Jeff M. Smith

Cost-effectiveness of a Primary Care Depression Intervention

AbstractOBJECTIVE: To determine the incremental cost-effectiveness of a quality improvement depression intervention (enhanced care) in primary care settings relative to usual care. DESIGN: Following stratification, we randomized 12 primary care practices to enhanced or usual care conditions and followed patients for 12 months. SETTING: Primary care practices located in 10 states across the United States. PATIENTS/PARTICIPANTS: Two hundred eleven patients beginning a new treatment episode for major depression. INTERVENTIONS: Training the primary care team to assess, educate, and monitor depressed patients during the acute and continuation stages of their depression treatment episode over 1 year. MEASUREMENTS AND MAIN RESULTS: Cost-effectiveness was measured by calculating incremental (enhanced minus usual care) costs and quality-adjusted life years (QALYs) derived from SF-36 data. The mean incremental cost-effectiveness ratio in the main analysis was

Models, Strategies, and Tools

15,463 per QALY. The mean incremental cost-effectiveness ratios for the sensitivity analyses ranged from

Digital Imaging: Enhancement and Authentication

11,341 (using geographic block variables to control for pre-intervention service utilization) to

Audio Enhancement and Authentication

19,976 (increasing the cost estimates by 50%) per QALY. CONCLUSIONS: This quality improvement depression intervention was cost-effective relative to usual care compared to cost-effectiveness ratios for common primary care interventions and commonly cited cost-effectiveness ratio thresholds for intervention implementation.

Models, strategies, and tools. Theory in implementing evidence-based findings into health care practice.

This paper presents a case for careful consideration of theory in planning to implement evidence-based practices into clinical care. As described, theory should be tightly linked to strategic planning through careful choice or creation of an implementation framework. Strategies should be linked to specific interventions and/or intervention components to be implemented, and the choice of tools should match the interventions and overall strategy, linking back to the original theory and framework. The thesis advanced is that in most studies where there is an attempt to implement planned change in clinical processes, theory is used loosely. An example of linking theory to intervention design is presented from a Mental Health Quality Enhancement Research Initiative effort to increase appropriate use of antipsychotic medication among patients with schizophrenia in the Veterans Health Administration.

Advances in ENF Database Configuration for Forensic Authentication of Digital Media

This article presents the current techniques and latest developments in digital image enhancement and authentication, from both judicial and scientific points of view. Every digital image consists of a finite number of pixels arranged by a series of mathematical algorithms. It is necessary to apply signal processing techniques and computational methods to investigate, enhance, and authenticate this kind of evidence.

Analytical Framework for Digital Audio Authentication

This article presents the current techniques and latest developments in the enhancement and authentication of forensic audio. While recorded audio may exist in either analog or digital form, care must be taken in the handling of evidence and a clear understanding of audio recording technology, acoustics, and signal processing must be possessed. In addition to providing a general methodology for audio enhancement, this article presents an introduction and resources for further reading regarding audio authentication.