risk behavior of active duty Navy women aged 18 to 44 years assigned to a ship based command or a shore based command. Cox's Interactive Model of Client Health Behavior provides the organizing framework for this study. Cognitive, affective, motivation and background variables (demographic, social, environmental, and previous health care experience) will be evaluated in relation to the health outcome of condom use. A cluster sample of at least 300 women will be selected from the ship and shore based commands at a southeastern naval base. Data will be collected using the Coopersmith Self-Esteem Inventory (25 items), the Problem Solving Inventory (32 items), the modified Health Self-Determination Index (17 items), and modified sexual history form. The data will be analyzed using descriptive and multivariate statistics. Before prevention programs can be considered, it is essential to understand why women practice behaviors that place them at risk for HIV/STDs or unintended pregnancy. The findings from this study will provide knowledge of the factors which influence safer sex among active duty Navy women.

Anderson FD. (Army Active; Eisenhower Army Medical Center, Fort Gordon, GA). 1994. Efficacy of Case Management in a Military Medical Center. $97,564.

The dramatic rise in health care has provided impetus for thoughtful evaluation of how medical care is organized within the Military Health Care System. In response to a mandate to maximize access to and quality of care, to minimize the cost of care, and to utilize resources more appropriately, the Department of Defense implemented a managed care program in January of 1992. Managed care is a comprehensive approach to the delivery of health care designed to efficiently direct quality health care within a cost-contained environment. The overall goal is to achieve optimal patient outcomes, within fiscally responsible time frames, and with an appropriate utilization of resources. Case management is a patient-focused strategy often used in managed care systems. As an approach to health care delivery, it makes one identified individual responsible for the coordination of a patient's care across the continuum of care. A critical path is a paper and pencil tool, often used in conjunction with case management, that identifies expected patient/family and staff behaviors that must occur in order for a desired health care goal to be reached. The plan is plotted against a time line for a specific diagnosis or case type. Implementation of case management, in combination with critical paths, has been reported to result in increased quality of care as measured by patient satisfaction, decreased inpatient length of stay, decreased readmission rates in high-risk patients, and decreased cost of care through more appropriate utilization of resources. Case management has been associated with increased job satisfaction in nurses, and increased communication and collaboration between health care providers. Most of what has been reported has been anecdotal in nature. Indeed, efficacy of case management in a military health care setting has not been scientifically studied as of this date. The purpose of this study is to examine the effects of nursing case management and implementation of critical paths on select variables at Dwight David Eisenhower Army Medical Center. This is an intervention study, with a pre- and post-evaluation design. The patient study sample will consist of a convenience sample of the patients in need of case



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