Provider documentation of patient education: a lean investigation

Purpose

The study evaluates how providers give patient education materials and identifies improvements to comply with Meaningful Use (MU) requirements.

Methods

Thirty-eight patient-provider interactions in two health care outpatient clinics were observed.

Results

Providers do not uniformly know MU patient education requirements. Providers have individual preferences and find gaps in what is available. Accessing and documenting patient education varies among providers. Embedded electronic health record (EHR) materials, while available, have technical access barriers.

Conclusions

Providers'' EHR skills and knowledge levels contribute to non-standardized patient education delivery.     

Maltreatment of children in The Netherlands: an update after ten years

Governmental consultation and advice on child abuse and neglect in the Netherlands started in 1972 as a two-year experiment with four offices for "confidential doctors" in four major cities of the country. After these two experimental years, a governmental institute for prevention of child abuse and neglect was organized. Over the ensuing decade the number of offices increased to ten, covering the whole country. The State Department of Welfare, Public Health, and Environment collected data from the confidential doctors and their coworkers every year. This study compares the data of the first year 1974 with those of 1983 in order to detect changing patterns over a 10-year period. The major changes are as follows: a threefold increase in cases, an extraordinary increase in cases of emotional maltreatment, an increase in detection of child fatalities but decrease in severity of physical abuse. Sexual abuse was hardly recognized in 1974 but gradually was recognized more frequently during the study decade and accounted for an alarming 7.2% of detected cases of maltreatment in 1983. No change was found in the social conditions of the family and the identity of the perpetrators--primarily fathers and/or mothers. A decrease was noted in the percentage of married parents. The increased percentage of single parents was primarily represented by mothers alone. An increase in the numbers of victims residing at home and a decrease in the need for children's homes as a temporary or permanent residence is attributed to aftercare. The discrepancy between the results of this voluntary notification system in the Netherlands and the results of a mandatory reporting system as used in the U.S.A. is still very high. The hope is that the government will decide to make reporting of maltreatment mandatory for everyone.     

Effects of writing instruction and assessment on functional composition performance

In this study the relationships between writing instruction and functional composition performance were analyzed. The data were obtained in a national assessment on the language proficiency of students in the third year of Dutch secondary education (age ±15). Multivariate multilevel analysis showed that 10 out of 36 instructional characteristics were related to functional composition performance. The effective instructional characteristics included: instruction and exercises in writing functional texts, writing for a specific purpose, tailoring to a particular audience, global rating of writing products by the teacher, and frequent evaluation of Dutch language proficiency through teacher-made tests and written assignments. No effects were found for the rather popular subskill exercises on idiom, syntax, spelling and punctuation, and for pre-writing activities, text revisions and peer-review. Furthermore, the effect of instructional characteristics was often different on one task than on another. Finally, there was little differential effectiveness for different groups of students. If one instructional characteristic was more effective than the other, this was generally true, to an equal degree, for boys and girls and for promoted and non-promoted students.     

Towards Inclusive Schooling

Mel Ainscow, Professor of Special Education at the University of Manchester, is the third of the new professors to articulate his views on the future of special education as the millennium approaches.
He speculates on some of the reasons for the apparent lack of overall progress towards a more inclusive school system in order to identify some possible ways forward.