Paul M. Wortman

Medical Information Systems: Assessing Impact in the Areas of Hypertension, Obesity and Renal Disease

This study describes the influence of a computerized medical record summary system in three disease areas (hypertension, obesity and renal disease) observed in the course of a controlled, randomized and prospective study of 479 Northwestern University Clinic patients. Experimental patients, who had available automated record summaries, and control patients, who had available only the manual record, were compared on several medical tests and procedures whose yearly occurrence was considered good medical practice for this patient population, and were compared as well on several measures of outcome of medical care. Evidence suggesting better care and outcome of care among patients with computerized record summaries available is presented.

Reanalyzing Program Evaluations

Secondary analysis is not a new research technique. Research reports have been reexamined for as long as they have been written. Likewise, data collected for one purpose have long been put to other uses. Though the concept of secondary analysis may be simple, evaluators have seldom addressed issues regarding the purpose of secondary analysis, its uses, and its problems. Further, the advantages of secondary analysis are bought at a price that has not been considered fully. Few

8: Implications of Educational Evaluation for Evaluation Policy

The aim of this paper is to review certain policy implications of evaluative research. Our special interest lies in evaluation policy, rather than in the broad category of educational policy, which may be educed from research results. Of the several reasons for the choice of topic, not the least is a simple, perhaps morbid curiosity about what can be said about evaluation policy, taking account of recent large-scale efforts to estimate the effects of educational programs. A second reason is rather more pragmatic. Policy does affect the quality of evaluative research (at least at times), and the United States lacks a coherent evaluation policy in education as it lacks such policy in health services and other areas. We do not pretend that this paper provides coherent policy. However, we do believe the matters covered here are a legitimate part of any durable evaluation policy. Part I of the paper deals with the recent history of evaluation including the instability of national interest in evidence, unfounded discouragement, and catholicity. Part 2 focuses on design of evaluations, especially its influence on the quality of information that is generated about an educational program. The implementation of new pilot programs and the independent execution of evaluation design are discussed in Part 3; policy implications of collective experience in analyzing results are discussed in Part 4. Part 5 deals with the availability of

The Educational Voucher Demonstration: A Secondary Analysis:

Implicit in the notion of a planned innovation is the concept of a treatment or service program. In fact, most social reforms, particularly those in education, involve a specific program or set of programs such as preschool, career, or vocational training. This service strategy formed the basis of the Johnson administration’s attempts to redress the balance of economic resources and achieve equality between the advantaged and disadvantaged members of society (e.g., Head Start and Follow Through). As these and other Great Society programs of the late 1960s came under increasing attack, policy-makers (Friedman, 1962; Moynihan, 1973) offered an alternative class of social action policies based on an “income

Evaluating health care technology: an example from electrocardiography.

This paper discusses the evaluation of innovations in health care technology using an illustrative example drawn from computerized electrocardiography. It focuses on the increasing role of such soft technologies that involve computer- assisted diagnostic problem-solving. The purpose is not only to present one evaluative methodology, but also to detect any unanticipated side effects. Since knowledge of the patients true state is usually not possible in these situations, an alternative evaluative approach has been used to assess the automated system. It is argued that if computer-physician agreement is as high or higher than that between different physicians or the same physician over time, then the computer is interpreting electrocardiograms on an equal par with physicians even though at times both could be wrong. By this criterion, computer interpretation was judged as inadequate for one of five diagnostic classifications. In addition, it was found that the computer systematically biased the judgment of those physicians previously unfamiliar with computerized electrocardiography.