Jacob W. Dembosky

Recommendations for improving the maternal and child health care system in the Pittsburgh region. An overview of a family-centered, community-based approach to improving the maternal and child health care system in the Pittsburgh region. Based on a review of best practices in maternal and child health care and an assessment of strengths, weaknesses, and barriers to improvement in the current system, targets for local policy reform are identified and a vision, strategy, and action plan for achieving systemwide improvements in maternal and child health care processes and outcomes are outlined.

This book updates the policy context of the Agency for Healthcare Research and Quality (AHRQ) patient safety initiative; documents the current priorities and activities undertaken; and assesses contributions of funded projects and dissemination actions to support adoption of evidence-based safe practices. It discusses implications for future AHRQ policy, programming, and research; suggests ways to strengthen AHRQ activities. It evaluates progress of the patient safety initiative led by the Agency for Healthcare Research and Quality (AHRQ), focusing on how the current experiences of AHRQ and its funded projects can be used to strengthen subsequent program activities.

Lessons learned from Pittsburgh's bold but troubled Early Childhood Initiative; The Early Childhood Initiative (ECI), an ambitious effort to provide high-quality early care and education services to at-risk children, failed to achieve its goals, although participating children may have derived substantial benefits from it. This report summarizes ECI's organizational history, analyzes and explains its critical weaknesses, and articulates lessons to inform the design and implementation of future large-scale reform initiatives.

Lessons learned from Pittsburgh's bold but troubled Early Childhood Initiative The Early Childhood Initiative (ECI), an ambitious effort launched in Pittsburgh in 1996 to provide high-quality early care and education services to at-risk children, failed to achieve its goals, although participating children may have derived substantial benefits from it. This report summarizes ECI's organizational history, analyzes and explains its critical weaknesses, and articulates lessons to inform the design and implementation of future large-scale reform initiatives. The Early Childhood Initiative (ECI) was an ambitious effort launched in Pittsburgh in 1996 to provide high-quality early care and education services to at-risk children, on a countywide scale and under the direction of local neighborhood agencies. Its goal was to improve the preparation of these children for kindergarten, promote their long-term educational attainment, and give them the early tools to help them become productive, successful members of society. Initially funded by foundations and private donors, ECI planned to become financially sustainable over the long term by persuading the state of Pennsylvania to commit to funding the program at the end of a startup period. Four years after its launch, ECI was far short of its enrollment targets, the cost per child was significantly higher than expected, and the effort to secure a commitment of state funding had failed. ECI was therefore converted to a small-scale demonstration program, leaving a residue of disappointment in many communities around the county. Although findings from a parallel study suggest that participating children may have derived substantial benefits from ECI, it failed to achieve its goals in terms of scale and sustainability. In the aftermath of ECI's scale-down, RAND was commissioned by the Heinz Endowments (ECI's largest funder) to study why ECI fell short of its objectives and to learn from its mistakes. The findings of the study are presented in this report, which summarizes ECI's organizational history, analyzes and explains critical weaknesses that hindered ECI's ability to succeed, and articulates lessons to inform the design and implementation of future large-scale reform initiatives, whether in early care and education or in other areas of social services. (JDL)