience? Civic organizations in Miami's Cuban community are overwhelmingly ethnic-based organizations. The organizations recreate collective symbols that come from community members' memories of and attachments to the place of origin they hold dear as ethnic Cubans. They recreate a collective Cuban past that community members remember and that is the very basis of the community to which they belong. Cuban Miami's ethnically based civic organizations have generally performed better than the literature on civic organizations says they should. They gained greater access to community ties and social capital, and they exhibited greater organizational longevity. The fit between the political culture of civic organizations and that of the broader political community helps to explain this success. Yet they do not perform in the same way or in support of the same social purposes. Some stress individual agency rather than community agency, and some pursue an externally-oriented social purpose, whereas others focus on building an internal community.

Book review : Community development in theory and practice : an international reader

Book review of Community Development in Theory and Practice: An International Reader. Edited by G. Craig, K. Popple and M. Shaw.

Children's Fiction About 9/11: Ethnic, Heroic and National Identities

In this study, Lampert examines how cultural identities are constructed within fictional texts for young people written about the attacks on the Twin Towers. It identifi es three significant identity categories encoded in 9/11 books for children:ethnic identities, national identities, and heroic identities,arguing that the identities formed within the selected children’s texts are in flux, privileging performances of identities that are contingent on post-9/11 politics. Looking at texts including picture books, young adult fiction, and a selection of DC Comics, Lampert finds in post-9/11 children’s literature a co-mingling of xenophobia and tolerance; a binaried competition between good and evil and global harmony and national insularity; and a lauding of both the commonplace hero and the super-human. The shifting identities evident in texts that are being produced for children about 9/11 offer implicit and explicit accounts of what constitutes good citizenship, loyalty to nation and community, and desirable attributes in a Western post-9/11 context. This book makes an original contribution to the field of children’s literature by providing a focused and sustained analysis of how texts for children about 9/11 contribute to formations of identity in these complex times of cultural unease and global unrest.

The Second Life of urban planning? Using neogeography tools for community engagement

The majority of the world’s citizens now live in cities. Although urban planning can thus be thought of as a field with significant ramifications on the human condition, many practitioners feel that it has reached the crossroads in thought leadership between traditional practice and a new, more participatory and open approach. Conventional ways to engage people in participatory planning exercises are limited in reach and scope. At the same time, socio-cultural trends and technology innovation offer opportunities to re-think the status quo in urban planning. Neogeography introduces tools and services that allow non-geographers to use advanced geographical information systems. Similarly, is there potential for the emergence of a neo-planning paradigm in which urban planning is carried out through active civic engagement aided by Web 2.0 and new media technologies thus redefining the role of practicing planners? This paper traces a number of evolving links between urban planning, neogeography and information and communication technology. Two significant trends – participation and visualisation – with direct implications for urban planning are discussed. Combining advanced participation and visualisation features, the popular virtual reality environment Second Life is then introduced as a test bed to explore a planning workshop and an integrated software event framework to assist narrative generation. We discuss an approach to harness and analyse narratives using virtual reality logging to make transparent how users understand and interpret proposed urban designs.

Learning, evaluation, action and reflection for new technologies, empowerment and rural sustainability (The LEARNERS project)

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Research Monograph: Building Online Participatory Systems: Towards the Community Based Interactive Environmental Decision Support Systems

The importance of broadening community participation in environmental decision-making is widely recognized and lack of participation in this process appears to be a perennial problem. In this context, there have been calls from some academics for the more extensive use of geographic information systems (GIS) and distance learning technologies, accessible via the Internet, as a possible means to inform and empower communities. However, a number of problems exist. For instance, at present the scope for online interaction between policy-makers and citizens is currently limited. Contemporary web-based environmental information systems suffer from this lack of interactivity on the one hand and on the other hand from the apparent complexity for the lay user. This paper explores the issue of online community participation at the local level and attempts to construct a framework for a new (and potentially more effective) model of online participatory decision-making. The key components, system architecture and stages of such a model are introduced. This model, referred to as a ‘Community Based Interactive Environmental Decision Support System’, incorporates advanced information technologies, distance learning and community involvement tools which will be applied and evaluated in the field through a pilot project in Tokyo in the summer of 2002.