Effectiveness of public health quality improvement training approaches: application, application, application.

CONTEXT: Quality improvement (QI) has been identified as a key strategy to improve the performance of state and local public health agencies. Quality improvement training effectiveness has received little attention in the literature. OBJECTIVES: To evaluate the effectiveness of 3 QI training types: webinars, workshops, and demonstration site activities on improving participant knowledge, skill, and ability to conduct QI through a questionnaire conducted after training participation. DESIGN: We used a natural experimental design hypothesizing that demonstration site participants would have the greatest gains on outcomes of interest compared with webinar and workshop participants. Bivariate and multivariate models were used to examine outcome differences between questionnaire respondents who participated in various training types. PARTICIPANTS: Local health department employees who participated in the 3 training strategies. MAIN OUTCOME MEASURES: Measures included knowledge and skill gain, skill application, QI receptivity, and ability to successfully participate in a QI project. RESULTS: Two hundred eighty-four unique individuals who work in 143 health departments completed the questionnaire for a 59% response rate. The majority of these health departments serve midsize populations. Demonstration site respondents had significantly greater gains in knowledge and skills, skill application, and ability to successfully participate in a QI project. Webcast training participants had significantly higher QI receptivity in adjusted models. Respondents who participated in both webcast and demonstration site trainings had higher mean scores on all outcomes when compared with demonstration site single training participants, these differences were significant in unadjusted models. CONCLUSION: Our findings suggest that QI training for public health agency employees should include both didactic training on QI content and opportunities for QI application. Future research should examine if this approach can effectively increase successful participation in QI projects for staff in LHDs of all sizes.

Risk factors for injury among high school football players.

BACKGROUND: Football is the most popular interscholastic high school sport in the United States. Prior research has described a higher rate of injury among high school football players than in other sports, but few studies have examined potential predictors while controlling for other risk factors. METHODS: Using a 2-stage cluster sampling technique, we conducted a prospective cohort study from 1996 to 1999 among varsity athletes from 12 sports in 100 North Carolina high schools. A total of 3323 football players participated. Injury exposure and risk factor data were collected by trained school personnel. Incidence rates, rate ratios, and odds ratios (ORs) were estimated using Poisson and logistic regression. RESULTS: There were 1064 injured athletes and 1238 injuries; 106 injuries resulted in greater than 3 weeks lost from participation. The overall incidence rate was 3.54 per 1000 athlete-exposures (95% confidence interval [CI] = 3.31-3.78). The rate of game injury was 9 times that of practice injury (OR = 9.2; 95% CI = 6.6-11). Athletes with a prior injury had twice the injury rate of those without (1.9; 1.5-2.4). Among those injured, having a coach with more experience, qualifications, and training was associated with half the odds of severe injury (0.49; 0.27-0.92). CONCLUSIONS: Prior injury, additional years of playing experience, and older age were predictors of injury incidence after controlling for multiple risk factors. A high level of coaching skills did not reduce the injury rate, but was protective against severe injury.