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Getweenlrarch and Medical Practice 1, DOCUMENT RESUME BD 172 920' PS 010 671 6 . AUTHOR' Bosch, Samuel J., Ed.; Arias, J < .Fd. 'rtrLE ,.Evaluation Child, tHx?Alth Satvices; The Interface getweenlrarch and Medical Practice. Fogarty'I er4ational Center (DHEW/PHS),' Bethesda, SPONS AGENCY Natloval Institutes of Health (DREW), Bethesda, Md.' - REPORT NC UHEW- NI/1 -78 -1066 PUB DATE 713 NOTE 247p.; 'ftoc.iedltngS ()Era- conference '3* the John E. Fogarty Internonal cent..-!r(Bethesda, Maryland, March 7-9, 1977r .Som puts may- not reproduce 4 AVAILABLE FROM Superintend:,nt Of Documents, U.S. Government Printing Office, ,Washington,. D.C..20402 (Stock Number 017-046-00043-A, $4.75) . ENRS PRICE MR01/PC12 Plus Postage. DESCRIPPOR_"; ...Case Studies; *Chifld'Car; Children; Commilnity Eddcation; Community Health; *Evaluation Methods;. *Family Health; *Health Programs; Health Services; *Mdical*.Care EvaluaTion; Program.Effectiveness; rogram EVialuation; Research 1:411ENTIFIERS. *Latin. America; *United States ABSTRACT This. monograph derives from a confer;?nce sponsored by the Fogarty International Center for 'Advanced Study in the. Health Sciences. Ths 'goals(:), the conference were (1) to,:zstablish channels cf'communica'tion between health care evalsaators.rfroNm different disciplines and :from different.countries in the Americas, and (2) to promote an eXchange of information and experien6P in evaluation techniques: comparing approaches, methods, .Deeded ,,,sources,- diffiou,lties, achievements, and failures. Of prima jconcern was the need-for .a current evaluation of maternal a Ichild health services delivery systems andthe implications of tthis ev illation for health professional education in the Americas. lhe mono raph consists of Jive' position papers onchild health care,10 p.prs on case studies volving differen methods Of evaluatioa and different types of childhealthoare.programs, followed by discussions, and two papers on.uses of evaluation in education. The contributors, representing a variety of perspectives and backgrounds, include experts in evaluation, healtk.care,,social science research, education, policymaking, and economics.. (AUNor/SS) 4**********************************************************************, * Reproduct4ons supplied 'dy EDRS are the best that canb made * * from the original locum nt. : . *. *****************4;**************************4r*************************./ ( EVALUATION OF CHILD HEALTH SERVICES: cr (N1 N- The Interface BetweenResearch and Medical Practice U S DEPARTMENT OF HEALTH, EDUCATION lyIELF ARE NATIONAL INSTITUTE OF 11113UCT ION THIS DOZUMENT HAS BEEN REPRO- Samuel J. Bosch and Jaime Arias DUCED EXACTLY AS RECEIVED .F ROM TH.E PERSON OR ORGANIZATION ORIGYN- Scientific Editors 446 ATING IT POINTS OF VIEW.OR OPINIONS STATED DO NOT NECESSARILY REPRE- SENT OFF ICIAL NATIONAL INSTITUTE OF EDUCATION POSITION OR POLICY Proceedings of a Conference Sponsored by American College of Preventive Medicine Pan American CoMmunity Health Association Bureau of Community Health'Seqices, Health Services Administration, Office of Ctiltd-Development, Office of Human Development,DHEW National InStitute of Child Health and- HumanDevelopment, NIH The John E. Fogarty International Center, NIH March 7-9, 1977 National Institutes of Health Bethesda, Maryland U.S. DEPIRTMENT. OF HEALTH,EDL1CATION, A WELFARE : Publl,c Health service National Institutes ofealth DHEWPUBLICATIONNo. (NIH) 78-1066 C I- t , 9" Information i6nt'ated in this publication in no way reflects the fopitOons of the Fogarty. International Center, the Nationali Institutes of Health, tilt De- partment of Health, Education, and Welfare, or any other agency of the federal government. ,1 4 Forsale by the Superintendent of Documents, U.S Government Printing Office Washington, D.C. 20402 (Paper Cover) ' 'Stock Number 017-046-00043-8 , 3 FOREWORD . .The.John E. Fogarty International Centerfor Advanced, Study in the Health Stiencel ,is.a federaHyestablished focal poirit for sharing America's: health research withmore than 48 other nations of the world, The Center 'also functionsas a forum for drawi".4ogether tfe',t-eats,and resources of othercountries,andengaging them in. way ..arbear on the mahy ancrv.aried healthproblems of the.U.nited Since States.... Since, 1968 when itwas designat d a memoriatt.o Congressman John E.' Fogarty of. Rhode Island,thCenter hVs pursued Mr. Fogarty';visionof Interhational scientific cooperationin the interests of mankind.' The Fogarty Center's programs,developed by medi al,chealth,;a nd administrative professionals,promote advanced study iii biomedical and re1 l:ited sciences with *viewtoward improving health and physical weitheing through practicalmeans. Under the aegis of the Confer- et and Seminar Prograni of theCenter, scientists are brought to .ey` for' study Iind .discussion oftonicssuch as liverdisease, 'cliflifites- mellitus, andchronic childhood illness. The'Geographic Health StudiesPimp-amsponsors analyses of.the health care system and medical research of Othercountries to detefmine hoW their experiences ,might serveas models la health cape in the United ,1 tares. Moreover, scientists Whohave been singled out for their I'-'.11 eclat :concerns by theirown countries can apPly for fellowship aw ids through the Scholars and FellowshipsProgram. These awards.. ble" thin to work closely withU.S. scientists at NIHor at academic institutions throughout thecountry. In like manner,' American 'researchers are sponsored for study abroad. During the year of its formation andgrowth, the Fogarty Inter-. uitional Center has been dedicatedto the use of science __for peacefial. purpoSes,' for thegood Okall.humanbeings. To, this end, the pres8nt monographhasbeen prepared, in cooperation withthe American College of Preventive Medicintm thePan .American Community 'Health Association; theBureau of Community Health. Services,. Health Services Administration; theOffice of Child De.elopmefrt and the Office of Human Development,DpIEW; and the Natio Institute-of Child Health and Human Development., This monograph derives from.a conference sporAred by t Fogarty Center.'w ich brought together 65 experts in evaluation, Organizers of healtcore systems, cllireceotsof child health programs, k.. IV university-affiliated eddcatprs, social ,cielitists, economists, policymak- ers, and consumer advocates the United States.and Latin Amefica. Of primaryprim'y concern waswas the need for a current &valuation of ..thaterivil and child health services. delivery systems and the 9 implications of thiS evaluation for health professional education in -the Americas. It is hoped that the discussions in this yolume will form 'a comprehensive report about a variety oL issues relati4 to thehealth of the world's children. ! Mu.o D. LEAVflT, JR., M. D. Director Fogarty International Center a V .t4 . 4 4 c V ,i,CONTENTS Page IN)ROD ORY RMARKS Milo D. Leavitt, Jr. .Samuel J. AP(ch'". r POSiTION PAPERS 4.0 -...._ _I 1 Child Hotith in theAmericas: A tfistorical and,- Glo .Perspective '. ...--- foe D.'Wrai,. 3% 2Child :Health in Latin America ancj the Caribbean4 Jorge V. RosSelot 23 3Questions Behind to Answeri: Why.We Do NotZvalu- ate and WhyWe Slibuld . k Abraham Horwitz 37 4Pragmatic Aspects of Program .Evaluation- Regarding Child Care and 'its Relation to Decisionmakingat the PolitiCal-Administrative Levtl Antonio Ordoriez-Plaja 47 .5 Evalitatton of Child Health Care'As Seen by Evaluators Jaime Arias , . 57 1 - CASE STIJDqS C 40 ..6. Nine Evaluation Case Studies: An Approachto Their Classification c . :Samtiel f: Bosch, and Jaime Arias 69 e 7 Sociotnedical Indicators` foti Child Health Carlas J. M. Martini andgan McDowell 73 Discussion . Milton I. Roemer and Gabriel Olasquez 87 8Applicatipn-de the Tracer Method to Child Health Care l' ,D'avid X.Kessner 89 iscussion-:--... -, . aurice,Backett and !Barbara Starfield 115 9 An Approach to the Evaluation of Child HealthCare Through a Simulations Model Rodofo A. Heredia, Alejandro Vivcis, Luis Hernando Ochaa 117 F vi -0 Page 10Eval uation of Child Health Care in PRIMOPS: A Comprehensire Health Program in Gall, Colombia Gildarzlo Agudelo Gil (editorial summary) 145 11 Goal Conflicts' in d Child Health Station: A Problem in Action Research Jane Z. Moss, Renate Belville, Bernard Levenson 153 Discussion Maurice Backett and Barbara Starfield 166 12 Nutrition Indicators and the Barbados Preschool Child: Nutrition Intervention Program, 1967-76 Frank C. Ramsey 169 Discussion . Milton I. Roemer and Gabriel Velasquei 193 13 Response of Indicators of Nutritional Status to Nutri- 'tional Interventions in Populations and Individuals Charles Yarbrough, Jean-Pierre Habicht, R. E. Klein, R. Martorell, A. Lechtig, G. Guzman 195 Discussion Maurice Backett and Barbara ,Starfield 207 V 14Child Health and the Community: The Rochester Child Health Studits, 1967-77 I. B. Pless 209 Discussion DaviVersh and Carlos V. Seirano 227 15' Health Accounting: An Outcome-Based Strategy of Health Care Quality Assurance John W. Williamson 229 Ls_ Discussion 1. Milt9n I. Roemer and Gabriel Velasvez 244 USE OF EVALUATION EDUCATION , 16Mirror or WiritiOw: The Interface of Health Services Evaluation and Provider Education John L. Simon 249'k 17 Evaluation as a Tool for Community Educatidn Rolando Merino, Samuel J. Bosch, Auth Zambrana 257 Discussion: Education and Evaluation David J. Jones 266 r vii Page CLOSING REMARKS f. Robert J. Haggerty 271 Antonio Ordoriez-Plaja 281 PARTICIPANTS' 283 INDEX 287 '7 I INTRODUCTORYREMARKS 9 WELCOMING REMARKS . Milo D. Leavitt,Jr. In September 1975, an agreementwas
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