Health outcomes, quality improvement and cost-effectiveness of the Community Diabetes Education (CoDE) program: Results of a randomized controlled trial

The objectives of this dissertation were to evaluate health outcomes, quality improvement measures, and the long-term cost-effectiveness and impact on diabetes-related microvascular and macrovascular complications of a community health worker-led culturally tailored diabetes education and management intervention provided to uninsured Mexican Americans in an urban faith-based clinic. A prospective, randomized controlled repeated measures design was employed to compare the intervention effects between: (1) an intervention group (n=90) that participated in the Community Diabetes Education (CoDE) program along with usual medical care; and (2) a wait-listed comparison group (n=90) that received only usual medical care. Changes in hemoglobin A1c (HbA1c) and secondary outcomes (lipid status, blood pressure and body mass index) were assessed using linear mixed-models and an intention-to-treat approach. The CoDE group experienced greater reduction in HbA1c (-1.6%, p<.001) than the control group (-.9%, p<.001) over the 12 month study period. After adjusting for group-by-time interaction, antidiabetic medication use at baseline, changes made to the antidiabetic regime over the study period, duration of diabetes and baseline HbA1c, a statistically significant intervention effect on HbA1c (-.7%, p=.02) was observed for CoDE participants. Process and outcome quality measures were evaluated using multiple mixed-effects logistic regression models. Assessment of quality indicators revealed that the CoDE intervention group was significantly more likely to have received a dilated retinal examination than the control group, and 53% achieved a HbA1c below 7% compared with 38% of control group subjects. Long-term cost-effectiveness and impact on diabetes-related health outcomes were estimated through simulation modeling using the rigorously validated Archimedes Model. Over a 20 year time horizon, CoDE participants were forecasted to have less proliferative diabetic retinopathy, fewer foot ulcers, and reduced numbers of foot amputations than control group subjects who received usual medical care. An incremental cost-effectiveness ratio of $355 per quality-adjusted life-year gained was estimated for CoDE intervention participants over the same time period. The results from the three areas of program evaluation: impact on short-term health outcomes, quantification of improvement in quality of diabetes care, and projection of long-term cost-effectiveness and impact on diabetes-related health outcomes provide evidence that a community health worker can be a valuable resource to reduce diabetes disparities for uninsured Mexican Americans. This evidence supports formal integration of community health workers as members of the diabetes care team.^

Effectiveness of global analysis in strict independence-based automatic program parallelization

This paper presents a study of the effectiveness of global analysis in the parallelization of logic programs using strict independence. A number of well-known approximation domains are selected and tlieir usefulness for the application in hand is explained. Also, methods for using the information provided by such domains to improve parallelization are proposed. Local and global analyses are built using these domains and such analyses are embedded in a complete parallelizing compiler. Then, the performance of the domains (and the system in general) is assessed for this application through a number of experiments. We argüe that the results offer significant insight into the characteristics of these domains, the demands of the application, and the tradeoffs involved.

Sources of selection bias in evaluating social programs: An interpretation of conventional measures and evidence on the effectiveness of matching as a program evaluation method

This paper decomposes the conventional measure of selection bias in observational studies into three components. The first two components are due to differences in the distributions of characteristics between participant and nonparticipant (comparison) group members: the first arises from differences in the supports, and the second from differences in densities over the region of common support. The third component arises from selection bias precisely defined. Using data from a recent social experiment, we find that the component due to selection bias, precisely defined, is smaller than the first two components. However, selection bias still represents a substantial fraction of the experimental impact estimate. The empirical performance of matching methods of program evaluation is also examined. We find that matching based on the propensity score eliminates some but not all of the measured selection bias, with the remaining bias still a substantial fraction of the estimated impact. We find that the support of the distribution of propensity scores for the comparison group is typically only a small portion of the support for the participant group. For values outside the common support, it is impossible to reliably estimate the effect of program participation using matching methods. If the impact of participation depends on the propensity score, as we find in our data, the failure of the common support condition severely limits matching compared with random assignment as an evaluation estimator.

An Investigation of the Features and Effectiveness of the Full-Day Early Learning Kindergarten Program in Ontario

This dissertation includes two studies. Study 1 is a qualitative case study that describes enactment of the main components of a high fidelity Full-Day Early Learning Kindergarten (FDELK) classroom, specifically play-based learning and teacher-ECE collaboration. Study 2 is a quantitative analysis that investigates how effectively the FDELK program promotes school readiness skills, namely self-regulation, literacy, and numeracy, in Kindergarteners. To describe the main components of an FDELK classroom in Study 1, a sub-sample of four high fidelity case study schools were selected from a larger case study sample. Interview data from these schools’ administrators, educators, parents, and community stakeholders were used to describe how the main components of the FDELK program enabled educators to meet the individual needs of students and promote students’ SR development. In Study 2, hierarchical regression analyses of 32,207 students’ self-regulation, literacy, and numeracy outcomes using 2012 Ontario Early Development Instrument (EDI) data revealed essentially no benefit for students participating in the FDELK program when compared to peers in Half-Day or Alternate-Day Kindergarten programs. Being older and female predicted more positive SR and literacy outcomes. Age and gender accounted for limited variance in numeracy outcomes. Results from both studies suggest that the Ontario Ministry of Education should take steps to improve the quality of the FDELK program by incorporating evidence-based guidelines and goals for play, reducing Kindergarten class sizes to more effectively scaffold learning, and revising curriculum expectations to include a greater focus on SR, literacy, and numeracy skills.

Lake Erie nutrient control program : an assessment of its effectiveness in controlling lake eutrophication /

Mode of access: Internet.

Roadside barrier effectiveness - noise abatement program. Final report.

National Highway Traffic Safety Administration, Office of Research and Development, Washington, D.C.

Influencing human interaction in public schools : studies of IPR effectiveness as an inservice teacher training program /

Research performed under contract with the National Institute of Mental Health.

Agricultural Stabilization and Conservation Service payment-in-kind (PIK) program : a review of PIK program compliance and effectiveness.

"Audit report no. 3621-4-KC."

Life-cycle costing manual for the Federal Energy Management Program : a guide for evaluating the cost effectiveness of energy conservation and renewable energy projects for new and existing federally owned and leased buildings and facilities /

"Issued originally December 1980 ; revised May 1982 ; revised November 1987."

Report on the effectiveness of financing and selected eligibility, job search, and benefit payment operations of the unemployment insurance program : State of Montana, Department of Labor and Industry, Employment Security Division.

Mode of access: Internet.

An experimental project appraising the effectiveness of a program series on reading instruction using open-circuit television.

Mode of access: Internet.

A study of factors relating to favorable attitudes toward the salary plan and the effectiveness of the performance appraisal program; the second phase of an exploratory investigation of the feasibility of including the measurement of "motivation" in the study of human behavior in the work situation.

"A technical account of this study appears as part 2 of a report entitled 'Motive patterns of managers and specialists!'"

Evaluation of the cost effectiveness of the 1983 stream-gaging program in Kansas /

Bibliography: p. 56-57.

Cost-effectiveness of the U.S. Geological Survey stream-gaging program in central Florida /

Bibliography: p. 86-89.

Cost effectiveness of the U.S. Geological Survey's stream-gaging program in Illinois /

Tables.