Browsing by Subject "dissemination"
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Item Open Access Dissemination of Evidence-Based Recommendations for Sickle Cell Disease to Primary Care and Emergency Department Providers in North Carolina: A Cost Benefit Analysis.(Journal of health economics and outcomes research, 2021-04) Tanabe, Paula; Blewer, Audrey L; Bonnabeau, Emily; Bosworth, Hayden B; Clayton, Denise H; Crego, Nancy; Earls, Marian F; Eason, Kern; Forlines, Grayson; Rains, Gary; Young, Matthew; Shah, NirmishBackground: Sickle cell disease (SCD) is a genetic condition affecting primarily individuals of African descent, who happen to be disproportionately impacted by poverty and who lack access to health care. Individuals with SCD are at high likelihood of high acute care utilization and chronic pain episodes. The multiple complications seen in SCD contribute to significant morbidity and premature mortality, as well as substantial costs to the healthcare system. Objectives: SCD is a complex chronic disease resulting in the need for primary, specialty and emergency care. Many providers do not feel prepared to care for individuals with SCD, despite the existence of evidence-based guidelines. We report the development of a SCD toolbox and the dissemination process to primary care and emergency department (ED) providers in North Carolina (NC). We report the effect of this dissemination on health-care utilization, cost of care, and overall cost-benefit. Methods: The SCD toolbox was adapted from the National Heart, Lung, and Blood Institute recommendations. Toolbox training was provided to quality improvement specialists who then disseminated the toolbox to primary care providers (PCPs) affiliated with the only NC managed care coordination system and ED providers. Tools were made available in paper, online, and in app formats to participating managed care network practices (n=1 800). Medicaid claims data were analyzed for total costs and benefits of the toolbox dissemination for a 24-month pre- and 18-month post-intervention period. Results: There was no statistically significant shift in the number of outpatient specialty visits, ED visits or hospitalizations. There was a small decrease in the number of PCP visits in the post-implementation period. The dissemination resulted in a net cost-savings of $361 414 ($14.03 per-enrollee per-month on average). However, the estimated financial benefit associated with the dissemination of the SCD toolbox was not statistically significant. Conclusions: Although we did not find the expected shift to increased PCP visits and decreased ED visits and hospitalizations, there were many lessons learned.Item Open Access Promoting community practitioners' use of evidence-based approaches to increase breast cancer screening.(Public Health Nurs, 2013-07) Leeman, Jennifer; Moore, Alexis; Teal, Randall; Barrett, Nadine; Leighton, Ashely; Steckler, AllanMany women do not get mammography screenings at the intervals recommended for early detection and treatment of breast cancer. The Guide to Community Preventive Services (Community Guide) recommends a range of evidence-based strategies to improve mammography rates. However, nurses and others working in community-based settings make only limited use of these strategies. We report on a dissemination intervention that partnered the University of North Carolina with the Susan G. Komen Triangle Affiliate to disseminate Community Guide breast cancer screening strategies to community organizations. The intervention was guided by social marketing and diffusion of innovation theory and was designed to provide evidence and support via Komen's existing relationships with grantee organizations. The present study reports the findings from a formative evaluation of the intervention, which included a content analysis of 46 grant applications pre- and post intervention and focus groups with 20 grant recipients.Item Open Access Unifying Databases and Internet-Scale Publish/Subscribe(2008-08-01) Chandramouli, BadrishWith the advent of Web 2.0 and the Digital Age, we are witnessing an unprecedented increase in the amount of information collected, and in the number of users interested in different types of information. This growth means that traditional techniques, where users poll data sources for information of interest, are no longer sufficient. Polling too frequently does not scale, while polling less often may result in users missing important updates. The alternative push technology has long been the goal of publish/subscribe systems, which proactively push updates (events) to users with matching interests (expressed as subscriptions). The push model is better suited for ensuring scalability and timely delivery of updates, important in many application domains: personal (e.g., RSS feeds, online auctions), financial (e.g., portfolio monitoring), security (e.g., reporting network anomalies), etc.
Early publish/subscribe systems were based on predefined subjects (channels), and were too coarse-grained to meet the specific interests of different subscribers. The second generation of content-based publish/subscribe systems offer greater flexibility by supporting subscriptions defined as predicates over message contents. However, subscriptions are still stateless filters over individual messages, so they cannot express queries across different messages or over the event history. The few systems that support more powerful database-style subscriptions do not address the problem of efficiently delivering updates to a large number of subscribers over a wide-area network. Thus, there is a need to develop next-generation publish/subscribe systems that unify the support for richer database-style subscription queries and flexible wide-area notification. This support needs to be complemented with robust processing and dissemination techniques that scale to high event rates and large databases, as well as to a large number of subscribers over the Internet.
The main contribution of our work is a collection of techniques to support efficient and scalable event processing and notification dissemination for an Internet-scale publish/subscribe system with a rich subscription model. We investigate the interface between event processing by a database server and notification delivery by a dissemination network. Previous research in publish/subscribe has largely been compartmentalized; database-centric and network-centric approaches each have their own limitations, and simply putting them together does not lead to an efficient solution. A closer examination of database/network interfaces yields a spectrum of new and interesting possibilities. In particular, we propose message and subscription reformulation as general techniques to support stateful subscriptions over existing content-driven networks, by converting them into equivalent but stateless forms. We show how reformulation can successfully be applied to various stateful subscriptions including range-aggregation, select-joins, and subscriptions with value-based notification conditions. These techniques often provide orders-of-magnitude improvement over simpler techniques adopted by current systems, and are shown to scale to millions of subscriptions. Further, the use of a standard off-the-shelf content-driven dissemination interface allows these techniques to be easily deployed, managed, and maintained in a large-scale system.
Based on our findings, we have built a high-performance publish/subscribe system named ProSem (to signify the inseparability of database processing and network dissemination). ProSem uses our novel techniques for group-processing many types of complex and expressive subscriptions, with a per-event optimization framework that chooses the best processing and dissemination strategy at runtime based on online statistics and system objectives.