PROMs use in primary care has expanded from simply describing patient populations to contributing to decision-making, in response to the increasingly complex, ever-changing healthcare environment. In Alberta, primary care is organized into primary care networks (PCNs), where family physicians are grouped geographically and supported by allied health professionals. PCNs implement programs and services in response to local population health needs with frequent evaluation, often incorporating PROMs for this purpose. As PCN programs and services vary greatly across Alberta, so do their use of PROMs. An area of commonality is the use of the EQ-5D-5L instrument; 29 out of 41 PCNs are registered and licensed to use the instrument. It is often administrated by paper, pre- and post-program, and in combination with other specific measures, depending on the program or target population. Some PCNs share programming and therefore outcome measurement, but often the selection, implementation (including training and administration procedures) and evaluation/reporting of PROMs are unique to the PCN. As well, data analysis is largely dependent on the size and capacity of the PCN. Using PROMs for PCN program evaluation supports clinical understanding and complements clinical outcomes. PROMs describe the population attending a program, as well as provide an element of consistency when examining trends across multiple programs or timepoints. This contributes to inquiries and decisions around program development, components, administrative features, resource allocation and delivery. Challenges of PROMs use in primary care include the absence of cohesive data capture technology. This limits data capabilities and presents difficulties with data fidelity, storage, export, and analysis. Additionally, this real-world application lacks a control arm and presents methodological challenges for comparative research purposes. Furthermore, capturing long term patient outcomes poses administrative challenges of multiple follow ups. More research is required into best reporting mechanisms to ensure the data is used to its full potential. To overcome these challenges, leadership and clinician engagement are key. As well, determining consistent PCN PROM reporting requirements will ensure data are comparable across PCNs and contribute to provincial level evaluations, further supporting the movement towards overall health system quality improvement.

An evaluation advisory group can be a vital resource, particularly for evaluations of collaboration-driven initiatives, but only if we apply skills and knowledge to use them effectively. In this paper, we will discuss the basics of evaluation advisory groups on four themes: purposes, structures, processes, and pitfalls. We will discuss insights from a review and synthesis of the evaluation advisory group literature and illustrate with our own real-world experiences of developing and implementing evaluation advisory groups on a national and state-wide scale, in a university setting, and within a localized health setting.

Program planners in all educational organizations and situations are responsible for carrying out the various steps of program planning and for understanding the context and politics involved. The situation for planners in community-based contexts differs from those who plan institutional program, however, in that the direction comes from the learners themselves. Grassroots organizations are usually flat in structure, with few administrative personnel. The stakeholder population consists of board members, volunteers, and participants as well as government programmers, funders, and policy makers. Program planners must work with all interests, keeping in mind that the learner comes first. Operating with a guiding principle of participation as the foundation for program planning makes it challenging for the program planner as ethical dilemmas emerge in the negotiation process. This chapter examines the intentionality of the program planner and the ethical dilemmas encountered as she works through the negotiation process with a community-based, grassroots organization. Community-Based Education: Models, Processes, and ProgramsAn examination of the literature on community-based or grassroots education reveals numerous models, processes, and programs. Because of the emancipatory and process-based nature of this type of education, a great deal has been written about the involvement of the community or organization in determining its own future. However, much of this literature does not address program planning specifically, nor does it provide a detailed analysis of the role of the N w DIRECTIONS FOR ADULT AND CONTINUING EDuCATIDN, no. 69, Spring 1996 OJos+~y-Bass F'ublishm 69

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